Population health management, one of the goals of health reform, requires hospitals change processes to focus on prevention and wellness instead of only treatment. While some hospitals already engage in community outreach activities, a more concerted, systematic effort will be necessary to make long-term changes in people's health behavior. Erin O'Connor, practice leader at Cammack LaRhette Consulting, describes two key approaches hospitals need to manage population health.
1. Bringing mid-level providers to the forefront. A general approach hospitals can take to manage population health management is recruiting more mid-level providers to monitor patients to give physicians time for more complex patients, Ms. O'Connor says. "There are more efficiencies to be gained if physicians use their expertise in helping patients who can't respond to traditional therapies or have something that needs a certain amount of attention beyond the normal course of the illness," she says.
In this approach, physicians would oversee care delivery, but would become directly involved only in more complex cases, leaving routine care to providers such as advanced practice nurses and physician assistants. In addition, by adding other clinical experts to a team of professionals to advise and manage care for complex patients, the physician will play a new role in managing the team to promote patient well-being. These clinical experts typically include clinical pharmacists, diabetes educators, exercise physiologists and dieticians. For example, advanced practice nurses can care for diabetes patients — providing education, medication and checking blood sugar results. If the patient does not respond to these standard interventions, the advanced practice nurse can then coordinate with a physician to determine what other therapies would be effective.
"There will be a huge change in how we deliver healthcare," Ms. O'Connor says. "Today it is built on physicians treating every single patient for every single issue. We're expecting too much and not leveraging their subject matter expertise. They're there to take care of patients, but they don't have to take care of every issue a patient has when another appropriate clinical resource can do that and free up physicians' time to take care of more complicated patients."
2. Relying on data. Collecting and analyzing data will also be crucial to any population health management strategy. "The most fundamental thing that healthcare organizations need to do is to get the data," Ms. O'Connor says. "Get the data in a way that can be built into actionable intelligence, because that's key to figuring out what conditions my patients most frequently present with and what resources are needed to be able to help them achieve their health management objectives."
Data on the population, including demographic information, socioeconomic status and location relative to healthcare resources can help hospitals prioritize population health management goals. For example, if a map of primary care physician offices shows a gap in one area of the community, a hospital may decide to focus on implementing telemedicine to allow patients to communicate with physicians remotely in real time. "You can't change everything at once," Ms. O'Connor says. "You will get change fatigue. Go in a systematic way where people can adapt their business processes."
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1. Bringing mid-level providers to the forefront. A general approach hospitals can take to manage population health management is recruiting more mid-level providers to monitor patients to give physicians time for more complex patients, Ms. O'Connor says. "There are more efficiencies to be gained if physicians use their expertise in helping patients who can't respond to traditional therapies or have something that needs a certain amount of attention beyond the normal course of the illness," she says. In this approach, physicians would oversee care delivery, but would become directly involved only in more complex cases, leaving routine care to providers such as advanced practice nurses and physician assistants. In addition, by adding other clinical experts to a team of professionals to advise and manage care for complex patients, the physician will play a new role in managing the team to promote patient well-being. These clinical experts typically include clinical pharmacists, diabetes educators, exercise physiologists and dieticians. For example, advanced practice nurses can care for diabetes patients — providing education, medication and checking blood sugar results. If the patient does not respond to these standard interventions, the advanced practice nurse can then coordinate with a physician to determine what other therapies would be effective.
"There will be a huge change in how we deliver healthcare," Ms. O'Connor says. "Today it is built on physicians treating every single patient for every single issue. We're expecting too much and not leveraging their subject matter expertise. They're there to take care of patients, but they don't have to take care of every issue a patient has when another appropriate clinical resource can do that and free up physicians' time to take care of more complicated patients."
2. Relying on data. Collecting and analyzing data will also be crucial to any population health management strategy. "The most fundamental thing that healthcare organizations need to do is to get the data," Ms. O'Connor says. "Get the data in a way that can be built into actionable intelligence, because that's key to figuring out what conditions my patients most frequently present with and what resources are needed to be able to help them achieve their health management objectives."
Data on the population, including demographic information, socioeconomic status and location relative to healthcare resources can help hospitals prioritize population health management goals. For example, if a map of primary care physician offices shows a gap in one area of the community, a hospital may decide to focus on implementing telemedicine to allow patients to communicate with physicians remotely in real time. "You can't change everything at once," Ms. O'Connor says. "You will get change fatigue. Go in a systematic way where people can adapt their business processes."
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