Population health programs must think beyond clinical measures

To scale population health management efforts to their specific systems, healthcare providers must think beyond clinical measures and partner with vital resources from inside and outside the industry, according to a new report from PwC.

Population health programs typically tier patients according to the financial risk to the organization their conditions represent, according to the report. However, if providers aim to truly scale their population health programs, their approach must be far more comprehensive, encompassing social and environmental needs along with medical ones.

The report cites the case of Partners HealthCare's High Risk Care Management Program, launched as part of a demonstration project in 2006. The program incorporates both clinical indicators and data from electronic health records about patients' backgrounds and characteristics, and thus far, it works: the program saves more than $2.50 for each dollar it spends.

It's also vital for organizations to design full-service networks with a broad range of patient engagement capabilities. Too often, the authors write, organizations model their programs only on current capabilities when they should target their populations' areas of need and partner with entities that can help close gaps. "The backbone of the network should be a community-based primary care hub that coordinates specialty medical and non-medical services on behalf of the patient," the report states. Advanced practitioners and primary care doctors must lead these hubs, but such plans also need non-physician care coordinators such as nutritionists, social workers and pharmacists.

Cultural competency is also vital to partnerships, particularly with community institutions. For example. Research by the Health Research Institute indicates non-traditional care settings such as retail clinics are a bigger draw for Hispanic patients, which led Florida Blue to launch three integrated retail care sites last fall and California's Molina Healthcare to install an information center in a nearby mall.

To learn more:
- read the report (.pdf, registration may be required)