First, what is the definition of population health? I was asked last year for a definition from George Washington University’s School of Public Health. Its MHA class was trying to define the term and asked healthcare leaders from across the country for their definition. I defined population health as transitioning care delivery to a model that is valued-based that includes focusing on better case management of those patients with multiple co-morbidities, partnering in care delivery with other providers including previous competitors, better managing overall utilization and caring for patients in the most appropriate setting, not necessarily acute care.
Now with that said, the simple answer to the question in the title is: You bet they are dragging their feet! Neither payment systems nor incentives are aligned in 49 states, and many of the payers have little to no interest in cooperating with providers on population health initiatives.
Engaging with new models of care delivery for the last six years has made me a firm believer in the overall triple aim of healthcare reform of which population health is an integral part. Western Maryland Health System (WMHS) has been delivering value based care since 2010, but because I am from a health system in Maryland, it made the decision to make the change an easy one. The state of Maryland worked with the Centers for Medicare & Medicaid Services (CMS) to create a payment methodology to match the care delivery model.
The reason why my colleagues haven’t necessarily gotten on board is very simply that they are still being paid under fee for service. I just read recently about a number of initiatives that are being pursued by CMS related to value-based care delivery, but they are not in place as of yet. In addition, there appears to be little to no support for such initiatives from many of the payers. You shouldn’t expect health systems to change their care delivery model 180 degrees without some form of financial assistance to support infrastructure changes. There is a great deal of upfront cost when such a transition begins.
When we made our change, funds were provided by the state to assist with our transition initiatives. We immediately added care coordinators, we expanded our home care program, we needed clinical staff to deliver care in the area’s skilled nursing facilities and we brought new information systems on line for data analytics on a real-time basis without that six, nine or 12 month lag in acquiring such data. We implemented a host of initiatives; these were some of the first to be put in place.
Population health is an all-out change in how care is delivered, and it can be very costly at its inception. Over time, we have saved significant dollars in reduced admissions, readmissions, emergency department visits, observation unit stays and ancillary utilization, but such a change doesn’t occur overnight.
At WMHS, we saw the same engagement issues with our providers whose incentives were not aligned with ours. It certainly helped by putting value-based incentives in place for our physicians and advanced practice professionals recognizing that most were still being paid under fee for service. We also took the opportunity to get them to understand that changes in care delivery and payment methodology were on the horizon for them, so why not learn from us based on what we were putting in place? Fortunately, it worked.
Today, providers keep hearing that the time to act is now on population health initiatives, but still there are so many who control the financial component of care delivery that are dragging their feet by not aligning a payment methodology to match the new demands for care delivery.
Barry Ronan is the president and CEO of Western Maryland Health System in Cumberland, Maryland.