The growing population health movement has led insurers and providers to patient-centered medical homes (PCMH), accountable care organizations and other integrated care models to improve the outcomes and reduce the costs for patient populations.
But throwing around buzzwords like medical homes isn't enough to better manage population health. In this special report, FierceHealthPayer spoke with healthcare leaders from hospitals and insurance companies to identify essential ingredients for successful population health management.
Look beyond medical care
In trying to better align payment and care for patient populations, healthcare organizations need to take a public health approach and truly look at the entire population and their needs.
"Everybody needs clean air to breathe, everyone needs clean water to drink," Jeff Harness (pictured left), director of integrated care and population health at Cooley Dickinson Health Care, Northampton, Mass., told FierceHealthPayer in an exclusive interview. Cooley Dickinson is working toward PCMH status for all of its primary care practices.
Connected to its medical home goals is Cooley Dickinson's integrated care management program for chronically ill patients. That program includes a social worker so patients who have serious social issues--unstable housing, inability to afford utility bills--have someone to help them find resources they're eligible for and figure out other ways to get their needs met, Harness said.
Moreover, healthcare organizations increasingly consider insufficient resources, such as people who don't have enough food to eat, as a health issue. The ProMedica nonprofit hospital system screens for food-insecure patients at its northwest Ohio and southeast Michigan facilities, helping high-risk patients sign up for food stamps or providing them with groceries upon discharge, FierceHealthcare previously reported.
Think like the other guy
The continuing shift toward PCMHs, ACOs and integrated care delivery can be seen in Humana's recent transition from a traditional insurer that just pays out checks to a health company actively involved in helping members with their health, according to Humana Chief Medical Officer Roy Beveridge, M.D., (pictured right).
The Louisville, Ky.-based insurer recognized the need to marry providers' clinical expertise with Humana's business views to drive integrated care, Beveridge told FierceHealthPayer in an exclusive interview.
Along with provider and payer points of views, healthcare organizations must not ignore what the consumer wants. "Unless you really look at it from the patient standpoint, member standpoint, doctor standpoint, business standpoint, you really can't be successful," Beveridge said.
Population health also has forced hospitals and health systems to think like insurers, as evidenced by MedStar Health, the largest health system in the Baltimore-Washington, D.C., metropolitan area. MedStar has its own health plan offering called MedStar Select, as well as a medical home project with CareFirst Blue Cross Blue Shield and quality-based incentive payment arrangements with other insurance companies.
"You actually have to be thinking that you want to transform healthcare delivery and use the knowledge that you have from a health plan perspective as well as from a provider perspective to do that better," Eric Wagner (pictured left), MedStar's executive vice president of external affairs, told FierceHealthPayer in a previous interview.
"You actually have to run it as a health plan and not just as something that pays every claim that comes in the door," he explained.
Target the right members
A key factor to medical home success is targeting the right people, such as those patients who are likely to continue to have problems, Scott Sarran, chief medical officer of Health Care Service Corporation's government programs, told FierceHealthPayer in a previous interview. Chicago-based HCSC looks at cost, quality and utilization issues to generate a list of appropriate members, and then has physicians validate the data and contact eligible members about the medical home program.
"We've seen a persistent, relatively small percent--maybe 10 percent of members in a commercial population--who are really challenging and who, despite our existing programs, need more help," Sarran (pictured right) said about designing an intensive medical home model around high-risk, high-cost members.
With similar targets, Philadelphia's Independence Blue Cross also found a PCMH directed at high-risk members lowered costs and utilization rates, FierceHealthPayer recently reported.