WASHINGTON, D.C.—Eric Hunter, CEO of safety-net health plan CareOregon, said that if the group’s population health efforts were truly successful, hospitals would offer significantly scaled-back services.
“I tell hospitals, and they hate when I tell them this, ‘In my perfect world, I would never need you,’” Hunter said. “My goal is to put you out of business. If we can do the right thing, all you’ll have is an ER for when somebody gets in a car wreck.”
Hunter was one of the panelists at a Politico event centered on population and public health. His organization increases access to healthcare services for patients on Oregon’s Medicaid programs for a per-member, per-month capitation rate. CareOregon focuses on the social determinants of health; for instance, in the example case of a child with uncontrolled asthma and mold in the home, CareOregon would provide air filters, air conditioners or other interventions to help stabilize that child’s asthma.
Since it launched in 2011, CareOregon has seen a statewide 23% drop in unnecessary emergency department visits, admissions have decreased as well.
Data sharing gets the full picture of patient health
Not every provider will have access to a robust support program like CareOregon offers, so organizations must embrace a culture change and acknowledge that “there’s more to health than healthcare,” said panelist Karen DeSalvo, M.D., former national coordinator for health information technology at the the Department of Health of Human Services.
This culture change includes breaking down data silos that would prevent providers from seeing the full picture of a patient's, or community’s, health. Having the full picture allows for a system that “wraps around people and supports them.” Plenty of tech innovations can be brought into play, but it really comes down to a change in culture, she said, where providers embrace the data they have to consider the health of populations outside of a healthcare facility.
“It means that we really have to rethink how we look at health,” DeSalvo said.
For example, providers must take better advantage of self-reported patient data that tells the whole story of a patients' living situation, she said. The policy framework for this level of data analytics is in place, DeSalvo said. Both the Medicare Access and CHIP Reauthorization Act and the 21st Century Cures Act include elements that push for this level of data gathering and sharing, she said, particularly as those bill would prevent data-blocking.
Health technology over the past five years has been highly focused on electronic health records, she said, and that covers just one slice of the healthcare puzzle. Increased data sharing allows for more effective tech and programs to come to the forefront.
"Data shouldn't be trapped in an electronic health record or any other device," DeSalvo said.
The impact of funding cuts
DeSalvo and Hunter were joined on the panel by Joseph Wright, M.D., chairman of the department of pediatrics at the Howard University School of Medicine. Wright, who specializes in emergency pediatric care, said that the future of health is “not focused in sick care,” which is why it’s vital that investment in science and tech continues.
Public and population health are a long game, Wright said, and require a generational approach. Moving upstream to improve health can reduce costs, and it’s less expensive to prevent a chronic illness than to treat one in the acute phase, especially if it’s poorly controlled. So population health is something that “can’t be held to an election cycle,” Wright said.
Hunter: "With talks of reducing the spend in medicaid...that affects the ability do [pop health] to change the cost curve" #OutsideIn— POLITICO Live (@POLITICOLive) June 27, 2017
Hunter said proposed cuts to Medicaid give organizations would make it more difficult for them to pay for the services they offer. Significant funding reductions, he said, could force a scale back to episodic care, a move that would be “setting up for future failure.”
A livestream of the full event is embedded below: