South Florida Hospital News
Friday February 26, 2021
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October 2013 - Volume 10 - Issue 4
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Population Health Management: A Hospital Necessity

In today’s ever-changing regulatory reform environment, hospital systems must stay ahead of the curve to ensure viable financial sustainability.
 
The change of the traditional hospital business model from heads-in-the-beds to a value-based reimbursement system is among the forces now pressing organizations to take a proactive approach to patient care, by reaching out to the population beyond the traditional hospital’s four walls. The Patient Protection and Affordable Health Care Act (ACA) and other external forces have caused CEOs to pause in an effort to better understand how to define a strategy which will simultaneously reduce cost, improve quality, and implement value-based payment programs. Organizations will of necessity, have to examine how to manage the health of their patient populations to improve outcomes.
 
Population Health Management (PHM) is a patient care approach that focuses on “closing the gap between optimal and actual care,” as defined by the Institute of Medicine’s Committee on Quality of Health Care in America. Successful PHM yields improvements in clinical process, patient outcomes and the cost-effectiveness of care. Although “PHM” is an easily defined term, a successful PHM formula, is at present, a significant challenge to many organizations. Such a system requires an equation of “visionary Leadership + a computer literate workforce + an organizational culture willing to embrace change + fiscal accountability metrics correlated to patient care outcomes + a focus on wellness and prevention.” The endeavor sounds like a tall order.
 
Even with the many challenges of creating a successful shift to PHM, there are many more reasons to embark on such an endeavor. The ACA defines several aspects of PHM. ACA requires tax-exempt hospitals to conduct community health needs assessments and to adopt strategies that meet the identified needs, including identifying reasons why such needs are not being addressed. The law expands coverage for a wide range of prevention and wellness services by increasing incentives. The elimination of payment for unnecessary readmissions increases a hospital’s accountability for care outside its four walls.
 
Executing a successful PHM strategy requires organizations to deploy, embrace, and hard-wire a organizational change management strategy, while simultaneously implementing health information technology systems. Organizational change is a structured approach to ensure changes are smoothly and successfully implemented to achieve lasting benefits. In today’s fluid regulatory environment, organizations are experiencing rapid change like never before. The constant innovation of technology results in a continually evolving health care environment. The growth in technology also has a secondary effect of increasing the availability, and therefore accountability, of knowledge. Easily accessible system performance information has resulted in unprecedented scrutiny from patients, boards, the community, government and the media. Prying eyes and listening ears raise the stakes for low performing organizations and increase the pressure on struggling executives. The ability to manage and adapt to organizational change, is a skill essential in the healthcare market today.
 
A health information technology platform for PHM is as essential as the deployment of a change management strategy. A successful PHM software application is built upon the use and functionalities of patient registries. Although some limited PHM functionalities are found with current Electronic Health Record (EHR) systems, EHR products rely solely on the data generated by the EHR application and often do not provide the integration of multiple data sets and data sources to support an enterprise PHM system. Registries are collections of information about a cohort of patients with shared characteristics. ‘Shared characteristics’ may be a shared medical condition, but may also include age/gender, clinical events, physician concern, risk assessment, family or social history, and other characteristics. Registries are created to monitor the health of the cohort and to support the efforts to identify and close the gaps in care.
 
To do this monitoring well, a PHM system needs functionality beyond data aggregation. The PHM platform needs to be uniquely designed for PHM, with core components that support team-based care and patient-centered management. In addition, a robust PHM system should provide high-risk predictive models that drive real-time clinical decision support, and identify optimal workflow conditions for a given population management initiative by using queuing network simulations. For example, a PHM system provides the ability to look at all patients, identify those with diabetes and monitor them closely, intervening as needed to ensure process and outcome standards are met. A robust PHM should also offer the ability to identify and monitor scenarios and populations such as newly discharged patients for at least 30 days to prevent re-admission; patients who had CABG for 180 days following their procedure; and women aged 50+ to ensure they receive annual mammograms.
 
To date, there are very few programs hospitals can benchmark against while creating and designing a PHM strategy. The progress that the Pioneer ACOs have achieved across the country, one Pioneer ACO stands out among the CMS designated ACOs - Partners Pioneer ACO in Boston. A recent Wall Street Journal article cited Partners as a top performer among the group, realizing over $14 million in Medicare savings which attributed to a direct $7 million to Partners. Through the deployment of a system-wide change management strategy and a PHM software system, Partners ACO has positioned themselves as a leader in PHM, and represents a valuable source of best practices in this arena.

Lisa Rawlins is Health Care Director, SRG Technology, and Dr. Nabil El Sanadi is Chief Medical Officer, SRG Technology. For more information, call (954) 766-4489.

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