Population health management is the future for health systems. It's how they're going to navigate reimbursement cuts and abide by healthcare reform while improving patient care at the same time. That's what healthcare leaders are saying and being told.
The PHM concept makes sense, especially from a clinical standpoint: work across the care continuum to coordinate care and improve the overall health of a community, including the chronically ill and expensive frequent-flier visitors to the ED.
But in hashing out the details, some health systems and practitioners will be winners and others will be losers—and it's too early in the game to know for sure which will be which. That's the counsel of executives of leading systems whom I spoke with recently while preparing for an executive Roundtable discussion on population health.
To begin with, "It's important to pick the right dance partners," says Earl Steinberg, MD, who is executive vice president for innovation and dissemination and chief of Healthcare Solutions Enterprise for Geisinger Health System in Danville, PA. Health systems must enter into networks with physician groups, post-acute care facilities, and even competitors to ensure the broad spectrum of patient care that will be required.
These networks will succeed or fail on the strength of their leadership, says T. Clifford Deveny, MD, senior vice president for physician practice management at Catholic Health Initiatives, the 73-hospital system based in Englewood, CO. "Someone has to become the convener and create a vision, a burning platform, for why we have to move to population health management," he says. The convener may be the health system board or perhaps the lead insurance payer.
Without this guiding force, the trust necessary to shared risk and data is likely to be lacking. "This is difficult ... It's not 'Can't we all get along,'" Deveny says. Trust takes time and a "matured relationship." "The sharing of information is going to drive a lot of this ... and if there's not trust to exchange information, then everything breaks down."
Most deeply affected by shifts to PHM will be physicians—employed and independent, primary care and specialists all to some degree. "'Primary care transformation' is our internal term for the cultural change that needs to happen" for primary care physicians, says Christopher Stanley, vice president of care management for Catholic Health Initiatives. "The specialist world will be quite different than it is now. There will be different payment mechanisms. How will specialists work in a team around bundled payments?"
Tim Petrikin, executive vice president, ambulatory care services, for Vanguard Health Systems, the for-profit system headquartered in Nashville, says that healthcare executives must work to modify existing clinical workflows. Already, Vanguard is sending workflow coaches to address how its physicians must act differently under PHM.
Such workflow and behavior changes "take a long time to build. If you're not thinking about it now, it will be impossible to rush later," Petrikin says.
But all the current efforts toward population health management are no more than experiments, caution these executives. "All of this is a work in progress. No one knows how it will turn out," Steinberg says. Deveny adds, "We're not far enough into it with new products to see failure yet."
A transcript of the executive Roundtable will be published in HealthLeaders magazine and online in April. Use the insights to give serious consideration on how your organization will fit into the new PHM world.
Edward Prewitt is the Editorial Director of HealthLeaders Media.
