The healthcare industry is rapidly changing; the unsustainable costs, when combined with the disparity in healthcare quality being delivered to some populations, are bringing forth a healthcare revolution. Provisions in the Affordable Care Act of 2010 ensure that millions of Americans will now have health insurance—and that the healthcare paradigm will shift from volume to value. With significant government funding at stake, more than 700 healthcare organizations have classified themselves as Accountable Care Organizations (ACOs) and others are developing ACO-like healthcare delivery systems. A recent study conducted by Oliver Wyman, a management consulting firm, estimates that 25 to 31 million Americans are currently receiving health care services from an ACO and more than 40% of Americans live in areas with at least one ACO. And this shift is more than a classification change. In order to be eligible for the incentivized government funding, organizations must prove their commitment to—and implementation of—population health. They will be required to improve the patient care experience, the overall health of populations, and lower per capita costs of care.
This transformation comes down to data, personnel, and the changing nature of the overall healthcare experience.
Data: Implementing population health management requires information-powered clinical decision making. This means real time access to comprehensive and segmented data for all care team members. The organizations that are able to most effectively aggregate and distribute data—to collaborators, team members, and even patients themselves—will succeed.
And data means more than Electronic Medical Records (EMRs); healthcare systems are now implementing robust software systems and population health management programs that help automate data integration, analysis, reporting, and communications so that real time evaluations—and adjustments in patient care plans—can be made. Having the right IT systems (and IT personnel) in place is critical in order to advance clinical outcomes, improve care, and lower costs. Organizations with the ability to master data control and predictive analytics to generate decision-driving insights will succeed in population health management.
Personnel: In the population health management scenario, primary care physicians (PCPs) will direct care management teams to manage patient populations. Teams will span industries and resources and may include advanced practice providers, nurses, social workers, pharmacists and other non-clinical workers who will offer ongoing coaching and support. Team members could also include outside resources; for example, some organizations are implementing transportation systems or signing contracts with transportation companies if transportation is a barrier to healthcare in a specific population. An entire collaborative team of varied professionals will be led by PCPs in this new healthcare world.
Healthcare experience: Population health will change the healthcare experience as we know it. Healthcare will be more seamlessly integrated into patients’ daily lives and routines. To make an impact, providers must: understands a patient’s values in order to develop personal care plans; bridge gaps in care by communicating continuously; and work with other community advocates and systems to identify cost-effective resources for patients that will impact overall population health (transportation resources, diabetic programs, fitness programs, Alzheimer’s programs, and other ancillary services).
In addition, healthcare systems will need to reach patients who are not already in the system. This means door-to-door grassroots efforts and access to care outside the hospital walls. Innovations that help make proactively managing one’s health easier will be highly sought after. Examples may include one-stop healthcare “shops”—facilities that offer dental care, fitness and educational programs, health screenings, and physical therapy services. Automated outreach to patients between visits will increase, as will interaction with care managers via phone calls, texts, and emails.
As a more comprehensively integrated system focused on population health begins to dominate, the healthcare industry, the healthcare experience, and provider recruitment initiatives must also evolve. Stay tuned for our next blog which will explore how population health will affect both physicians and the recruitment of healthcare providers.