Population health management requires fundamentally rethinking processes engrained within organizations and legacy processes from the fee-for-service world. And it requires healthcare executives to embrace new strategies, technologies and mindsets.

“The big challenge surrounding population health is understanding how to plan care needed for more complex patients while at the same time building systems of care for these patients and analyzing how that care gets paid for,” said Madeleine Biondolillo, MD, vice president of population health management at the Connecticut Hospital Association. “Hospital executives must condition themselves to enter into contracts that support the kind of care that now is necessary.”

Biondolillo added that the shift from fee-for-service to what is effectively fee-for-value will demand that hospitals figure out new ways to structure care services and provide care services.

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“Under fee-for-value, if you can keep people out of the hospital when they do not need to be in the hospital, if you can structure your contracts properly and get paid for doing that, then that is a win for all parties,” she said. “But that is a huge switchover from getting paid when people come into the hospitals.”

Hospitals have to study and understand their data to identify areas where they can reduce costs and mechanisms they can put in place to keep those costs down, Biondolillo said.

“It’s really all about knowing your data related to the provision of care and the costs of that care relative to how you get paid,” she added.

One of the lessons Biondolillo and her colleagues in Connecticut have learned is that population health and value-based care require a focus on teamwork like never before. And that includes the patients as well as organizations throughout the community served by a hospital.

“Even as healthcare organizations adhere to national guidelines and best practices, at the end of the day there is only so much a healthcare organization can do to improve patient outcomes unless they also have social support that also supports outcomes,” she said.

“With asthma, for example, you can teach a patient how to use difficult medications and have a longitudinal care plan and have a great communication system with care providers, but if that patient is going home to an apartment full of mold or if they do not have the money to buy their medicines, then what?”

There are many social and environmental factors that go into having good health, Biondolillo added.

“The efforts we’ve been undertaking from inside the provider organization, don’t change the fact that this has to be a community team effort,” she said. “Generally speaking, this is not something that is well laid out yet. We now are going down that path, exploring the best ways to include considerations for these other factors that cause health problems.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

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