6 Tips for Hospitals to Improve Population Health Management
By Bob Spoertl
Now more than ever, it’s imperative for hospitals to have a strong game plan for caring for patient populations. The rise of accountable care offers financial incentives for physicians and hospitals to improve population health. Notably, one of the main premises of an accountable care organization is to care for a set population and ensure that a group of patients are guaranteed care across a continuum.
Hospitals are increasingly expected to serve as more than a place where patients come for care, by providing an entryway to a long-term care plan that reaches well beyond the confines of a brick and mortar with beds. But trying to control the health of a patient population with unique health concerns is challenging.
Pearson Talbert, CEO of Aegis Health Group, a Nashville, Tenn.-based consulting firm specializing in revenue growth strategies for hospitals, shares six tips for hospitals looking to improve population health management.
1. Take a proactive approach and connect with community and leaders. Mr. Talbert says hospitals need to accept they are no longer just places to care for sick patients. Hospitals cannot afford to take a “field of dreams” approach to operation strategy; the idea that if the hospital is built, patients will come. Hospitals are true centers of healthcare, but a lot of people still don’t necessarily think of them that way.
Mr. Talbert says hospitals are doing a better job now of reaching out to the community than ever before, but he suggests they take a step back and seriously analyze what more they can do. Some are hiring business development C-level executives to coordinate community development strategies. At the end of the day, hospitals need to take a strategic, proactive approach and not wait for the public to come to them, Mr. Talbert says.
The benefits of being proactive include boosting the hospital’s brand. Mr. Talbert points to Texas Health Resources in Dallas as a prime example of a hospital with an “impeccable” brand. He notes how Texas Health Resources is able to do an incredible amount with the significant market share they’ve claimed in the Dallas area. Members of the community recognize that brand. Mr. Talbert also points to Mayo as another great example of an organization with a recognizable brand.
Hospitals taking a proactive community approach position themselves well for transitioning into pay-for-performance models. If the hospitals focus on population health management, they will better understand risk aggregation and hold the tools to mitigate potential costs that come with caring for a set population. For example, in an accountable care model, physicians and hospitals may receive a bundled payment for caring for a given number of people. Knowing the risks of that population’s health is crucial to cutting costs and delivering quality care.
2. Pinpoint the most prevalent population health issues. One way for hospitals to pinpoint population health concerns is through data aggregation, which means creating health profiles of all potential hospital consumers. It’s also important to recognize where a hospital’s customer base is located geographically. Most healthcare is provided locally. Approximately 80 percent of patients come from within 10 miles of a hospital’s borders.
“Our belief is that data needs to reside with the hospital because employers may change insurers but stay with the same hospital,” Mr. Talbert says.
Before venturing out to the local community to analyze health issues, Mr. Talbert recommends hospitals first consider the health needs of their employees.
He is reminded of a conversation with a hospital executive who was surprised by how many people he saw in the staff parking lot were overweight or smokers. The head of human resources at the hospital suggested the organization start working on improving the health of its own employee base. The initiative saved the Aegis’ client some $1.6 million.
Showing a hospital’s staff has improved its own population’s health can serve as an example for the rest of the community, Mr. Talbert says.
After conquering health concerns at home, hospitals can then take their message to employers, churches and other social organizations. While hospitals have not traditionally had a sales focus, ones that actively engage the community and study population health may succeed in the long run as pay-for-performance models expand.
3. Develop a strategy to align with payors that share strategic and clinical goals. It’s imperative for hospitals to find payors willing to embrace a population health management agenda. Hospitals and health systems that adopted capitation models in the 1990s may be the best suited to do that, Mr. Talbert says. “Those are the organizations that are going to be best situated in pay-for-performance,” he says.
He mentions how a hospital that is self-insured can more easily create a pay-for-performance model to take to the market. As both payor and provider, they may have a leg up in reinforcing the importance of embracing population health management. Kaiser Permanente utilizes an HMO model as both payor and provider, but limits non-emergency care to people enrolled in the plan.
Then there are a growing number of private insurers launching accountable care organization partnerships. Cigna, Aetna and Blue Cross Blue Shield are a few examples of insurers moving toward pay-for-performance models. Some payors are getting skin in the healthcare delivery game out of necessity.
It’s increasingly important for hospitals to develop relationships with key players in the community that share its goals. “The hospitals that have a strong population health management strategy also have relationship managers who work with community organizations, churches, YMCAs and other groups,” Mr. Talbert says. The hospital’s outreach to non-profits and employers in the community can help “show the group why they need to make sure the hospital is on their insurance plan.”
Hospitals can then sit down with payors and negotiate. They’ll have more skin in the game during the bargaining process in part because of the connections they’ve made with the community. Payors will likely want to work with respected hospitals and health systems with a strong reputation in the community.
4. Embrace the fact that population health management is a win-win for both hospitals and physicians. As Mr. Talbert points out, “it’s rare to see someone self-admit to a hospital.” Physicians are more often than not referring people to receive care. “Having referral relationships with area physicians is becoming more and more powerful,” Mr. Talbert says. “The hospital systems that do are winning.”
As hospitals employ more physicians from a variety of specialties, and as the Patient Protection and Affordable Act adds millions of people to the pool of insured patients, there’s an incentive for physicians and hospitals to better manage their growing population’s health. Physicians employed by hospitals are likely to be more conscious of the financial future of the hospital employing them.
Embracing population health management will help physicians and hospitals looking to benefit from performance incentives and meeting or exceeding quality metrics.
5. Use data analysis and tracking tools to manage population health. Aegis helps hospitals looking to capitalize on the increasing focus employers put on workplace wellness programs. The company has created a personal health profile that collects personal health information from employees of target businesses. Client hospitals can then access the information through Aegis’ database.
“The data we collect are individual health profiles — we take that data and aggregate it,” Mr. Talbert says. “That allows the hospital to look at the data and see health concerns within their population.”
The database offers hospitals access to participating individuals’ health information and incorporates functions that allow healthcare executives to query the data.
Aegis’ database is able to:
Profile and segment patients by physician affiliation, insurance plan, family history and other health identifiers
Monitor managed care purchasing decisions and link insured patients with hospital service lines
Facilitate centralized marketing campaigns
Aegis and other third party companies are providing software solutions for hospitals looking to get ahead of the curve in population health management.
6. Utilize pre-primary care programs to manage population health. “Hospitals need to think along the lines of ‘in the future, admission into a hospital is a potential loss. Let’s educate people first,'” Mr. Talbert says.
Utilizing pre-primary care programs involves connecting with the community not only to get the hospital’s name out there, but also to educate members about healthy choices and direct them to the hospital for services when they have concerns or need further support. It’s no secret that our country faces serious health issues. Obesity, Type II diabetes and other chronic illnesses plague tens of millions of people living here. To make matters worse, many people don’t receive regular checkups.
“We see in the population that we screen, about 40 percent do not have a primary care physician,” Mr. Talbert says.
Improving patient health long-term involves meeting patients before they come into emergency rooms with life-threatening ailments. It involves meeting the patient where they are and teaching them how to stay healthy.
“It starts with education, but to make education work you have to make it personal and practical,” Mr. Talbert says.
He suggests hospitals set up simple health appraisals at places of employment or community centers. These non-invasive health risk assessments should be very simple and not too clinical, as small as a one page questionnaire for people to fill out.
“It takes less than 10 minutes,” Mr. Talbert says.
Hospitals can then show employers how cost-effective it is to support primary care for employees. And that’s when hospitals can bring in physicians and nurses to start primary care.
The future of healthcare delivery, at least under an accountable care model, begins even before primary care. Hospitals that understand their evolving role as the nucleus of an accountable care delivery model may reap rewards down the road.