Population health management (PHM) is a cornerstone concept that emerged from the Affordable Care Act (ACA) that has proven it’s here to stay – even if the ACA goes away. Because this is a valuable topic that will affect hospitals and providers for years to come, we decided to dedicate a blog series that explores the aspects of PHM. The following is the first post in the series.

In order to provide holistic healthcare to a community and improve clinical outcomes, hospitals need to pull out of the mindset of only optimizing care and consider their impact on population health management (PHM). Social determinants, including access to care, access to exercise, food availability, living conditions, etc. play a fundamental role in the overall clinical outcomes of patients in a certain area. In order to improve the population health of a community, hospitals are looking at strategies that engage patients to talk about and improve their lifestyle choices.

Effective population health management requires hospitals to think outside of the box

Modern healthcare in a value-based era requires effective population health management.

We take a dive into the world of population health management. How will this be affected if the ACA is repealed? How does PHM contribute to value-based care? Keep reading to learn the answers to these questions and valuable insights into how hospitals can implement strategies to improve population health.

Would Population Health Carry on Without the ACA?

While the fate of the Affordable Care Act (ACA) remains uncertain as many lawmakers continuously pour effort into a repeal and replace measure – the cornerstone of Obamacare remains according to a recent Health Catalyst survey. Population health management as defined by the Wellcentive: “…is the aggregation of patient data across multiple health information technology resources, the analysis of that data into a single, actionable patient record, and the actions through which care providers can improve both clinical and financial outcomes.”

The following are highlighted results of the survey:

  • 80% of healthcare executives surveyed feel that the efforts made toward the repeal and replacement of the ACA has not caused them to change their approach or pause their population health management practices.
  • Of the healthcare executives surveyed, 68% report that population health management is “very important” to their strategy for the delivery of healthcare.
  • Less than 3% of the health executives felt PHM had no importance at all.
  • 82% of survey takers indicated that they will continue on with their current PHM strategy regardless what happens to the ACA.
  • 4% of the healthcare executives said their organizations were set to ramp up their PHM plans.
  • 10% were unsure if they were going to continue, accelerate, or pause their PHM strategies.
  • 4% answered that their PHM plans would be put on hold in response to the current situation politically.

In response to why those were accelerating their plans, an article in Healthcare Informatics states that the respondents mirrored the response of one physician leader for a multispecialty physician group near Boston, who stated, “Accelerating your PHM strategy has never been more important given the uncertainty and expanding hurdles to achieving quality care and outcomes.”

How PHM Facilitates a Value-Based Care Model

Value-based healthcare model is the new framework for all healthcare delivery in the United States (see our previous post about hospitals and value-based care). So how does population health management tie into value-based care? According to David B. Nash, MD, MBA, editor-in-chief of P&T, is Dean of the Jefferson College of Population Health:

“Now, is the theme of transparency and accountability specifically and traditionally part of population health? Well, from my perspective, how can you improve the health of the population if the population doesn’t have access to the best possible information regarding cost, quality, outcomes—in one word, value?”

Optimizing Population Health Strategies to Improve Outcomes

Nashville Post recently touched on the subject of population health strategies and some barriers to overcome in order to be successful. The author explains that often times providers and policymakers overlook the access barrier, “Social determinants account for up to 50 percent of what impacts health and the care patients receive — even if the patient has health care coverage, said Dr. Cheryl Whitaker, chairman, and CEO of Chicago-based NextLevel Health.

“If you look at all the data, low income has the biggest impact on health outcomes. Where people live has a great influence on health outcomes.” – Dr. Cheryl Whitaker

Whitaker has a solution for the problem. The NexLevel non-profit startup is a Chicago-based healthcare facility founded by Whitaker that helps the “underserved access and manage Medicaid services with the assistance of a care management team.” She employs workers from the communities in which they serve.

“If you’re going to address population health, you have to look at the social determinants. Then you must look and think, if you’re a hospital, what tools do you have at your disposal to make a difference? I believe the way to succeed in population health is to take this anchor we call a healthcare system and change our course of business to address social determinants and create programs around them.” – RWJBarnabas Health President and CEO Barry H. Ostrowsky (full interview in Becker’s Hospital Review)