Transforming Care, Controlling Health Care Costs Through Value-based Population Health Programs
By Dr. Carrie Nelson is System Vice President Population Health at Advocate Aurora Health, Enterprise Population Health; Chief Clinical Officer, Advocate Physician Partners
Last year Advocate Health Care and Aurora Health Care combined to form Advocate Aurora Health, now the tenth largest not-for-profit integrated health system in the U.S. Together we serve nearly three million people annually. Our combined scale and expertise provide a unique opportunity for us to achieve efficiencies, advance our population health efforts, and above all, help people live well.
So, what is “population health” and why is it important? Health care consumers today seek value
, and so do the payers who expect and demand value for the financial investment made in their covered population. Population health management can be described as strategic efforts designed to increase the value that businesses (and other payers) derive from their investment in health care.
Population health efforts seek to improve the health outcomes of people who belong to a larger group, whether that group is a company’s own workforce or members of a particular community, while simultaneously controlling health care costs for that group. This is the definition of value.
Where we’ve been; where we are headed
Historically, third-party payers (insurance companies and the government) reimbursed health care providers for the procedures performed or services rendered, rather than for the outcomes they achieved. Today there is a growing shift away from “doing more to earn more” toward reimbursement models based on rewarding physicians and hospitals for achieving better outcomes.
For example, the Centers for Medicare & Medicaid Services (CMS) is changing the way Medicare pays both physicians and hospitals by rewarding providers for delivering services of higher quality
and higher value
. Medicare has been very innovative is this regard, with many private insurers now following Medicare’s lead.
Saving costs while improving health
In recent years, organizations such as Advocate Aurora have kept costs under control for payers, employers and individuals through:
- better management of patient conditions
- enhanced care coordination
- addressing behavioral health and other non-medical barriers to good health (called social determinants of health)
- increasing the use of technology
Health care continues to move beyond a “sick care” mindset into a “wellness and well-being” mindset. In the past, patients primarily sought medical care when they were sick, injured or had an immediate medical problem. Today, the health care continuum begins with wellness and prevention efforts and continues through diagnosis, treatment and beyond.
This movement is reflected in the Advocate Aurora mission: “We help people live well” and is relevant no matter what health circumstances a person might find themselves in. Establishing and improving upon more person-centered measures of success is important in achieving this mission. For example, our health system has started tracking the “Days at Home,” in which days spent not
in a hospital or other facility (such as skilled nursing) are measured as a marker of success. This metric has shown significant improvement over the past year.
Engaging health care consumers
Today health care consumers increasingly drive their own care and want to be active partners with their health care providers. Population health strategies are designed to leverage what the science tells us about health behavior change and focus on teaching and activating people to manage their own health to keep them at optimum health throughout the lifespan. This includes focusing on preventive care and managing chronic health conditions (examples: diabetes, COPD, hypertension and high cholesterol) for all members of the population group. In addition, maintaining consistency and repeatable practices improves the overall health of an entire patient population, patient-by-patient.
The key takeaway?
Employers and HR professionals should take notice: Population health management initiatives are changing the way we view health care, and the way it’s being delivered. A well designed, value-based, population health management strategy can yield improved health outcomes for a given population group, while improving an organization’s bottom line.
Our own population health efforts at Advocate Aurora are producing some impressive results — as we continue to collaborate and find new ways to transform health care and help people live well.
Note: In next month’s newsletter we will examine how successful population health efforts are data driven.