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70 Executive Briefing: Population Health Even if a hospital has a well-adjusted workforce and change- friendly culture, the concept of population health and all it entails can prove overwhelming. People must remap their view of what the healthcare system is supposed to do and develop new capa- bilities. To mitigate exhaustion and cynicism, leaders must mind- fully communicate the implications of population health to drive engagement, understanding and morale. Given the "rookie" na- ture of population health — hospitals are still very much learning from one another via trial and error — it is also beneficial to make the transformation as collaborative as possible. "There's an old saying," says Dr. Steinberg. "'If you want some- one with you on the landing, you want them there for the takeoff.' Involving people and getting their fingerprints on the design of a solution is more effective than shoving it down their throats," he says. For instance, if physicians are missing from the table when population health decisions are made — such as those involving evidence-based protocols or care redesign — hospital leaders may have a difficult time gaining their engagement going forward. Operational challenges Once a hospital's workforce embraces the changes required in population health, the work really begins. The operational chal- lenges involved in this transformation are aplenty. For instance, hospitals need to master and employ entirely new sets of population health-related data analytics, such as clinical and financial analyses of insurance claims and electronic medi- cal record data. They also need to take on responsibility not only for the inpatient component of an episode of care but also for the broader continuum. This requires hospitals and leaders to con- sider other parts of the delivery system, such as home health, post-acute facilities and various ambulatory care settings, all of which are important to transitions of care. Hospitals embracing population health also need to slash unwar- ranted variation in care, a task many have not focused on in the past, says Dr. Steinberg. This doesn't mean hospitals and physi- cians were negligent. Rather, unwarranted variation is a byprod- uct of the autonomous nature of medicine and the traditionally fragmented healthcare system. "Doctors would pretty much deliver the care they wanted, and that resulted in variation in almost every aspect of care," he says. Now, hospital and physician leaders must identify these variations and root them out in a way that improves outcomes and reduces costs. Lead- ers must think about variation not only at a physician level, but also in terms of facility and regional variation. The lens needs to widen. These challenges are interrelated, and healthcare organizations won't succeed if only some behaviors change. For instance, a primary care physician may take on accountability for a popula- tion. But if the health system really needs the physician to drive down the total cost of care and improve quality outcomes, the PCP will need to be accountable for what happens to that patient in the nursing home or under the watch of a specialist, as well as for primary care. "While they may not provide the care, they still need to keep the patient in the line of sight and remain accountable for what other Helping providers succeed under risk-based payment arrangements We are powered by Geisinger. Deep experience. Strong history of results. TM Email us for more information: info@xghealth.com