Issue link: https://beckershealthcare.uberflip.com/i/501108
36 Executive Briefing: Population Health Management care management, as opposed to having everything focused on in-office encounters, according to Dr. Steinberg. Additionally, Dr. Davis notes that a signifi- cant behavioral shift will be necessary for fee-for-service providers if they wish to im- plement successful population health man- agement programs. In a fee-for-service world, physicians are reimbursed on the amount of services they provide to individual patients, independent of outcomes or possible complications. In a value-based approach, physicians will be responsible for managing the health of de- fined populations as opposed to individual patients during in-office encounters; and, as such, they will become accountable for both the quality outcomes and the total cost of care of that defined population. Implicit in this transition from a volume- to value-based world where providers will be assuming more accountability for both the quality and cost of a defined population is also the taking on of financial risk for the care and outcomes of that population. This is a huge change for physicians. The transition poses obstacles for providers According to Dr. Davis, the process of shift- ing from volume- to value-based care mod- els poses several key challenges. First, the transition will require physicians to operate in teams and give up some of their individual au- tonomy in that process. The professionals at xG Health firmly believe in physicians-directed teams, but all members have an equal voice. A key part of this team-based work includes monthly meetings focused around reviewing data to help inform clinicians on how well they are doing on a regular basis. "Most physicians aren't used to meeting like this, but these meetings are important and focus on care management processes and transitions of care," says Dr. Davis. "Physi- cians will now be responsible for patients after they go home." If a patient is readmit- ted, in a value-based system this could im- pact how the physicians involved in his or her care are reimbursed. The team-based approach is designed to alleviate burdensome, nonclinical work physicians currently perform, but develop- ing an effective team takes time and com- mitment. According to Dr. Davis, every member of the team must be accountable for providing highest quality care possible in a patient-centered manner. In addition, the clinical care teams have to learn to use EHRs not just as a representation of old paper records, but redesign them to reflect not only how physicians think and act, but how to provide the most efficient care to the population they are accountable for. Another important process that providers must understand is the use of technology to engage patients — such as online portals or devices that measure vitals. These tools enable phy- sicians to collect information from patients in between and in advance of visits, providing patients with the opportunity to play a much more active role in their care. "Patient involve- ment and engagement is being increasingly recognized as an extremely important element in achieving improved outcomes — the com- plimentary side of successful provider-driven care is highly engaged and informed patients," says Dr. Davis. While there is efficiency and convenience for patients, physicians and administra- tors in leveraging such information, the key component is that there must be someone on the receiving end in the doctor's office who is recording and acting on this data, according to Dr. Steinberg. Strong physician leadership is key To achieve all of these changes, physicians must be receptive to the various require- ments of effectively managing population health under a value-driven system. One of these requirements is transitioning away from a care delivery "system" in which different fac- ets operate in silos to one focused on integra- tion and evidenced-based medicine. Many physicians tend to resist change, but they must move away from this and become change agents, according to Dr. Davis. Specifically, physicians must not only develop their own leaders but also acknowledge the need to bring in trusted experts and partners who can assist in the large-scale changes that are occurring within the world of medicine. According to Dr. Davis, more physicians today are actively seeking leadership positions. "There are more physicians who are step- ping up to the plate with a vision because they understand medicine is more than pro- viding good care one patient at a time, but also about how the care system should be organized and implemented to achieve the goals of the triple aim," says Dr. Davis. "It's slow, but it's happening." Investing in formal training and giving phy- sicians management experience is a cru- cial aspect of preparing physicians to be- come leaders in the new models of health care delivery. What models of provider-driven care exist? According to Dr. Davis, provider-driven care management systems exist across a spectrum. The most successful of these are tightly integrated organizations that own most of the elements across the whole con- tinuum of care. "Examples of those organizations include the Geisinger Health System, the Mayo Clinic and Kaiser Permanente — highly integrated delivery systems with strong physician leadership and highly developed physician cultures with a focus on high quality care and outcome measurement," says Dr. Davis. Another model of provider-driven care is em- bodied in accountable care organizations, which require provider groups/hospitals to enhance care coordination and take clinical and financial accountability for a large popu- lation. ACOs ensure patients — especially the chronically ill — receive the right care while avoiding the duplication of services and preventing medical errors. A third model that is being implemented within primary care and multispecialty groups is the deployment of patient-centered medi- cal homes which highlight the role of primary care providers in providing highly coordinated, team-based care for a defined population. Each of these platforms are examples of newer delivery models which require sig- nificant clinical re-engineering in order to deliver efficient, high quality care to popu- lations and that require strong physician leadership to succeed. Role of the payer When it comes to negotiating payers' in- volvement in provider-driven care manage- ment systems, the more collaboration, the better — because providers treat patients covered by multiple payers, they must have the capability to coordinate with case man- agers from each. "The best option in population health man- agement is not an either-or between the provider and payer," says Dr. Steinberg. "The payer ought to be providing claims data to the provider, and if the payer has case managers, they should make an effort to get the case managers integrated in the physician's office." n xG Health Solutions' mission is to help health systems and others committed to high quality, value- based care succeed under risk-based payment arrangements. Our services are powered by Geisinger Health System's methods that have been proven to achieve best-in-class outcomes. xG Health is the primary provider of Geisinger's Health Care Performance Improvement Intellectual Property (IP).