Issue link: https://beckershealthcare.uberflip.com/i/501108
35 Executive Briefing: Population Health Management Sponsored by: E ffective population health manage- ment is a critical aspect of hospitals' and health systems' efforts in transi- tioning from volume- to value-based models of care in which reimbursement becomes more and more closely related to outcomes, readmissions and other quality indicators. When facing such a paramount paradigm shift, who is best suited to lead? Earl Steinberg, MD, CEO of xG Health So- lutions, a care delivery improvement com- pany powered by innovations and learnings from Danville, Pa.-based Geisinger Health System, makes the case for provider-driven population care management. While many physician practices are beginning to reengi- neer their practices to better handle popula- tion health management, providers have not always led this initiative. Historically, health plans were the ones that provided population health manage- ment with their own case managers, health coaches and call centers. Payers have cer- tain assets and capabilities that are valu- able for population health management, according to Dr. Steinberg. First, payers have claims data, which allows them to construct a picture of all billable uti- lization of a patient regardless of which pro- vider was involved in a particular encounter. In comparison, EMR data is limited to the data generated at a particular provider site — it is not comprehensive in that it does not include the treatments or services a pa- tient obtains outside of a particular provider. Health plans also have analytic expertise, allowing them to use data to identify pa- tients who would most benefit from some type of care management intervention, ac- cording to Dr. Steinberg. Additionally, health plans have an abun- dance of nurses who use sophisticated telephony that enable them to reach out to patients efficiently. However, the exclusive use of health plans to handle population care management is inadequate in several substantial ways, em- phasizes Earl Steinberg, MD, MPP. "There is a significant lag in the availability of data relative to an encounter that a claim is generated for," says Dr. Steinberg. "The lag could be months, so information is of- ten outdated. Or, something could happen and would not be reflected in the claim until much later on." In addition to issues of timeliness, health plans alone lack the clinical data that elec- tronic health records offer to inform future interventions. Finally, health plan-led care management typically uses separate software for utiliza- tion management, disease management and case management, making integration and coordination with provider-driven care management difficult, if not impossible. What makes provider-driven care management preferable to health plan-driven management? There are several attributes of provider- driven care that make it effective for leading population health improvement. Close relationships with patients and among providers According to Dr. Steinberg, provider-driven care necessitates nurses and case manag- ers to be physically present in the office, which enables them to establish much clos- er relationships with patients than could be done over the phone. "By being embedded in the practice, it is pos- sible for the nurse to arrange to have a pa- tient come in for certain types of service and obviate the need for the patient to go to the emergency room," says Dr. Steinberg. Provider-driven care also allows case manag- ers to form close relationships with the physi- cians and the office as a whole, which leads to enhanced coordination — instead of waiting for the physicians to call them, the case man- agers can just knock on their doors. Team-based care improves operational efficiency One of the founding principles of xG Health is recognizing the value and efficiency of team-based care that operates within pro- vider-driven population care management. "At xG Health, we strongly believe in a team-based care approach in which every member operates at the top of their license or skill set," says Dr. Steinberg. According to Jeffrey Davis, MD, senior medical director at xG Health, substantial portions of physicians' time today is spent on activities that can be automated or del- egated to other team members, which ulti- mately reduces the amount of time they can spend with patients. For example, in an effective team-based care approach, case managers are as- signed to monitor the sickest patients and perform many of the tasks for these pa- tients, allowing physicians to focus on what they are trained to do — making complex medical decisions and building patient rela- tionships. According to Dr. Davis, it is essential for the case manager — usually a registered nurse — to be embedded in the practice. In this role, the case manager not only helps man- age the highest risk and complex patients but does it in a much more collaborative and coordinated way because he or she works right alongside the physician and the rest of the team at the practice site. What must providers do to become effective population care managers? Providers must learn and acquire certain essential capabilities to effectively manage population health. Key capabilities for provider- driven care management First, providers need to do everything that is good about health plan-driven care manage- ment. "They need to become agile and able to analyze and interpret claims data so they can understand both the view of the population and of the patient," says Dr. Steinberg. Physicians must also learn to use this data in conjunction with clinical EMR data, ac- cording to Dr. Steinberg. If physician prac- tices don't have the manpower to achieve this data extraction and analysis, they must broaden their team. Monitoring this data and using it to proac- tively deliver early interventions to patients and identify ways to prevent patients from needing to come into the office for visits is an integral component of provider-driven Why Provider-Driven Care is Best Equipped for Population Health Management