Becker's Spine Review

14 Population Health Population Health and Spine: 5 Ways to Prepare for the Future By Laura Dyrda How are physicians — especially specialists — in- teracting with population health? It's moving physicians from the fee-for-service model where "more is better" to the risk-based model where "less is more." But physicians are still accountable for providing good quality care and outcomes in addition to lowering costs. So where are the biggest opportunities to reach these goals? • Eliminating waste • Reducing medical errors • Eliminating unnecessary testing • Preventing 30-day readmissions "We are a healthcare system on the edge of a big decision. Are we really able to make the change from volume to value?" asked David B. Nash, MD, MBA, Founding Dean of the Jefferson School of Population Health at the 13the Annual Spine, Or- thopedic & Pain Management-Driven ASC Con- ference + e Future of Spine. Patients come in all shapes and sizes, and a variety of factors impact their health, from their socioeconomic status to socialization. e biggest predictor of a person's health isn't what you think. "e most important five-digit number I need to know about you to predict your life span is your zip code," says Dr. Nash. Bedside medical care is only about 10 percent to 20 percent of what makes a society overall healthy considering pop- ulation health. "From a society perspective, the access to good medical care is only a small part of the story," says Dr. Nash. "Twenty percent is mom and dad; 20 percent is where you live; 50 percent is indi- vidual behavior. But if you look at how we spend our money, most of it is on medical services. We spend so much on a small percentage of what actually contributes to making us healthy. That's the conundrum. That's the inner guts. That's what the complexity of population health is all about." Healthcare delivery changes Healthcare delivery is changing, and the most suc- cessful providers in the future are already begin- ning to reshape care delivery around care coordi- nation. ese providers are connecting patients with rehabilitation, occupational therapy, behav- ior modification and pain control in addition to their specialists. e information about each pa- tient circulates among all their care providers. "at is what population health, in a very practical way, is going to be all about," says Dr. Nash. "Even five years ago, none of this existed. As we move from volume to value, the challenges are incredible." ere are physicians doing things like pre-habil- itation to engage core strength activity and physi- cal therapy before surgery to prepare for better outcomes. Exercising can also help the patient lose some weight before surgery, which is associated with better outcomes as well. Practices are also hir- ing nutritionists, exercise physiologists and diabe- tes nurse practitioners to help patients live more healthy lives. Others are working with home health providers to ensure patients have a consistent care plan when they return home from surgery. "At the moment, we don't get paid to improve be- havior, but we will be paid to improve behavior in the world that's moving from volume to value," says Dr. Nash. Dr. David Nash Challenges & Opportunities in Spine Population Health By Laura Dyrda Clinical Professor of Surgery, Director, Spine Trauma at Cedars-Sinai Spine Center Neel Anand, MD, discusses how spine surgeons are thinking about population health, and who is responsible for educating patients about prop- er spine care in the future. Dr. Neel Anand: Spine health is a pretty good determinant of public health. One of the biggest issues is chronic back pain because it sends pa- tients down a spiral to many other problems. Back pain is depressing and stops people from enjoying their lives. e key is to treat the patient before it impacts their quality of life. e onus is on the spine surgeons to educate patients in a number of things. You are dealing with patients who have spinal disorders, but sur- geons don't cure backs; we make them better. is is just like patients with diabetes; you don't cure it, you control it. Back pain and chronic degenera- tive pain is no different than that. You want to help the patient maintain quality of life, and education is an im- portant part of that. Patients need education on preventing chronic back pain, and they need to know narcotics isn't the way to succeed. Narcotics only make it worse. It's more difficult to treat patients af- ter they're addicted to narcotics. Surgeons should be educating patients ev- ery day when they come in for a visit. We can still provide treatment, but we need to educate them on life changes to prevent back pain. We also need to curb their ex- pectations. Just because they feel better aer treatment doesn't mean they'll never have back pain again. ey have to know what activities to avoid and how to control their pain. e biggest challenge spine surgeons face with population health is the notion that spine surgery is the most horrible surgery in the world. For the right patient with the right diagnosis and right procedure, results are fantastic. And at the end of the day, there is nothing better than patients with good outcomes. For every patient that does well, another 10 patients will hear about it. ere is no better marketing than that. n Dr. Neel Anand

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