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32 Executive Briefing Sponsored by: Making the Transition to Population Health: Healthcare Leaders Share Challenges, Opportunities and a Roadmap for Success A s the healthcare landscape evolves, provider organizations are expanding their focus beyond individual patient care and looking toward managing the health of populations. The goal of population health is clear: improve the quality and effectiveness of care while controlling costs for a defined group of people. However, as Megan Clark of the Advisory Board notes, "the transition path couldn't be murkier." To help provide some clarity, athenahealth brought together 79 executives from 72 accountable care organizations, health sys- tems, provider organizations or consulting firms for a series of roundtable discussions to find out what it takes to successfully tran- sition to a population health model of care. They examined obstacles and opportunities their organizations face and identified prom- ising strategies for navigating the transition process. "Managing population health is a challenging concept," says Anil Keswani, MD, corporate vice president of Ambulatory Care and Population Health Management at San Diego-based Scripps Health. "It involves a set of strategies and capabilities that many of us are still wrestling with at this point." Throughout the discussions, athenahealth used Amy Edmonson's leadership triangle framework to help leaders focus on aligning three crucial elements of their organizations — Vision, Culture and Operations — to drive and sustain future success in population health. Identifying Obstacles Vision refers to clarity about where an orga- nization is strategically headed and what val- ue it seeks to add in its community or market. Many healthcare leaders struggle with vision because they see the population health mod- el of care as very different from the prevail- ing focus on individual patient care. In fact, only 15 percent of leaders polled during our roundtable discussions strongly agreed their organizations were well aligned around a shared vision of population health. In some cases, executives reported feeling pressure from payers to enter population health man- agement before they were ready, or are en- tering the fray simply to keep up with com- petitors. Few, if any organizations seem to have defined a clear and compelling value proposition or a way of measuring and vali- dating the benefits a population health focus brings to their organization or community. As a result, many leaders worry about moving too quickly on population health. They are concerned that focusing on population health will undermine revenue — that is, a healthier population will require fewer hospitalizations and procedures. Additionally, leaders report that providers are reluctant to enter into risk- based contracts, fearing they may be unfairly penalized on already low profit margins. The greatest cultural challenge for health- care leaders is realigning an organization's focus away from acute, episodic care and toward a team-based, collaborative model for sustaining wellness across a population. First and foremost, this shift requires buy- in from physicians. Although many leaders point out that many physicians want to be involved in population health efforts, they are often too busy taking care of sick pa- tients to take on new roles. In addition, spe- cialists are still struggling to find their place in population health efforts. Health system leaders also question how their organizations can appropriately engage pa- tients, families and communities in the pop- ulation health model. How, for example, do they encourage patients at high risk for emer- gency services or hospitalization to make pos- itive behavior changes? Population health is impacted by a complex array of factors that in- clude socioeconomic status, ethnicity and the ability to access care. "We underappreciate the degree to which the patient — the custom- er, if you will — is in the driver's seat in terms of what really happens to their health and well- being," says Brian Goldstein, MD, executive vice president and COO, Chapel Hill-based UNC Hospitals. "Population health is the ag- gregation of the health of each individual, and each individual is autonomous." Healthcare leaders also face operation- al challenges they must overcome as they continue to develop and experiment with population health. They agree that deliver- ing meaningful, usable data at the point of care is the most significant barrier to indus- try-wide adoption of population health man- agement. The key term is "usable data," says Poonam Alaigh, MD, an internal consultant with Atlantic ACO Strategy at Morristown, N.J.-based Atlantic Health System. "Some- times there's so much information that you can't get any directional signal. And groups can interpret that information to their advan- tage, versus having a unified approach and gaining an unbiased understanding of what that information means." Provider organizations struggle with aggre- gating data across their systems, making it actionable, and having the tools to scale the data to the level that's needed for population health. Physicians simply don't have access to the right information at the point of care — from costs to complete patient histories — to inform their treatment decisions. Leaders stressed the need to create a more seamless process for moving patients through the care system, moving away from the fee-for-ser- vice model that has health systems function- ing as competing silos of care and toward a team-centric approach to coordinating care. Finally, leaders expressed uncertainty about the best organizational structure for pop- ulation health models. Some leaders felt strongly that healthcare providers should be payers, and others felt just as strongly that they shouldn't be. Many agreed that there would be a blurring of the lines be- tween insurers, providers and hospitals as organizations figure out how to effectively band together and scale up. A Roadmap for Population Health Organizations face significant challenges as they move toward managing the health of populations. But as our discussions pro- gressed, healthcare leaders identified key strategies that could make the road to popu- lation health less bumpy. 1. Prioritize High-Value Interventions Wondering where to start? Many leaders recommend focusing on high-risk groups. These include both medically underserved populations who have more limited access to care, as well as patients with multiple chron- ic conditions, who are associated with a high percentage of healthcare expenditures. "True population health is about understanding the disparities in your community. If you look at the management of cost, it's about managing the high risk of super-utilizers. This is the top 5 percent of healthcare utilizers, or the top 10 percent who are about to join their ranks," says Scott Reiner, president and CEO of Ros- eville, Calif.-based Adventist Health. High-risk populations are the most respon- sive to prevention and expense management strategies. They are also common in the fee- for-service world, and leaders point out that managing their care can prove to be an effec- tive "bridge" in migrating to risk-based mod- els of care. "Our approach is to try to reduce the cost of taking care of people with complex illnesses, or where there's the most opportuni- ty to cut cost," says Dr. Goldstein, "and then concurrently, and hopefully incrementally, add populations of the healthy majority who sometimes need episodic care."