Becker's Hospital Review

80 Executive Briefing Sponsored by: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., has paid [in part] for and provided editorial input on this material. Population Health Management — An Achievable Strategy in a Value-Based World W ith value-based models apt to occupy a larger share of healthcare reimbursement, health system and hos- pital leaders must place added emphasis on popula- tion health management to foster improved patient care. According to projections released by CMS in 2015, approxi- mately 90% of Medicare fee-forservice payments will be linked to value-based care by 2018. The shift, facilitated by the pas- sage of the Affordable Care Act (ACA), is designed to increase the accountability of healthcare organizations regarding both the total cost and quality of care and to promote a greater focus on population health management. In this modern healthcare environment, it is critical for hospitals and health systems to focus improvement initiatives on achiev- ing the quadruple aim: reduce per capita costs, improve both the patient and provider experience, and create healthier pa- tients by focusing on population health. The 4 tenets collective- ly set the table for improving the overall quality of America's healthcare system. Defining population health management with an out- comes-based mindset Population health has become a ubiquitous term in today's healthcare environment. Popular variants of the phrase include population health management and population medicine. The precise parameters for the term's definition have been widely scrutinized; however David Kindig, MD, PhD, of the University of Wisconsin School of Medicine in Madison, and Greg Stod- dart, PhD, a professor in the department of health research methods at McMaster University in Ontario, Canada, discussed a more universally accepted definition in the American Journal of Public Health in 2003. Their proposed definition was as fol- lows: "the health outcomes of a group of individuals, including the distribution of such outcomes within the group." In a 2015 Health Affairs Blog, Dr. Kindig revisited the term. In the blog, Dr. Kindig states that the debate to establish a pre- cise definition for population health has largely been fueled by the complex, multiple determinants of health that may affect populations, making a specific definition difficult to pin down. Dr. Kindig argues for not losing sight of the importance of out- comes when discussing population health. "Some may argue that multiple determinants are so fundamen- tal to population health that they deserve definitional status," wrote Dr. Kindig in the blog post. "I believe, however, that in- cluding multiple determinants in the definition could lead to confusion between the outcome goal and the determinants needed to achieve that outcome." In accordance with Dr. Kindig's view, healthcare leaders should not get lost in the semantics of population health. If one focus- es on how healthcare can improve health outcomes, the term becomes more palatable. In 2011 the journal Population Health Management published main themes from industry thought leaders after the 11th Population Health and Care Coordina- tion Colloquium in Philadelphia, describing the 3 essential out- come-related goals of population health management as: • Keeping patients healthy • Reducing health risks for patients • Ensuring sick people receive appropriate care Hospitals and health systems looking to achieve these out- come-centered goals should consider first stratifying their patient populations into risk groups, with higher risk pa- tients defined as those more likely to require medical inter- ventions. Once risk levels are determined, leaders can work to implement preventive strategies and initiatives that may keep low-risk individuals healthy and to move high-risk in- dividuals into lower risk groups. These efforts may work to mitigate the natural progression of patients from lower risk groups to higher risk groups. Anchoring population health management efforts with a focus on prevention Preventive healthcare strategies include primary preventions, such as health education and vaccination programs; second- ary preventions, such as biometric testing and early detection programs; and tertiary preventions, such as disease and dis- ability management. In a 2008 study published in Population Health Management, researchers documented the impact of preventive health strat- egies on an employee population of more than 2,600. Prima- ry, secondary and tertiary strategies were implemented over a one-year period. At the conclusion of the year-long study, there were 5.8% fewer employees in the high risk category and 3.6% fewer in the moderate-risk category. Overall, there was a 9.4% increase in employees added to the low-risk category. In a CDC Morbidity and Mortality Weekly Report published in 2015, agency researchers examined the receipt of preventive health services by adults from 2011 to 2012. Researchers an- alyzed a nationally representative sample of survey responses from the National Health Interview and found there was signifi- cant room for improvement with regards to prevention practic- es. The analysis revealed 61.6% of women between 50 and 74 years of age reported being screened for breast cancer, 45.3% of respondents ages 18 and older reported diabetes screening, CDC=Centers for Disease Control and Prevention.

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