How can you adapt to population health? If you’re a health care provider, such a question can’t be answered in a sentence or a paragraph—or even an entire article. But providers who are undergoing a fee-for-service to fee-for-value transformation have offered some insight into how and why they’re evolving to become excellent at managing the health of their care community.
The ability to manage risk and profit from it is a learned skill, and large organizations such as hospitals and health systems are at various stages in having such a capability. “Our hospitals are in many different places in terms of where they are on the spectrum of taking risk and how they are engaging in population health,” says Ashley Thompson, director of policy at the American Hospital Association. But, by and large, they are making the effort. “As part of the Triple Aim, we are committed to improving population health.”
Providers large and small have seen the writing on the wall. Some need to adapt. Others are nimble enough to turn risk into opportunity.
“The truth about health care is that no matter what happens, we are going to spend less money on it,” says Bruce Muma, M.D., chief medical officer of the 1,200 member Henry Ford Physician Network, part of the five-hospital Henry Ford Health System based in Detroit. He’s not alone in that opinion.
“It is anyone’s guess how much of our revenue will be at risk five years from now, but it will be more than it is today,” says Juan Serrano, senior vice president of payer strategy and operations at Catholic Health Initiatives. “To be paid for value, we have to be adept at creating and maintaining value—that is a requirement. We don’t believe we have the choice but to invest in population health programs.”
One organization that is making the most of the trend toward value is Oak Street Health, which serves at-risk populations at four clinics in the Chicago area. By focusing on physical and social health, the organization has successfully reduced hospital admissions and emergency department utilization, and has achieved shared savings under value-based contracts.
“The biggest levers to improve performance are primary care and social services,” says Mike Pykosz, Oak Street Health chief executive officer. “If you do both, you can save a lot.”
Oak Street is profiting from the low-hanging fruit of population health management: complex and chronic patients. But opportunities exist elsewhere.
“Our next challenge in preparing for alternative models of capitation or global payment is extending them to a less-complex population,” says Dan Anderson, chief operating officer and president of community hospitals, Fairview Health Services based in Minneapolis. “The impact on total costs is less for an individual, but the size of the population in less critical categories is quite large.”
To learn more about how these and other provider executives are incorporating population health, see the article “How Will You Adapt to Population Health?”, reprinted from H&HN Daily with the permission of Health Forum, on page 20 of the Spring 2015 edition of RISKMATTERS.
–Elena White, Vice President, Risk Quality & Network Solutions
About the author
Elena White currently serves as Vice President of the Risk Quality & Network Solutions division for Optum. She has over 18 years experience leading network optimization initiatives, network development and expansion, business planning, provider reimbursement development, transformation to risk based arrangements and medical cost management strategies for both health plan and provider organizations.
Elena holds a Bachelor’s Degree from University of California at Riverside and Master’s Degree in Business Administration from Loyola Marymount University.