Defin­ing the job de­scrip­tion for pop­u­la­tion health

Modern Healthcare - - COMMENT - By Rita Numerof and Dr. David Nash

Many health­care or­ga­ni­za­tions are scram­bling to de­velop their own pop­u­la­tion-health strate­gies and look­ing to their physi­cian lead­ers to take charge. That’s put many chief med­i­cal of­fi­cers in an un­com­fort­able po­si­tion.

A col­league re­cently reached out for ad­vice as he tack­led this is­sue: “I’ve been a CMO, but now I’ve been asked to take on a new role—vice pres­i­dent of pop­u­la­tion health. In ad­vance of a for­mal project kick-off meet­ing, I re­al­ized I had no idea what this means! We’re mov­ing into un­charted wa­ters for our sys­tem, and ev­ery­one is go­ing to be look­ing to me as the in­ter­nal leader.”

Physi­cian lead­ers who sud­denly find them­selves des­ig­nated as “Dr. Pop­u­la­tion Health” need to know some ba­sics, in­clud­ing un­der­stand­ing what “pop­u­la­tion health” ac­tu­ally means, the pre­req­ui­sites for such a pro­gram and what con­sti­tutes a rea­son­able start­ing point.

Broadly de­fined, “pop­u­la­tion health” means im­prov­ing the over­all health sta­tus and low­er­ing the cost of care for a spe­cific pop­u­la­tion. The first chal­lenge is to de­cide what par­tic­u­lar pop­u­la­tion will be the fo­cus, as de­fined by payer, ge­og­ra­phy, con­di­tion, or other at­tributes. It’s pru­dent to start with a con­cen­tra­tion on a sin­gle, well-de­fined group or ther­a­peu­tic area. Many or­ga­ni­za­tions choose the em­ployee pop­u­la­tion de­fined by their own health plan. That choice points out the need for ac­cess to pa­tient-level data across the care-de­liv­ery sys­tem.

De­mo­graph­ics, health sta­tus, di­ag­noses, ser­vices, costs and re­im­burse­ment across the care con­tin­uum are data pre­req­ui­sites. While an in­te­grated elec­tronic health record would be op­ti­mal, work-arounds are avail­able. Don’t make the mis­take of let­ting in­for­ma­tion tech­nol­ogy in­te­gra­tion be­come an ob­sta­cle on the crit­i­cal path to pop­u­la­tion health; that’s a cer­tain strat­egy for los­ing the race.

Pop­u­la­tion health’s goals re­quire base­line mea­sures of treat­ment costs and health sta­tus, and the track­ing of costs and out­comes over time. Pro­grams need to set goals, eval­u­ate the im­pact of clin­i­cal in­ter­ven­tions and mon­i­tor progress. A lack of pro­ject­man­age­ment dis­ci­pline, an­a­lytic ca­pa­bil­i­ties, or a clear-eyed vi­sion of goals are pit­falls that physi­cian lead­ers should take steps to ad­dress.

Mak­ing an im­pact on pop­u­la­tion-health sta­tus and the cost of care re­quires care in­ter­ven­tion de­signs. Choose spe­cific sub­groups that are out­liers on cost and out­come met­rics, and de­fine changes to their care pro­cesses that will make a dif­fer­ence. This typ­i­cally in­volves re­defin­ing roles, clar­i­fy­ing ac­count­abil­ity and re­think­ing care paths across the or­ga­ni­za­tion.

Change-man­age­ment lead­er­ship and the need for buy-in from the people on the front lines of care de­liv­ery will be crit­i­cal here. Un­for­tu­nately, most people think change is a fine idea, as long as some­one else does the chang­ing. The abil­ity to have con­struc­tive in­flu­ence over the process will be es­sen­tial to suc­cess.

A suc­cess­ful ef­fort also re­quires build­ing a com­pre­hen­sive plan to cap­ture, an­a­lyze, and uti­lize data on in­puts and out­comes, which puts a pre­mium on IT and an­a­lytic ca­pa­bil­i­ties. Again, the EHR sys­tem doesn’t have to be fully in­te­grated to get ef­fec­tive ef­forts un­der­way. Care­ful track­ing of clin­i­cal in­ter­ven­tions, costs, pa­tient com­pli­ance, sat­is­fac­tion and real-life out­comes (such as re­turn to work, pro­duc­tiv­ity, ac­tiv­i­ties of daily liv­ing) will be crit­i­cal. Even more im­por­tant will be ac­count­abil­ity for re­sults from ad­min­is­tra­tive and clin­i­cal lead­ers.

The role of “Dr. Pop­u­la­tion Health” also in­cludes com­mu­ni­cat­ing progress to all lev­els of the or­ga­ni­za­tion, as well as cre­at­ing a feed­back loop that in­forms all stake­hold­ers re­gard­ing plans, ac­tiv­i­ties and re­sults.

Or­ga­ni­za­tions that don’t own all of the com­po­nents of the care con­tin­uum for their des­ig­nated pop­u­la­tion will need to de­velop af­fil­i­a­tions and part­ner­ships with other providers. The cen­tral fo­cus of those re­la­tion­ships should be on es­tab­lish­ing ac­count­abil­i­ties and demon­strat­ing qual­ity. Ser­vice-level agree­ments will play an im­por­tant role in suc­cess­ful ef­forts. Such con­cepts are not “na­tive” to the cur­rent health­care sys­tem, so ex­pect re­sis­tance and an ex­ten­sive need for sup­port.

Once the ini­tial pro­cesses and ex­pec­ta­tions are in place, other new pa­tient cat­e­gories can be iden­ti­fied.

Pop­u­la­tion health man­age­ment is a marathon, not a sprint—12 to 18 months is a rea­son­able amount of time to get an ini­tial ef­fort off the ground. The role of “Dr. Pop­u­la­tion Health” is ul­ti­mately to pro­vide guid­ance on how provider or­ga­ni­za­tions can de­velop and im­ple­ment so­lu­tions that ad­vance con­ti­nu­ity of care and help man­age costs.

Rita Numerof, Ph.D., is co-founder and pres­i­dent of Numerof & As­so­ciates, a strate­gic man­age­ment con­sult­ing firm based in St. Louis. Dr. David Nash is the found­ing dean of the Jef­fer­son School of Pop­u­la­tion Health at Thomas Jef­fer­son Univer­sity in Philadel­phia.

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