Renee H. McLaughlin, a speaker at the marcus evans ACO & Payer Leadership Summit 2014, on population health management. Interview with: Renee H. McLaughlin, MD, FACS, Medical Senior Director, Market Medical Executive, Cigna Healthcare

1. I nt erv iew w it h: Ren ee H.
McLaughlin, MD, FACS, Medical
Senior Director, Market Medical
Executive, Cigna Healthcare
“Healthcare organizations must
prepare for an environment where
doctors and other healthcare profession-
als will be compensated based on the
value, not just the volume, of the
services they provide. The push toward
value-based compensation is getting
stronger, so healthcare professionals
must devise a strategy for their journey
to a value-based role in the future and
find a partner who supports their vision
and principles,” advises Renee H.
McLaughlin, MD, FACS, Medical Senior
Director, Market Medical Executive,
Cigna Healthcare.
McLaughlin is a speaker at the marcus
evans ACO & Payer Leadership
Summit 2014, taking place in Atlanta,
Georgia, September 11-12.
What role do payers and healthcare
professionals have in advancing
population health?
Payers and healthcare professionals are
complementary but distinct stake-
holders. Payers can advance population
health by creating a financial model that
incentivizes physicians and delivery
systems to focus on better health,
affordability and patient experience.
There is a need for a payment model to
help us move from fee-for-service to
value-based reimbursement.
Secondly, payers must provide
informatics support. It is not enough to
implement a new payment model
without offering the resources and
support needed to help healthcare
professionals understand the key
opportunities and challenges of
managing population health. Physician
organizations must clearly understand
the changes needed to drive improved
health, affordability and patient
experience.
Finally, the third leg of the stool is
having an integrated, in-depth
collaboration between the payer and
healthcare organizations, with people
support, predictive modeling and case
management services. This ensures
everyone moves in the same direction
without duplicating services.
What must improve to ensure
people receive the best quality care
possible?
Payers and healthcare professionals
typically want to do what they have
always done well. When I was in
practice providing direct patient care, I
took excellent care of every patient who
walked through my doors.
However, what I could have done
better, if I had the right tools and
support, was to manage my patients’
care when they were getting that care
across the delivery system. We need to
make the delivery of healthcare less
fragmented and more coordinated.
We cannot continue doing what we have
always done and be successful at
population health. Payers and health
care organizations must embrace the
richness of the data available, push for
better data and adopt a mindset that
embraces the concept of managing
patients’ health care wherever they are.
We have to leverage resources and
most importantly, collaborate. The gap
that exists must be bridged, as we are
all working for the same end goal.
Why must the focus always be
prevention?
Most physicians are highly motivated to
ensure their patients get the best care.
The challenge is in knowing which
patients need which services when.
There is a tremendous opportunity for
payers to identify the patients who may
have gaps in preventive services and
deliver that information to doctors. This
must be done routinely, integrated with
the health record system, so doctors at
the point of care know, in real time,
which patients are due or overdue on
preventive services.
The gap that
exists must
be bridged,
as we are
all working
for the same
end goal
How Payers and Healthcare Professionals Can
Advance Population Health

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