Presentation on Population Health Management at Lancaster General Health 11/2011

1. Population Health –
The Myths and Realities of
Achieving a Healthy Community
Lancaster General Hospital
November 17, 2011
Steven Peskin, MD, MBA, FACP
EVP and Chief Medical Officer, MediMedia
Associate Clinical Professor of Medicine, UMDNJ

2. 2

3. Major Issues with the US Healthcare System
• Poor and uneven access to medical care, especially for
the uninsured
• Escalating costs and volume of services
• No link between cost and quality
• Excessive administrative costs
• Dysfunctional payment system
• United States is lagging internationally in health outcomes

4. Real Reform: Real Leadership
1. The missing link is links!
2. Comparative outcomes are all relevant and
visible to patients.
3. Many treat, few prevent.
4. Create a culture of health.

5. Real Reform: Real Leadership
Current Approach New Approach
---------------------------------------------- ----------------------------------------------
Focus on current medical problem Focus on all risks
Primary care physicians Cooperative team of providers
Care based on periodic visit Continuous healing relationships
Short visits with little information Emphasis on education & coaching
Decisions by clinical autonomy Evidence-based decisions
Information restricted Electronic information flows freely
One size fits all Care customized to needs & values
Patient a passive participant Patient/family active participants

6. The Concept of Population Health Management
• PHM programs are a set of interventions designed to
maintain and improve people’s health across the full
continuum of care
–from low-risk, healthy individuals to high-risk individuals with
one or more chronic conditions.
• Populations targeted by PHM are often delineated by
health benefit source rather than geography. However,
some proponents argue that because improving
population health is a national goal, a target population
can also be identified broadly, as in “all citizens of the
United States,” as well as narrowly, as in “all people who
call Dr. Jones their doctor” (Berwick et al. 2008).
6

7. Conceptual PMH Framework
7

8. The Conceptual Framework
Population health is person-centered; organizational
interventions are tailored to the individual and community
resources are targeted to individuals. Individuals are
evaluated to identify their place on a continuum of health
risks, from no or low risk to high risk. Specific
interventions, such as health promotion and wellness, risk
management, care coordination/advocacy, and
disease/case management, are targeted to people based
on where they fall on the continuum of risk/care.
8

9. Aspects of PHM Cont’d
• Patient self-management education
• Focus on health behavior and lifestyle changes
• Interoperable electronic health records
• Electronic registries
9

10. 10

11. 2011
Lancaster, PA
Snapshot
11

12. 2011 Snapshot
comparison of
Lancaster County
vs. the MOST
HEALTHY
(CHESTER) and
the LEAST
HEALTHY County
(Philadelphia)
County in PA
when comparing
Health Factors
12

13. 2011 Snapshot
comparison of
Lancaster County
vs. the MOST
HEALTHY
(UNION) and the
LEAST HEALTHY
County
(Philadelphia)
County in PA
when comparing
Health Outcomes
13

14. Population health engagement – menu of options
• Worksite
• Physician’s Office
• Hospital
Screenings • Other Clinical Facility
• At Home
• Lab option
Target • Telephonic Health Coaching
addressing lifestyle and chronic
Programs conditions
• Mail based programs
• Onsite programs
• Communications
• E-messaging
Population • Online Programs
Programs • Campaigns
• Warm transfers/ HA
• Health Plans
Referrals • Employers
• Physician’s
• Other Providers 14

15. The Three Pillars of Engagement
15
Source - Staywell Health Management 2011

16. Obstacles to PHM
In the U.S., the biggest barriers to
population health management are:
• Fragmentation of care delivery
• Misaligned financial incentives
• Lack of managed care knowledge
• Insufficient use of health information technology
16

17. Three Pillars of PHM
• To execute on the promise of PHM, physicians and their care teams
must strengthen their relationships with patients in a variety of
ways, including making sure they come in for needed preventive and
chronic care. Care teams, which include physicians, midlevel
practitioners, medical assistants, and nurse educators, must
optimize the services they provide to patients during office visits.
And as a coordinated team, they must extend their reach beyond
the four walls of the office to provide a continuous healing
relationship. The appropriate IT tools can facilitate achievement of
all three goals while lessening the burden on practices.
17

18. The Beginnings of Change
• Over the past 15 or 20 years, approaches such
as pay for performance and disease
management have had a limited effect on quality
improvement.
• More promising models have emerged in the
past few years. These include:
– Patient-centered medical home (PCMH)
– Accountable care organization (ACO).
18

19. Patient Centered Medical Homes
• While much progress is being made on the PCMH, practices that try
to become medical homes can encounter obstacles.
– Small primary-care practices may lack the time and the resources to
transform themselves and acquire the necessary information technology
(Nutting, Miller, et al.).
– They may find it difficult to gain the cooperation of specialists and
hospitals.
– Physicians may not receive adequate financial support from payers for
coordinating care (Landon, Gill,et al.).
19

20. Accountable Care Organizations
• ACOs consist of hospitals and physicians that take
collective responsibility for the cost and quality of care for
all patients in their population.
• ACOs may be single business entities, such as a group-
model HMO or an integrated delivery system. But they
could also involve an “extended medical staff” or a
contracting network that includes a healthcare system.
• Core of ACO’s may be medical homes
• ? The future of population health management
20

21. The Promise of Population Health Management:
Crucial Role of Automation
• What is also needed for successful PHM is an electronic
infrastructure that performs much of the routine, time-
and labor-intensive work in the background for
physicians and their staffs. Tools exist but are
underused.
• Technology is not a substitute for the physician-patient
relationship. But to the extent that automation tools are
used to strengthen that relationship, technology can help
drive population health management.
21

22. The Promise of Population Health Management:
Crucial Role of Automation
• In order to be able to effectively manage all aspects of health from wellness
to complex care, healthcare organizations must assess the entire
population, taking advantage of online or web-based programs.
• Patients can then be stratified into various stages across the spectrum of
health.
– Those who are well need to stay well by getting preventive tests completed
– Those who have health risks need to change their health behaviors so they don’t
develop the conditions they’re at risk for
– Those who have chronic conditions need to prevent further complications by
closing care gaps and also working on health behaviors.
• Technology can be very helpful in assessing and stratifying patients and
targeting interventions to the right people. The automation of the processes
provides a more efficient and effective way to do population health
management.
22