How quickly and successfully are the nation’s medical groups transitioning to the emerging population health care delivery and payment arrangements? There is huge variation across the U.S. healthcare system, of course. And when it comes to the successful leveraging of information technology to support the shift over to population health- and accountable care-driven care delivery and payment, well, things are rather uneven in that sphere, too.
In that regard, Mark Werner, M.D., the director and national leader for clinical consult at the Chicago-based consulting firm The Chartis Group, and Bob Schwyn, a director at The Chartis Group, spoke this summer with HCI Editor-in-Chief Mark Hagland, as he interviewed industry leaders for the magazine’s September-October cover story on population health. Below are excerpts from that interview with Schwyn and Werner, as they shared their perspectives on the population health phenomenon, and in particular on the IT and analytics aspects of that phenomenon.
What are medical groups learning right now, as they forge ahead into population health work?
Bob Schwyn: My background and role is on the technology side of things. And part of what I think is happening in the trenches is that people are gradually realizing that [shifting into a population health management focus] is not just an IT initiative or a primary care medical home initiative, or an isolated-contract initiative, but rather that it really does require an enterprise-level effort to link to your strategic plan. Part of the problem is that there remains confusion about population health at the public health or community health level, since we’re trying to achieve some public or community health goals via what is still an acute-care-based health system. So you have to begin to stratify populations and realize you’re already taking care of multiple populations.
Does IT governance become an issue? Also, overall strategic governance becomes an issue as well, correct?
Schwyn: Yes, we find it’s both. IT governance helps us figure out where we should make our investments, etc. But if your organizational plan isn’t strong enough and clear enough, it’s hard for IT governance to respond to it. So the in-the-trenches challenge we get into is in helping people to get some clarity around what problems they want to solve, and want technologies they need to build. What do I need and when do I need it? That kind of thing. And we also see a lot of folks who are trying to boil the ocean and they try to huge some kind of huge analytics platform and care management capability, and then they can check off the technology, but it’s not that easy.
Do you gentlemen see more clarity beginning to emerge around the concept of population health now?
Mark Werner, M.D.: One of the things we’re learning is that it’s a phrase with a lot of meanings. Part of what I think is happening in the trenches is that people are gradually realizing that it’s not just an IT initiative or a primary care medical home initiative, or an isolated-contract initiative, but rather that it really does require an enterprise-level effort to link to your strategic plan. Part of the problem is that there remains confusion about population health at the public health or community health level, since we’re trying to achieve some public or community health goals via what is still an acute-care-based health system. So you have to begin to stratify populations and realize you’re already taking care of multiple populations.
Mark Werner, M.D.
What are your perspectives on the challenges of beginning by identifying rising-risk patients, those not yet in the highest risk categories, when beginning to move forward under a risk-based contract?
Werner: I think we have to be careful about starting out thinking from the physician/provider perspective. We have to start out thinking from the health plan member perspective: we need to figure out how to engage patients and members. Physicians tend to start out saying, tell me who they are and I’ll treat them. But instead, what can be getting in the way of improving their health? Maybe some of them want virtual care. I was talking with someone recently who has an ongoing chronic disease and he sees a specialist who only sees patients Tuesdays and Wednesdays in the morning. And this person travels a great deal and says, I actually travel all the time and can’t get in to see my doctor on Tuesday or Wednesday mornings. He really could benefit from virtual visits or phone visits. So we really need to engage people and find out how they prefer to access care and get information, and then design care management around that.
Schwyn: Yes, and it really does lead you to more tailored interventions around what the best way is to help, and how I coordinate care across the continuum, and focus on those things depending on where that patient is in terms of chronic care or possibly on the wellness side of things. And understanding those needs really helps to identify where the technology efforts and the spend in technology can best be leveraged.
So you’re simultaneously looking at two axes, right? Engagement and health risk?