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It Takes a (Big) Village: Laying the Foundations for Population Health

August 27, 2012
by Mark Hagland
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Have we reached an inflection point on strategy and IT development, as the industry evolves forward towards the new healthcare?

Perhaps nothing encapsulates more succinctly how rapidly the perceptual landscape of healthcare is changing these days than what has happened with regard to the name of a recently established school of public health. As David Nash, M.D., dean of the Jefferson School of Population Health, explains it, “When we established this school, we took a big risk in 2008, calling it a ‘school of population health.’ But,” he says, “I got the name from the 2001 book Crossing the Quality Chasm [published by the federal Institute of Medicine], where they use the term.” What’s more, he adds, “When we did an informational search four years ago, we found only one other school with ‘population health’ in its name, and that one was in Adelaide, Australia. Now,” says Nash, whose school, affiliated with Thomas Jefferson University in Philadelphia, has 320 students currently enrolled, pursuing any of four different graduate degrees in public health, healthcare policy, health economics, and healthcare quality, “we’ve seen a lot of organizations moving into this realm in the past year, with Hofstra Medical School, affiliated with the Long Island-Jewish Health System, having just started a department of population health, and the NYU Medical School doing the same.”

David Nash, M.D.

It’s not surprising that Nash, a one-man healthcare policy think tank and publishing industry, would be on the leading edge in an area like this; for decades, he has seen the future, from clinical guidelines and practice protocols to outcomes measurement to comparative effectiveness to clinical care performance improvement, and has been trying to help cajole the industry forward in all those areas, and more. But these days, Nash is far from alone, and while it was indeed prescient for him and his colleagues to designate their new school a school of population health back in 2008, we seem to be reaching an inflection point now in 2012 in terms of the awareness of population health as a key concept for industry change.

Consider the following:

• At Presbyterian Health Services, an integrated delivery system in Albuquerque, N.M., clinician and operational leaders have created a groundbreaking program called “Hospital at Home,” which sends out teams of doctors and nurses to care for patients in their homes rather than admitting them as inpatients. Those patients are very carefully screened, using rigorous criteria, and fall into certain well-defined care categories. The concept, which the Presbyterian folks adapted after studying a white paper by Bruce Leff, M.D., a professor of Medicine at the Johns Hopkins University School of Medicine, who conceived of the idea and coined the phrase, is aimed at improving outcomes for certain frail elderly patients, while at the same time reducing care costs and optimizing care management practices. Using this model, the Presbyterian organization has been able to reduce costs per episode by about 20 percent on average, while improving outcomes and patient satisfaction.

Luch Savitz, Ph.D.

• This summer, leaders at Intermountain Healthcare in Salt Lake City, Utah, announced that they had been awarded a $9.7 million federal contract by the Centers for Medicare & Medicaid Services (CMS), as part of that agency’s Health Care Innovation Awards initiative. The award, according to Lucy Savitz, Ph.D., director of research and education at Intermountain Healthcare’s Institute for Health Care Delivery Research, will “greatly accelerate our ability to put into practice new ways for patients to partner with clinical teams in making decisions that will reduce potential health risks; take a population-based view of care delivery design and decision-making; and align financial incentives to insure sustained excellence in the care we are able to provide to our community.”

Evan Benjamin, M.D.

• At the four-hospital, Springfield-Mass.-based Baystate Health, Evan Benjamin, M.D., the health system’s senior vice president and chief quality officer, reports that Baystate has established a bundled payments contract with its affiliated health plan, Health New England, in order to find ways to improve outcomes and reduce costs in a variety of areas, beginning with total hip replacements in 2011, and total knee replacements and other surgical procedures this year. The planning for this pilot project, Benjamin notes, “took about six to seven months of planning…and that’s pretty typical, as we looked at the amount of work [involved] in terms of changing the model of care, setting up gainsharing models, looking at the patient population, setting up quality measurements.” The results so far? Using a gainsharing model of 45 percent of revenues going to physicians, 45 percent to the system’s hospitals, and 10 percent to its visiting nurse association, the Baystate folks have been saving about $800 per case (based on an average cost per case of $25,000), while reducing average length of stay for these procedures from 3.5 inpatient days to 2.75 days and maintaining consistent quality outcomes.