Amid all the broad, policy-oriented discussions, and the very broadly strategic discussions, about population health management, these days, what has it actually been like to execute on the population health promise, at the large multidisciplinary medical group level? In a word, challenging. Medical group leaders are clear on the fact that they’re trying to do something that essentially has never been attempted before in the U.S. healthcare system, and that is to transform the processes of care delivery.
What are the common denominators? In interviews with Healthcare Informatics, the leaders of pioneering medical groups, while pursuing a wide variety of strategies, are finding common challenges and opportunities in wading into the deep end of the pool in several key, overlapping areas. Among them:
- Medical group leaders are beginning to effectively harness clinical information systems (some of them anchored in electronic health records, some of them systems being connected to EHRs) and data analytics, to perform health risk stratification across broad populations under defined contracts.
- Medical group leaders are also moving ahead to put in place care management systems to support their chronically ill patients and enhance their health status—e.g., optimizing blood sugar control for diabetics, etc.
- Closely allied to those first two elements, group leaders are moving forward to participate in what is often referred to as the “blessed cycle” of clinical transformation and performance improvement, meaning, a cycle of data collection, data analysis, data reporting, data sharing with clinicians and staff, data-facilitated performance improvement around care delivery processes, and then further cycles of data collection, analysis, reporting, and sharing, to support continuous performance improvement.
- Embedded within all of these efforts are specific IT- and data-related efforts, including the creation of chronic disease patient registries, the IT facilitation of care management processes, the building out of data warehouses, the creation of dashboards for physicians and other clinicians, the facilitation of both clinicians and patient engagement via mobility and mobile devices, and the facilitation of data analytics combining claims-based and clinical (via the EHR) data, among other essential capabilities.
- Leaders at pioneering medical groups are currently busy addressing the welter of strategic, operational, clinical care process, data analytics, IT-technological, and other issues involved, and are laying the foundations for successful initiatives that will be replicable across the U.S. healthcare system.
Among the challenges involved is a very fundamental one, says Bob Schwyn, a director at the Chicago-based Chartis Group consulting firm, and a former healthcare CIO. “Our experience across our client base,” he says, is that getting clarity on what population health is and what it means, is very important to understanding your market and where it’s going, and what populations you’re focused on, and all the considerations around the value proposition and focus. In many cases, when our clients seek us out for technology assistance, they haven’t yet created enough alignment around how the technology will support the business, and often, there’s also a lack of clarity around the broader strategic plan for the organization.”
Schwyn’s colleague at Chartis, Mark Werner, M.D., the firm’s director and national leader for clinical consulting, adds that “One of the things we’re learning is that it’s a phrase with a lot of meanings,” he says, speaking of population health. “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.”
Below are three case studies that illustrate the challenges and opportunities involved, and the diverse approaches that physician group leaders are taking as they move forward to fully leverage IT and data analytics to facilitate population health management. Each illustrates different facets of the landscape.
A full-court press in New York state
At the Middletown, NY.-based Crystal Run Healthcare, a multispecialty group practice with 35 locations and 375 providers (300 of whom are physicians), all of the senior leaders are absolutely committed to a population health strategy as their organization’s core organizing strategy going forward.
Prefacing his comments modestly, Gregory Spencer, M.D., Crystal Run’s CMIO, says, “I don’t know that any of our learnings have been terribly profound.” Instead, he says, the basics are fairly clear: “Getting the data as right as you can at first is important; getting all the stakeholders in early to participate in the overall process, is really important. And having an iterative workflow so that people can see that there’s an end to the means, showing that you’re picking things that make a difference, so there are tangible real, a sense of purpose and gravity; those are the most important things.”