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Vancouver Dialoguing: The Crucial Importance of U.S.-Canada Transnational Discussions

September 23, 2015
by Mark Hagland
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Canadian and American healthcare leaders were able to learn from each other at the Health IT Summit in Vancouver last week

This past week, the Health IT Summit in Vancouver was the place to be for anyone interested in parsing the complexities of the forward journey in healthcare in North America. As the keynote presentations, plenary presentations, and especially the discussion panels affirmed, the present moment is a pivotal one in both Canada and the United States.

Both nations are facing burgeoning needs for healthcare, while the costs of healthcare in the advanced, industrialized nations are being driven forward towards unsustainable per-patient levels. Of course, for a variety of reasons, the U.S. healthcare system faces a financial crisis whose dimensions dwarf those of the smaller crisis facing the Canadian system (with many of those reasons policy-related and reflecting unique aspects of the U.S. healthcare system, and others reflecting American society); but both American and Canadian healthcare leaders face a generally comparable set of challenges around optimizing care delivery processes for improved patient safety and care quality, greater operational efficiency, enhanced consumer/patient and community experience, and other core issues.

And those similarities were on full display in many of our discussions, in a kind of “comparison/contrast” form, throughout the Summit. For example, right out of the gate, in the panel entitled “Data & Analytics: Driving Population Health Management,” which was held on Friday, Sep. 18, when the panel’s moderator, Trevor Strome, manager, Informatics & Process Improvement, in the Emergency Program at the Winnipeg Regional Health Authority (Winnipeg, Manitoba), asked panelists to help define population health management, for purposes of their discussion. The first response to his query came from Jat Sandhu, Ph.D., regional director in the Public Health Surveillance Unit at Vancouver Coastal Health Authority (Vancouver, British Columbia), who said this: “I agree, I think the term population health management is overused, particularly in the U.S.,” Sandhu responded. “In Canada, we think about it rather differently. It’s about the organization or management of health delivery focused on achieving outcomes that are effective and safe,” Sandhu said. “And at the crux, it’s about being proactive about the management of at-risk populations, making sure they don’t become too expensive to the system. So it’s about managing clinically defined populations or those that are frequent users of the system. And to be effective, we need to obtain good longitudinal data.”

Right there was a good comparison/contrast, given that so much population health management work in the U.S. is evolving forward in the context of accountable care organization (ACO) development, both under the aegis of the Medicare program, and as sponsored by private health insurers. Meanwhile, in a completely different reimbursement context, Canadian healthcare leaders are moving forward to leverage analytics for population health management initiatives, with provincial governments directing efforts, as the payers of healthcare in Canada.

And as Alyssa Daku, vice president for strategy, quality and risk management at eHealth Saskatchewan (Regina, Saskatchewan), noted thoughtfully, “When you talk population health, it very much sits in the health sphere. As soon as you add ‘management’ into that, there are so many variables that exist outside the healthcare system that exist outside our purview. It becomes incumbent on social services, education, and government, to become involved.”

And, said Larry Svenson, Public health perspectives are important in that regard, said Alberta Health Services’ Svenson. “Because I work primarily in public health,” he said, “we’re always thinking about these non-health entities and how you integrate that in. Looking at children in care—they have lots of mental health visits and other interventions. Once the interventions take place, their utilization actually drops off. The other part of this is that, in Alberta, 5 percent drive 65 percent of costs; but that is not a stable, permanent group. It changes over time. And there’s valuable data coming from many places. Our biggest challenge in government is how you derive meaningful policy decisions that turn into meaningful care decisions.”

And that is exactly the same core problem, expressed through different national healthcare systems, and encountered at different locus points within those different healthcare systems, but challenging in the same fundamental way, for healthcare leaders in both countries.

Meanwhile, it’s also clear that healthcare leaders in Canada and the United States can learn from one another. So many excellent examples of provincial healthcare authority leadership were offered at the summit, while on the U.S. side of things, it was great to hear Rick Skinner’s excellent presentation on the forward evolution of the ACO concept at his organization, the University of Virginia Health System.

As Skinner, the chief information and technology officer at UVA, explained to his audience in a plenary presentation, an early analysis of data related to UVA’s ACO, Well Virginia, revealed some interesting findings around chronic illness. Looking at three of the most prevalent chronic diseases, they found that over 30 percent of the ACO’s population had been identified as having diabetes; 18 percent had identified congestive heart failure (CHF); and 68 percent had identified hypertension. Meanwhile, 25 percent had both diabetes and hypertension; 15 percent had CHF and hypertension; 9 percent had diabetes and CHF: and 8-9 percent had all three major chronic illnesses—a daunting prospect indeed.