Last week, Lisa Bielamowicz, M.D., the chief medical officer at The Advisory Board Company, gave a very important presentation in a Healthcare Informatics webinar, and we at HCI were delighted to host her as a presenter. The subject was “Thriving as a Population Health Manager,” and when Dr. Bielamowicz said “manager,” she meant an entire patient care organization/integrated health system organization, not a person.
And Dr. Bielamowicz said several important things that the leaders of any organization moving forward to attempt population health management in any context should consider carefully, whether they are building accountable care organizations, bundled-payment programs, patient-centered medical homes, or broad care management programs, or any combination of the above.
Lisa Bielamowicz, M.D.
First, Dr. Bielamowicz did something that I’ve heard other presenters do, but she did it in a way that was both strategic and granular at the same time. She talked about “three very different patient subgroups” that every “population health manager” (and remember once again, this means organization, not person) needs to look at very differently. There’s the 5 percent of high-risk patients (some in the industry call them the “frequent flyers”) who are already interacting intensively with the healthcare system. Those patients/plan members are already known to care managers, but obviously, need very strategic, very intensive care management.
At the other end of the spectrum are the relatively health patients/plan members/ACO enrollees who, as Dr. Bielamowicz put it, don’t need a huge amount of intervention, but rather, primarily connectivity, especially through a patient portal, and information.
What’s important, as Dr. Bielamowicz noted, and as I’ve heard from other experts in this area, is to also figure out how to manage the “rising-risk” patients, as she called them (some have also called them “medium-risk” or “elevated-risk” patients). As Lisa noted, a typical example of the “rising-risk patient” is “the gentleman with two or three chronic diseases, who’s headed towards a heart attack. The perfect vehicle for managing these has to be in the primary care process,” she noted. “Boy, would it be wonderful if we could give them one-on-one case/care managers, but that’s not possible,” she added.
In other words, one key takeaway from Lisa’s presentation was the fact that it is important for any organization taking on risk and/or population health management activity, will be to figure out exactly how to establish, maintain, and enhance care management and monitoring mechanisms for this group of risking-risk plan members/patients. That, she noted, is where many population health efforts fail, because this group cannot be managed in the same way as the high-risk group—it is simply not economically feasible to do so—and therefore, often, they end up not being effectively managed, leading to problems and lost potential.
So that was one very important takeaway. Another piece of information that I would consider a second takeaway in this regard is this fact: “Every single year,” Dr. Bielamowicz told her listeners last week, “18 percent of those rising-risk patients will become high-cost patients. Think about aging, changing demographics, changes in chronic disease, obesity, all those elements are speeding up that conveyer belt,” she told the webinar audience. And, she added, in a slightly humorous way (but of course with all the serious implications involved), “It’s like the ‘I Love Lucy’ chocolate factory episode—if we can’t slow down the high-risk progression, we won’t be successful. And if you can slow that 18-percent progression just down to 12 percent, you can achieve that population health sustainability.”
Those two me were extremely significant observations, drawn from research that Lisa Bielamowicz and her colleagues at The Advisory Board Company have been doing recently. And together, they add up to a second incredibly important takeaway.
Lisa Bielamowicz offered her listeners two other key takeaways last week. The first one will be obvious in principle to all healthcare IT leaders; but of course, as with anything else, it is in the execution that an organization or collaborative will succeed or fail in this area. As she put it, “You’ll have two main IT goals. You have to begin with a comprehensive, sharable medical record. The EMR is important, but many of these successes involve focusing on the HIE [health information exchange] rather than a single EMR, and on physician portals; and second, you need a comprehensive care management analytics platform. And best population managers like Health Care Partners will tell you, trying to force a single EMR is just not realistic.” So strategic IT deployment is going to be second only to strategic care management resources deployment as a critical success factor in population health.
And finally, Dr. Bielamowicz pointed out, whatever electronic infrastructure one develops to support and facilitate population health, it’s got to be readily scalable, as these population health management initiatives grow over time and with additional contracting mass. And yes, that is a very obvious observation; yet amazingly, many, if not most, healthcare leaders are so focused these days on getting the initial work done that they haven’t focused clearly on that reality, meaning that many population health initiatives could hit major speed bumps just as they’re gaining mass and energy.
So there you have it. What Lisa Bielamowicz shared last week is not entirely unique, though the Advisory Board Company research backing it certainly provides valuable documentary foundation. But it was amazingly succinct and impactful to this editor’s ears. And clearly, as we move forward in population health—an arena that has tremendous potential to transform the U.S. healthcare system within several years—it will be exceptionally important to keep these things in mind. I salute Dr. Bielamowicz for providing the Healthcare Informatics audience with such clear, concise, actionable information and insights, at a time when that information and those insights are needed more urgently than ever.