For decades, hospitals and doctors were paid to take care of sick people. The more care clinicians provided, the more the compensation. Such a fee-for-service payment model was especially apparent when a patient was readmitted shortly after being sent home. At its core, it has been an inefficient system that has not done enough to promote long-term quality of life, especially among older, Medicare patients.
Everyone in the healthcare system knew that providing volume, as opposed to value, was inefficient – a truth that often frustrated hospitals, as well as their medical staffs and nurses. To finally realize such a goal, The Centers for Medicare and Medicaid (CMS) adopted the concept of caring for the whole person. Known as The Triple Aim, policy experts developed the strategy to address the weaknesses in the fee-for-service payment model. Triple Aim seeks three improvements: to better the patient experience; reduce costs; and enhance population health.
Population health management is a vital driver of the Triple Aim model. The idea is that providers – hospitals and doctors – will do better under a financial model to reward them more for keeping people (the population) well and out of the hospital. After all, patients want to be healthy and live independently. Such value-based care is the rationale for new payment models envisioned under the ACA. However, crafting such a financial model, it turns out, has been easier to envision than to accomplish.
Recently, the NYU School of Medicine (NYU) offered a framework for a value-based reimbursement that succeeds through population health. An NYU study team that first proposed financial payment models in 2014 have just published a follow-up paper with more detail to guide academic medical centers (AMCs) in making the jump to value-based payment. The article, “Advancing Population Health at Academic Medical Centers”, appears in the June 2019 issue of Academic Medicine.
According to the authors: “The framework we describe aims to advance both clinical and area-wide population health through institutional transformation and community and cross-sectoral partnerships.” They offer a primer on NYU’s Department of Population Health, created in 2012, to create an academic clinical program to bridge The Triple Threat gap between medicine and public health. Reinventing the way medicine trains the caregivers is key in this effort. The authors present examples of strategic collaborations, successes, challenges, lessons learned, and emerging opportunities.
The NYU Department of Public Health works in the community with local programs to promote population wellness. For example, their engagement with a local Asian American community group supports actions to improve the health of an Asian population that struggles with high rates of diabetes and hypertension. Among the improvements are fostering programs to promote healthy eating and the adoption of more physical activity into daily routines. Another program partners through barbershops and churches in African American communities to lower prostate cancer rates. Both of these outreach programs achieve The Triple Threat goals of managing population health, which in turn improves the patient experience by keeping people out of the medical system and reducing costs. The point the authors make is that successful population health strategies can pave the way for reform to value-based care.
It’s not just an AMC issue. Community healthcare systems, long the epicenter of the medical world, have to change as well. One think-tank, Open Minds, laid out strategies for hospitals and their array of employed physicians and clinics. These include:
Understand that hospitals play an essential role in the short term: Hospitals now deploy population wellness treatment protocols to remain financially viable. For example, with CMS now unable to pay for any readmission within 30 days, it’s a hospital’s concern if a patient didn’t have money for food and medications or a way to keep their post-discharge doctor appointments. Hospitals now have a much keener interest in the social care their patients need to stay healthy and at home.
Develop a standards-based continuum of services: Health systems are in a unique position to deploy population wellness resources across all of its community providers. They have both the relationships with their medical staff and network of community locations to create a continuum of care to meet value-based reimbursement contract obligations.
Focus on quality and performance: Use data to drive the switch from volume to value to drive better outcomes. Patients, with help from their insurance providers, will know which health systems are doing the best job in the new world of population health. Such knowledge will, in turn, help control costs through value-based reimbursement.
Hospitals want to do what’s right for patients. As the payment model shifts from volume to value, financial incentives become more humanistically aligned. Value-based, population health changes control costs and achieve better clinical outcomes. Such achievement makes for a better patient experience – as well as improving medicine for doctors, nurses, and other caregivers.