Transforming care, controlling health care costs through value-based population health programs

So, what is “population health” and why is it important? Health care consumers today seek value, and so do the payers who expect and demand value for the financial investment made in their covered population. Population health management can be described as strategic efforts designed to increase the value that businesses (and other payers) derive from their investment in health care.

Population health efforts seek to improve the health outcomes of people who belong to a larger group, whether that group is a company’s own workforce or members of a particular community, while simultaneously controlling health care costs for that group. This is the definition of value.

Where we’ve been; where we are headed

Historically, third-party payers (insurance companies and the government) reimbursed health care providers for the procedures performed or services rendered, rather than for the outcomes they achieved. Today there is a growing shift away from “doing more to earn more” toward reimbursement models based on rewarding physicians and hospitals for achieving better outcomes.

For example, the Centers for Medicare & Medicaid Services (CMS) is changing the way Medicare pays both physicians and hospitals by rewarding providers for delivering services of higher quality and higher value. Medicare has been very innovative is this regard, with many private insurers now following Medicare’s lead.

Saving costs while improving health

In recent years, organizations such as Advocate Aurora have kept costs under control for payers, employers and individuals through:

  • better management of patient conditions
  • enhanced care coordination
  • addressing behavioral health and other non-medical barriers to good health (called social determinants of health)
  • increasing the use of technology

Health care continues to move beyond a “sick care” mindset into a “wellness and well-being” mindset. In the past, patients primarily sought medical care when they were sick, injured or had an  immediate medical problem. Today, the health care continuum begins with wellness and prevention efforts and continues through diagnosis, treatment and beyond.

Engaging health care consumers

Today health care consumers increasingly drive their own care and want to be active partners with their health care providers. Population health strategies are designed to leverage what the science tells us about health behavior change and focus on teaching and activating people to manage their own health to keep them at optimum health throughout the lifespan. This includes focusing on preventive care and managing chronic health conditions (examples: diabetes, COPD, hypertension and high cholesterol) for all members of the population group. In addition, maintaining consistency and repeatable practices improves the overall health of an entire patient population, patient-by-patient.

The key takeaway?

Employers and HR professionals should take notice: Population health management initiatives are changing the way we view health care, and the way it’s being delivered. A well designed, value-based, population health management strategy can yield improved health outcomes for a given population group, while improving an organization’s bottom line.

Written by Dr. Carrie Nelson, System Vice President Population Health at Advocate Aurora Health, Enterprise Population Health; Chief Clinical Officer, Advocate Physician Partners

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