Barry Ronan,  president and CEO of Western Maryland Health System, in Cumberland, Md., asks whether his colleagues are dragging their feet on moving to population health.

Last year he “defined population health as transitioning care delivery to a model that is valued-based that includes focusing on better case management of those patients with multiple co-morbidities, partnering in care delivery with other providers including previous competitors, better managing overall utilization and caring for patients in the most appropriate setting, not necessarily acute care.”

Mr. Ronan says: “Now with that said, the simple answer to the question in the title is: You bet they are dragging their feet! Neither payment systems nor incentives are aligned in 49 states, and many of the payers have little to no interest in cooperating with providers on population health initiatives.”

“The reason why my colleagues haven’t necessarily gotten on board is very simply that they are still being paid under fee for service. I just read recently about a number of initiatives that are being pursued by CMS related to value-based care delivery, but they are not in place as of yet. In addition, there appears to be little to no support for such initiatives from many of the payers. You shouldn’t expect health systems to change their care delivery model 180 degrees without some form of financial assistance to support infrastructure changes. There is a great deal of upfront cost when such a transition begins.”

“Population health is an all-out change in how care is delivered, and it can be very costly at its inception. Over time, we have saved significant dollars in reduced admissions, readmissions, emergency department visits, observation unit stays and ancillary utilization, but such a change doesn’t occur overnight.”