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population-health management

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Optimizing data use for PHM


Anil Jain, M.D. writing in H0spitals & Health Networks, looks at how to access and use the data that are at the heart of population-health management (PHM) programs.

He notes that with the Medicare Access and CHIP Reauthorization Act, hospitals systems “are under increased pressure to support the Centers for Medicare & Medicaid Services’ Advanced Alternative Payment Models and Merit-based Incentive Payment System” and writes:

No one data source is going to provide a ‘gold standard’ for population health management. Claims data alone has often been used for PHM, but it is not timely, making it less useful for care management. In addition, because administrative and adjudicated claims data are not as rich as clinical data, both fail to provide a granular picture of clinical situations. Therefore, it is important to reconcile administrative, adjudicated claims and clinical data to optimally risk-stratify patients.’’

“Here are three key points to remember when building your data strategy for PHM’’:

  • “Start with an inventory of data sources and analysts who have expertise in accessing, extracting and curating the various data. This advice holds true whether you are developing your data strategy in house or working with a partner.
  • “Although it helps to have as much data as possible and to be able to combine different data types as needed into a common data platform, keep in mind that data-use agreements, privacy and security policies such as the Health Insurance Portability and Accountability Act and other constraints may limit your projects.
  • “Finally, iterate through your data projects with a few data types and incrementally layer on additional types as needed.”

To read more, please hit this link.

Wis. ACO laying off 40% of employees


The Milwaukee Business Journal reports that Integrated Health Network {IHN} of Wisconsin, an Accountable Care Organization based in Brookfield, has laid off 21 employees (40 percent of its employees) as  part of shifting some functions from ACO administrators to participating healthcare organizations.

“IHN is in the process of adjusting operations and staffing across the organization to most efficiently and effectively meet the network’s evolving strategic needs,” Kathy Allen, IHN’s vice president for  marketing and communications, told the publication.

The job cuts followed   strategic planning sessions with the ACO’s board of managers.

“It was determined that owner-member health systems and health plans now have the capabilities to absorb many functions IHN provides as they continue the transition to value-based care,” Ms. Allen said. Health systems can perform some of these functions. Some of these systems run their own health plans and population-health management programs.

Ms. Allen said that many of the employees being fired are being considered for jobs within health systems that are members of the ACO.

To read the Milwaukee Business Journal article, please hit this link.

5 ways to improve community health


Point Pinos Lighthouse, Pacific Grove, Calif., on the beautiful Monterey Peninsula.

Healthcare consultant Sita Ananth dispenses some advice on living with the contradictions of community health based on the experience of a California hospital and health system.

“At Community Hospital of the Monterey Peninsula, making the cultural and philosophical shift from volume to value began almost five years ago, President and CEO Steven Packer, M.D., told me. With almost 75 percent of its payments coming from public sources, the hospital’s leaders realized they had to find ways to bridge some of the costs of uncompensated care.

“Given the relatively small population of the county, they decided their only option was to collaborate with other providers, including competitors. The first step was to create a separate entity that would lead the collaborative efforts and provide the needed distance from the parent organization. They named the entity Community Health Innovations.”

“Packer stated that the key success factors for Community Hospital and Community Health Innovations have been the five T’s. I paraphrase them here:

  1. “Talent: finding and hiring the right executives and staff to engage in a new way of thinking, focusing on population health management (PHM) and building community partnerships.”
  2. “Training: Identifying best practices and learning from them. To that end, Packer and his team worked with the experts at Geisinger Health System to provide intensive training for case managers and care managers in various clinical settings.”
  3. “Technology: Realizing that interconnectedness is crucial. To manage the complexities of integrated electronic health records and practice management solutions, Community Health Innovations hired people with health informatics and implementation skills.”
  4. “Trustees: Educating governing boards that the move from volume to value will not translate into immediate profits….”
  5. Time: Building PHM capabilities and implementing them. It’s a time-consuming and all-encompassing effort, said Packer, and cannot be done either part time or in a hurry.”

To read her entire essay, please hit this link.

3 ways hospitals can collaborate but stay independent


Here’s a look at three ways in which hospital systems can cooperate without merging.

They are:

*Forming a management-service organization to centralize some functions to get efficiencies and economies of scale.

*Coordinating population-health management.

*Creating a joint health-insurance organization.

To read the article on this, please hit this link.

PwC touts broader idea of population-health management


The authors of a PwC report sat that population-health management efforts must think beyond the usual clinical measures and collaborate with groups outside healthcare.

The report notes that population-health programs usually  rank patients according to the financial risk to the organization  that their  specific conditions represent, at least at first glance.

But, the report says,  socio-economic and environmental needs and pressures must be considered along with their direct medical ones.

The report touts Partners HealthCare’s High Risk Care Management Program.  It uses  both clinical indicators and data from electronic health records about patients’ backgrounds and  other characteristics. So far, the program has been saving more than $2.50 for each dollar it spends.

Physician leaders in population-health era


This piece looks at what it takes to be a strong physician leader in an age increasingly focused on population health. The authors, Kathy Jordan, president of Jordan Search Consultants, and Regina Levison, Jordan Search’s  vice president of client development, conclude:

“In the era of population health management, the need for competent physician leaders will increase exponentially. Not only will primary care physicians (PCPs) direct care management teams to manage patient populations, but advanced practice providers, nurses, social workers, pharmacists and other non-clinical workers will also be required to lead teams and colleagues. The new paradigm necessitates it, but the statistics for best practices support it. According to a white paper published by the American Association for Physician Leadership, there is a link between physician leadership and organizational success; 21 of the 29 pioneer Accountable Care Organizations that earned bonuses from the Centers for Medicare and Medicaid Services were organizations led by physicians.

Effective clinical leaders will be the determining factor for success and growth in this new healthcare environment; as such, it is imperative that physicians are well-equipped to lead and organizations are prepared to better evaluate effective leaders. The competent, effectual physician leader appropriately employed by a strategic, visionary organization will create the dynamic needed to successfully navigate this new era of healthcare and improve the health of populations nationwide.”


Where population health and consumerism meet


Health Forum convened a panel of healthcare executives and other experts on June 11 in New York City to discuss the intersection of population health and consumerism.

Here’s their discussion.


Key findings from the panel, as summarized by Hospitals & Health Networks:

• “As hospitals and health systems strive to become more consumer-friendly, they may need to rethink some common terminology, such as ‘patient-centered medical home’ and ‘discharge’ to reflect consumer sentiment.

• “Population-health management does not mean an organization needs to provide all things to all people. Instead, hospitals and health systems should focus their efforts on providing preventive care and wellness to certain populations, such as patients with co-morbidities.

• “Price and brand are top of mind for consumers. However, consumers are willing to go out of network for services if they find poor ratings among in-network physicians. Other important considerations for consumers are convenience and wait time.”

Mount Sinai wants to empty its beds


Mount Sinai Hospital, New York, as seen from Central Park.

An ad for Mount Sinai Hospital in New York City says: “If our beds are filled, it means we’ve failed.”

The ad  explains how the new focus on population-health management means that “instead of receiving care that’s isolated and intermittent, patients receive care that’s continuous and coordinated, much of it outside the traditional hospital setting.”

The ad looks at Mount Sinai’s “tremendous emphasis on wellness programs”; its Mobile Acute Care Team, which treats patients at home for certain conditions that otherwise would land them in the hospital; and its Preventable Admissions Care Team, which works to  prevent readmissions  both through medical care and via help with such nonmedical matters affecting impact health and access to care as housing and literacy.

More hospitals reject job applicants who smoke



Sigmund Freud, M.D., died of oral cancer caused by cigar smoking.

Carmela Coyle,  president and CEO of the Maryland Hospital Association, writes in Hospital Impact about some hospitals in that state that have banned the hiring of tobacco users. As she notes, some other providers in the nation, such as Cleveland Clinic, Baylor Health System and WellSpan, have done the same thing.
They’re on to something, she writes:  “From a public relations perspective, it’s tough to preach smoking cessation to patients and the community when hospital employees, who, in this new world of community partnerships, serve in many ways as hospital representatives, are smokers themselves. More importantly, however, is that the mindset of hospital executives and trustees is changing, as hospitals shift from fee-for-service payment models to those built on a foundation of population-health management. This new zeitgeist is one of abiding responsibility, for every single life in a hospital’s care. Its employees are no exception.”

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