Viewpoints

Opinion and analysis on managing care from experts and KOLs

Stop Fooling Around Re: Population Health

Zachary Hafner
Advisory Board

It’s 2018 and I’ve got a resolution for you—it’s time to get serious about population health. At first this may feel like we are retreading old ground. After all, we have talked about population health for years now. But while it’s one thing to keep talking about managing populations, it’s another thing entirely to redesign the model, put the pieces in place, and tackle the obstacles to deliver results.

For example, it is commonly understood that integrated behavioral health is a critical pillar of effective population health management, yet in many markets we continue to treat behavioral health as something totally separate—separate providers of course, but also separate payment, separate facilities, separate drug formularies, separate benefit design, separate everything.

If we really want to drive better health and better outcomes, we need to integrate behavioral health into the care model in the same way we are integrating primary care: by expanding multimodal access with on-demand options, bringing 360-degree visibility into patient history, broadening care team integration, and finding new ways to get further in front of potential problems.

We can’t stop there though; this is just one example of many that are required to move the model toward true population health management.

Risk and reward

There are some areas where innovation has pressed forward—most notably in the realm of value-based payment. With MACRA, Medicare Advantage, and MSSP, the American health care system has become enamored with the idea of using financial risk as payment incentives for providers to deliver efficient, high quality care.

But while it is important that the economics go around the block, in some ways this has become a case of the tail wagging the dog. Payment innovation should be the mechanism for funding population health innovation, not the reason for doing it.

The good news is that most of the necessary building blocks already exist to make substantial leaps forward in population health management. In recent years, payers and providers in markets across the country have found common ground and are working in partnership to engage with targeted customer populations. Expanded options for primary care are broadening access in both the physical and virtual domains. Tremendous innovation in EMR and other technology is making collaboration possible across the care continuum, and new analytic tools driven by big data are delivering high-impact insights that can inform care in the moment.

Complete the engine

What is needed now is to go the last mile—integrating these building blocks and the disparate care delivery assets they connect—to begin proactively managing population health. And, along with this advanced “wiring,” to really embrace the culture change necessary to pivot away from today’s repair mindset to one far more oriented toward prevention, care management, and holistic health.

We can all agree that population health management shouldn’t be about the financial rewards. Rather, it should be about the collective societal benefits like disease prevention and better health—better behavioral health included.

Substantial investment is admittedly hard to make with no line of sight on where and when the cost benefits will come. It will take a leap of faith. Are you ready to jump?

Zachary Hafner leads the Advisory Board’s strategy consulting practice.

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