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A Population Health Initiative: What Should It Look Like At Its Core? Print E-mail
Written by Mario Espino   
Sunday, 13 August 2017 09:59

A Population Health Initiative is a fluid, dynamic process that is not yet, in its entirety, in place in many institutions. Yes, there are risks but the potential rewards won by capturing the marketplace early are clear. Time is of the essence and the collection of the right technology, people and processes is crucial. Implementing the initiative requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations and reducing the per capita costs (aka The Triple Aim). Analytics captured through a 360° view utilizing interoperability are the key to enabling and achieving The Triple Aim as defined by the Centers for Medicare and Medicaid Services (CMS).

Valued Based Care, at the core of population health, necessitates the collection of structured and unstructured data. Unstructured data is often overlooked as it presents challenges. That said, there are opportunities within the environment today that will allow for it to be collected and re-entered into a structured format. This would meet the goal that healthcare professionals seek: capturing the entire data throughout the continuum of care without limitations of interoperability. Care plans have to be comprehensive and rich in data and outcomes cannot be limited by lack of data.

Technology must be considered early and thoughtfully through process-rich algorithms as it is the only way to capture and stratify for desired results. It can make or break the initiative. In the first risk ventures, we saw that Medicare Advantage companies, without technology as it relates to population health management software, had the ability to control medical costs/ratios. They accomplished this by centralizing infrastructure. A couple of notable pioneers were Leon Medical Centers and Pasteur Medical. In today's era, possessing both infrastructure and population health software is essential. This gives the provider an opportunity to successfully promote the population health initiative to payers and risk-based participants. Attracting large payers requires replicating the infrastructure components agreed to, having the right strategic technology partner in place and expanding geographic footprint.

Coordination of care, medications, referrals and authorizations for the entire continuum of care, with one care plan, will serve as the best practice model. This strategy, if implemented properly, will survive rigorous comparative analysis. The Population Health Initiative should be wrapped into a Clinically Integrated Network (CIN) or Integrated Delivery Network (IDN). The ongoing costs associated with the initiative can be offset by the added revenue lines, particularly Transitional Care Management (TCM) and Chronic Care Management (CCM).

The initiative should look inward and outward for opportunities. Specifically, outward, there should be an upside for physicians by joining the CIN/IDN. For example, physicians could become Medical Home (PCMH) accredited, now no longer limited by lack of data to participate in risk opportunities. Their CIN/IDN participation provides them a mechanism for the reporting of metrics and other payments for performance strategies. Also, the CIN/IDN can protect them from any penalties e.g. not meeting reporting requirements demanded by the government (MACRA). CIN/IDN should include management assistance in modifying workflows or creating workflows that will enrich these practices, patient satisfaction and the overall goal of “Best Care Practice” models. This type of outreach will also encourage other practices to join the team as the CIN/IDN entity makes it easier for individual practitioners to manage MACRA and risk within their managed care contracts, meet outbound opportunities for patient satisfaction as well as reporting. From the institutional side (Healthcare Systems), the legacy process that has been in place should be modified and run in parallel, embracing the Primary Care Practitioner (PCP) as the Gate Keeper going forward.

Population health will dominate all future revenue lines. Do not underestimate the community of services and resources which will be needed to succeed.

About the author:
Mario Espino is the Chief Population Health Officer for Accountable Care Options of Florida, in Boynton Beach. Mr. Espino is the founder of MGM Medical Group as well as a Blogger/Writer for

Last Updated on Wednesday, 16 August 2017 18:19

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