Improving Health Care, One Population at a Time

It’s a startling statistic that causes heartburn for even the most experienced health care executives. According to the U.S. Department of Health and Human Services (HHS), 5 percent of Americans consume 50 percent of all health care resources. HHS adds that this 5 percent is a complicated group, coping with a series of costly medical conditions that include diabetes, high blood pressure, mental health, and substance abuse disorders. As a doctor turned health plan CEO, I’ve often wondered if we could cut costs for this group simply by taking better care of them.

The answer is yes. And it’s the driving force behind a movement toward population health management. The term, which you are likely hearing more and more these days, is based on the premise that doctors can improve the health of their patients if they know a little more about them.

A Population Health Approach to Diabetes

Diabetes, which is among the most costly conditions in the U.S., is one of the many diseases doctors are eager to tackle with a population health approach. Here’s why …

In 2013, the American Diabetes Association estimated that the cost to treat all diabetics was $245 billion, up 45 percent since 2008. In addition to rising costs, the number of people diagnosed with the disease is also on the rise. By 2050, it’s expected that as many 33 percent of adults will have diabetes.

While these numbers are downright scary, it’s important to remember that diabetes is largely preventable. If we can change the behaviors of people who are at risk of developing the disease, we can prevent its onset, as well as the development of other related conditions like heart attack, stroke, kidney disease, and more.

Population Health Management 101

That’s where population health management comes into play. If your doctor has access to information suggesting you’re at risk of developing diabetes, he or she can work with you on a weight-loss plan, which may include exercising more and eating better. Your physician might also recommend a series of follow-up visits to track your progress. Sounds simple, right? The problem is that most doctors are busy seeing patients, and keeping tabs on everyone is not easy.

Population health management often provides physicians with additional support in the form of case managers, care coordinators, pharmacists, and analysts, all of whom work together to identify patients with gaps in care and those at risk for unnecessary hospitalizations. Population heath management may also include changes to a practice’s workflows, processes, and technological capabilities.

Rewarding Doctors for Quality, Not Quantity

Implementing these changes has not been easy or cheap. To help, some health insurers – like CDPHP® — have partnered with doctors to assist with the transition. Recognizing that a team-based approach to care will improve patient health and reduce spending, some health plans have begun rewarding doctors for the quality of care they’re able to provide. This has resulted in a movement away from fee-for-service and toward value-based payments.

Value over Volume

The traditional fee-for-service model reimburses doctors based on the number of patients they treat, tests they perform, and procedures they complete. It’s a system that has – for the most part – encouraged more, not better, care. To the contrary, value-based payments reward doctors for value over volume.

Population health must reward doctors for the value of care they are able to deliver. That means, if their outcomes are better, if their standards of care are better, and most importantly, if their ability to make their patients healthier is better, they get paid more.

I used to say that medicine was something we needed to practice one patient at a time. That’s changing. Today, medicine must also be practiced one population at a time.