Home' The Source : Fourth Quarter 2013 Contents Q. How is population health related to healthcare reform?
A. Healthcare reform is really about quality—and that’s where it
connects to what we’re trying to do with population health manage-
ment. Population health follows the same movement being pushed
by the payers and purchasers of healthcare: toward evidence-based
medicine, value-based purchasing, continuous clinical performance
improvement, outcomes measurements, and increased transpar-
ency and accountability. I think we’re at a tipping point as more
hospitals and integrated health systems are moving in the direction
of managing the health of whole populations. That frontier is only
going to expand.
Q. What are some of the challenges of implementing
population health medicine?
A. To explain healthcare reform quickly, I often use the four-word
phrase, “no outcome, no income.” But changing clinical practices
to make this sink in is a much more involved challenge. Here are
five things we’re going to have to do in the future:
1. Begin practicing based on the evidence—and tie pay-
ment to those outcomes. It sounds great, but it’s hard to do.
Research tells us that clinicians make decisions based on grade-A
evidence 18 percent of the time. That means about one out of five
decisions has solid science behind it. The other four decisions are
what we call the art of medicine. Therein lies a key problem—the
payers of healthcare aren’t great connoisseurs of art.
Doctors will tell you their opinions are right and to trust them.
But you need proof to support those decisions. It’s a take on the
old saying, “In God we trust; all others, bring your outcomes data.”
2. Reduce unexplained clinical variation. This solution really
starts with supply purchasing. Stick with the four prostheses that
your doctors have reviewed and approved. Don’t allow that fifth
or sixth one if it costs four times as much and there’s no evidence
to support a better outcome.
3. Continuously measure and close the feedback loop
between physicians and the supply chain. Was it the right
decision to buy those four prostheses for spine surgery? Do re-
search and find the answer to back up future decisions.
4. Reduce slavish adherence to professional autonomy.
You’ve got to give autonomy away to get to the transparency and
public accountability that’s necessary in this age of reform. Ask
questions such as: Are there clearly identified conflicts of interest?
Do we have the value analysis to make this choice? Where is the
evidence to back up the purchases we’re making?
As the size of the pie decreases, and as bundled payments get
cut into smaller pieces, our table manners are going to deteriorate.
But we have to remember not to beat each other up and find a way
to be accountable and transparent.
5. Engage with patients across the continuum. To change
behavior, we’re going to have to communicate more than just at
the yearly appointment. It’s important that we build the right
kind of doctor and facility for the future. At your facility, can
your patients make an online appointment with their doctors?
Do your leading specialists email patients? What’s your blog like?
What’s your Twitter handle as it relates to consumer engagement?
It might frighten clinicians to consider, but we’re going to have
to have social engagement with our patients in this new world.
Q. What are some ways to get health systems engaged
in population-based care?
A. Here are some methods health systems can use to better
manage the health of populations:
• Engage in radical collaboration. Find out how certain
organizations engage with their sickest patients—those who drive
costs—and consider partnering with them. For example, 5 percent
of the 14-plus million members of Humana (where I’m a board
member) are driving 41 percent of total costs. We’re doing ev-
erything we can to lower these costs, including picking up these
patients for their doctor’s appointments; surrounding them with
nurses, care managers and care navigators; and sending caregivers
to patients’ homes to make sure they don’t trip on a rug or fall in
the shower. We’re doing whatever we can to coordinate the care
of these 5 percent. Humana has the economic incentives to make
this work—they know they’re going to get paid more to keep these
folks healthy and out of the hospital.
• Demand proof of better outcomes. Demand better eco-
nomic evidence before you add that 10th beta-blocker to your
• Tackle behavioral issues. It might be something as radical
as “no smokers can apply for this job” or something as simple as
giving employees an economic incentive to participate in a well-
• Begin collecting and analyzing “big” data. When people
leave Jefferson Hospital, they go home to approximately 42 ZIP
codes. Our patients have thousands of pharmacists, none of whom
are electronically connected to us. We’re going to have to push
for online registries to make it easier to integrate care delivery
among provider teams.
Besides these kinds of electronic records, find out more about
those ZIP codes where your patients go upon discharge. Find out
why so many people in this ZIP code go to the hospital every couple
of weeks, while they go less in another five ZIP codes. That’s the
kind of analytic support we will need in the future.
Q. What are the implications of population health man-
agement for the supply chain?
A. I strongly believe that supply chain leaders are going to play
an increasingly important role in health reform. After all, they do
the bulk of the purchasing and are on the firing line for having to
demonstrate value for the money being spent. By becoming more
efficient, by demonstrating value and by cutting waste, supply
chain leaders are going to play a key role in making healthcare
I also strongly encourage the supply chain industry to invest
in leadership training for clinicians of all types, especially physi-
cians, nurses and pharmacists, as these clinical leaders make many
decisions about supply chain purchases. This kind of education
is not part of the training in medical school now, but in this new
world it needs to be. S
30 The Source | Fourth Quarter 2013
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