Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Preparing to Manage Population Health: 2015 Update

5/14/2015 11:45:06 AM | 2 comments

As I write this, I'm fresh from a meeting about the rollout of our group's population health management strategy.
 
Wow, I thought as I listened to the speakers. This is really exciting. What a fantastic opportunity for us to lead and innovate.
 
Okay, so maybe that sounds overly idealistic. Then again, I'm fortunate to be part of a group that's demonstrated its ability to adapt to each new transformation in the healthcare environment. CEP America started as an emergency medicine practice way back at the dawn of the specialty. When national provider shortages led to emergency department (ED) crowding, we developed Rapid Medical Evaluation (RME)® to decrease wait times. And as the need for care coordination increased, we responded by evolving into a multispecialty group. Rather than defeating us, these challenges made us stronger and more desirable to our hospital clients. So you'd think we'd be ready for anything. But as the meeting wore on, it became clear that not everyone in the room was filled with optimistic thoughts about population health management.
 
When participants were invited to voice their concerns, they had many. Are the metrics by which we'll be evaluated truly valid? Are we ready to take on a higher level of risk?  How are we going to get there from where we are now? Do we know enough about what’s coming to be able to prosper in a whole different reality? What if some providers from other specialties don’t get the big picture and cause us to fail?
 
Uh-oh, I thought. If our very resilient group is this uncertain, how on earth is the entire industry going to cope?


Big Uncertainties


There's something about the coming shift toward population health management that unnerves even the most seasoned healthcare veterans.
 
One problem is the sheer magnitude of the change. We're moving from a straightforward fee-for-service system to value-based reimbursement. And while that may be good news for patients, taxpayers and the government, it's more complex and less secure for providers. It's one of the biggest paradigm shifts in the history of American medicine.
 
Transitioning to value-based care takes more than just process engineering. It impacts our professional values and identities. As a physician, I value my autonomy to decide the best way to care for my patients. That's difficult for some providers to square with clinical pathways,  increasing regulations and physician quality reporting. On the other hand, fighting or ignoring these changes will not make them go away. We need to learn the new rules and anticipate the possible unintended consequences. Then we need to work with our legislators to create a system that works best for everyone, where we can consistently provide better, more appropriate care for less cost.
 
Yet another issue is uncertainty.. All we have to go on are a compendium of best practices that work for certain organizations — many of them in foreign countries. It takes lots of data, research and creativity to tailor these successfully to one's own practice.
 
And finally, it's all happening very quickly. Just a year or two ago, we spent very little time tracking our patients in order to keep them healthy. Yet very soon, that will be a firm expectation. Absorbing the idea is a bit like walking down a staircase and then falling off a cliff in the middle.
 
To be fair, it's not like the situation just appeared out of nowhere. Politicians and industry leaders have known where the fee-for-service train was headed since at least the 1970s. Sans a crisis, it would have been career suicide for any government official to tackle the issue head-on.
 
But I am convinced the time has come.


A Rationale for PHM 


Here are a few good reasons to feel good about population health:
 
Economics. America is the only developed nation that treats healthcare as a privilege rather than a right. Excellent care is available, but only at a cost dictated by the market. Hence we have the world's most expensive healthcare by a wide margin — 17.4 percent of GDP as of 2013. If left alone, some estimates have that rising to 34 percent by 2040, leaving insufficient revenue for education, defense and other government programs. It could ultimately bankrupt our nation.
 
Rising healthcare costs are also hurting our country's ability to compete. A few years ago, General Motors estimated that employee healthcare spending added $1,525 to the sticker price of every car it produced. Meanwhile, our biggest automotive competitor (Japan) spends half as much as we do on healthcare.
 
Fairness. The United States delivers some of the world's most advanced treatments. Yet we have poor health outcomes when comparing ourselves with the other developed nations. This is likely due to our tiered system of access that depends on patients' ability to pay.
 
Reactivity vs. proactivity. Our current system is geared toward treating problems rather than promoting long-term solutions. Unfortunately, we humans are a little bit like cars; it's a lot cheaper to do routine maintenance than to replace the entire engine after it blows up.
 
The experience of other developed nations suggests that access to good quality preventative care improves health outcomes — and in many cases holds down costs as well.
 
Appropriateness. At present, our system spends a lot of money on services that have questionable benefits for patients.
 
For example, 25 percent of Medicare dollars are spent on people in the last year of their lives. Despite the good intentions of everyone involved, this can lead to suffering in the form of invasive treatments, side effects and loss of dignity and autonomy, without any reliable studies demonstrating that these interventions improve the quality or length of life.
 
Meanwhile, surveys show that 80 percent of Americans prefer to die at home, and that people who receive end-of-life palliative care may even live a little bit longer and have better quality of life than those who don't.


Seizing the Day


For the reasons above, I'm convinced that the coming shift toward value-based payments is both positive and necessary.
 
In terms of healthcare costs, our country has reached a critical point. We no longer have the option of standing back and hoping things will work themselves out. We can't afford to wait for someone else to fix the problem.
 
But we can choose to be a part of the solution. We can decide to be open, adaptable and more comfortable with the unknown. We can make this difficult hour our finest and emerge stronger than ever before.
 
So I'd like to send a message of encouragement to my group — and to all my colleagues out there who are in the same boat.
 
Value-based care is a big change. But change is nothing new to us.
 
We will no doubt experience bumps during the transition. On the other hand, we have an opportunity to be part of one of the biggest redesigns healthcare has ever experienced. Our work in this area can potentially improve the health of our population, bolster our nation's prosperity and create even more great career opportunities for our dedicated providers. I look forward to embarking on this journey with you. 


Comments
Cyndy Flores
Great article Jeff!
5/20/2015 10:02:26 PM

Jon Brummond
It is comforting to be a part of an organization that is proactively innovative rather than reactive. Nobody really knows what the future looks like or holds for us, but one thing is certain, CEP is poised to be a player and not a victim! Thank you for contributing.
5/20/2015 10:42:32 AM