Mary Brainerd has been a leader in healthcare since 1984. She is currently the President and CEO of HealthPartners, a Bloomington, Minn.-based integrated healthcare organization providing care, coverage, research, and education. Prior to joining HealthPartners in 1992, she held senior level positions with Blue Cross and Blue Shield of Minnesota. She was also senior vice president and chief executive officer of Blue Plus. At the 2015 Oliver Wyman Health Innovation Summit, Brainerd will be speaking on population health and what it takes to go beyond primary care and make it work in a complex health system. Here she describes the difference population health management has made for HealthPartners, the nation’s largest consumer-governed nonprofit healthcare organization:
- How would you describe your approach to population health management?
We approach population health with an understanding of the patients and members we serve and the unique healthcare needs they have so that we can work together to improve health and well-being. Through that lens, we think about the things we can do to move from managing health for one patient at a time to supporting the health of an entire population. As one example, we currently serve 30,000 patients who have diabetes and we’ve shifted our thinking to find new ways we can intervene upstream — what steps can we take to identify a potential problem and prevent it from happening in the first place? It requires a fundamental shift in the way we think and presents tremendous opportunity to use resources in more effective ways to improve population health.
- What are the differentiated health outcomes that result from a population health strategy?
Bottom line: improvements in health and well-being that help members and patients lead more satisfying lives. Again, thinking about the example of 30,000 patients with diabetes, through an intentional focus on health management and engagement, we’ve helped patients reduce the incidence of heart attack, loss of eye sight, and amputation in a very significant way. Our top priority has been chronic illness, across multiple conditions. Overall, this work has resulted in our achieving top ranking results in quality in our state, top decile HEDIS rankings, and 5-Star Medicare results. We think this is good evidence of improved value and impact of the work. Improving health doesn’t happen by waiting for patients to show up in a clinic or hospital. It requires a well thought, proactive model that identifies all of the potential touch points we have with a patient or member to help manage health. We know from research that 20 percent of health is determined by care in a clinical setting. It’s an important 20 percent, but it also means that 80 percent of health is influenced beyond the walls of an exam room. When you think about that, and how it relates to population health, you can’t help but ask, “What are we doing to influence the other 80 percent?” It’s important to consider all of the determinants of health and to take steps to help build healthy, thriving communities.
- What are the top requirements for population health?
Based on our experience at HealthPartners, there are four essential elements to population health to call out. They include analytics and informatics, an integrated and team-based approach to care, effective resources to engage the population, and the goals and will to make it happen to achieve results:
1) Analytics and informatics. Understanding the needs of the population that you’re serving is the starting place. Analytics tell us so much about a population and the subgroups within it, including current health, preferences, potential challenges, future health needs, predictive modelling and micro-segmentation, etc. This is important for a very clear focus, customized outreach, and the ability to predict future care needs.
2) Integrated, team-based approach. It takes a team to improve health — physicians, nurses, pharmacists, social workers, and health coaches to name just a few. Working collaboratively, the team-based model provides holistic care to address and support all components of health and well-being — physical, emotional, financial, professional, community, and social.
3) Resources to engage the population. Finding new ways to engage patients and members, and deliver services and support, is critical to population health. This is especially true for those experiencing chronic illness, since much of chronic illness is influenced by lifestyle choices like diet, exercise, and tobacco use. Similarly, creating low cost, easy access, and convenient approaches for common and routine health problems can help achieve “triple aim” results.
4) Goals and will. Establishing short- and long-term goals, with performance measures, has been key. And for us, those goals are in the areas of health, experience, and affordability (total cost of care). We’ve tried to be very disciplined about a sustained and simple focus on these key areas over the past five years.
- What are the benefits of provider vs payer-led population health at scale?
HealthPartners is unique in that we’re both a care delivery system and a health plan. Because we’re an integrated organization, we see the value of both. That’s important because it takes partnership to drive meaningful change in population health. It’s really a function of figuring out what capabilities are needed and how best to use them with the best interest of the population being served top-of-mind. For example, we use both electronic medical record and claims information as two important data sources for our analytic work.
- What are common challenges population health managers need to overcome?
Aligning payment models to support population health is one challenge. Historically, payment models have been fee-for-service, rewarding the volume of services provided and focused on the face-to-face patient visit. But I think we’re at a tipping point where we’ll see more adoption nationally for payment models that reward health outcomes and quality. One example is the Total Cost of Care and Resource Use measure we developed at HealthPartners that provides a framework to address one of the most fundamental problems related to population health, and that’s rising healthcare costs. This measure is one of the first of its kind to be endorsed by the National Quality Forum, and we’re seeing uptake nationally with more than 160 TCOC licensees in 35 states. Payment reform will intensify in the months and years to come, and it’ll advance work specific to population health. Another challenge is engaging the population at the right place and time to make healthy lifestyle changes. Having a conversation about diet and exercise with a patient in an exam room probably isn’t the best place to engage in meaningful conversation. More effective approaches may be support at the work place, mobile apps and messaging, and more support from care coordinators. This goes back to the complimentary roles of care systems and health plans.
- How important will continued technological innovation be in achieving better outcomes and lowering total costs?
Technology offers so many new ways for consumers to interact with and manage healthcare and coverage, and it’ll continue to be a major source of innovation as we look for new ways to improve health and well-being. More and more, consumers are looking for greater affordability and convenience when accessing care and support. Not only does technology present an opportunity to deliver that, but it makes it possible for us to provide outreach at more relevant touch points for the members and patients we serve. Telemedicine is one example that highlights the potential of technology. In 2010, we introduced an online clinic called virtuwell.com, through which nurse practitioners safely treat about 30 conditions online. Since then, the service has grown to treat 50 common conditions in 11 states at a cost of $45 or less if covered by insurance. We can clearly do so much more to meet the needs and preferences of consumers in new and innovative ways. And, as consumers share more of the healthcare cost through high deductible health plans, we’re almost certainly going to see greater interest in technological innovation and mobile capabilities in health care.