In this episode of the Oliver Wyman Health Podcast, Sam Glick, Partner, Health & Life Sciences, Oliver Wyman, chats with Dr. David B. Nash, Dean, Jefferson College of Population Health, and Dr. Stuart Baker, Executive Officer and President, Navvis, about the next wave of population health management programs. David and Stuart discuss their new joint professorship devoted to advancing population health management.
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“Devoting academic research and programs to the health and wellbeing of whole communities is an invaluable investment in humanity,” says David. “By translating scientific research into real-world practice, we ensure the next wave of population health programs will yield the best possible outcomes for health and prosperity."
Why did Navvis choose to partner with Thomas Jefferson University? “We are very interested in the effective management of populations. We want to help health plans and health systems transition from the classic fee-for-service, reactive, facility-based care, to a connected, proactive ongoing journey of health and healthcare for consumers, patients, and members,” explains Stuart. “And moving from asking the patient, ‘What’s the matter with you?' to 'What matters to you?'"
The work supported by their joint population health professorship will bring academic rigor to determine which population health practices and interventions are the most effective to keep people healthy and minimize the toll of chronic disease, such as diabetes, heart disease and obesity.
Even before research results are in, however, both David and Stuart have ideas about what combination of factors will likely produce a promising second-generation population health management effort.
They envision a payment structure that rewards those healthcare providers who, in addition to diagnosing and treating diseases, focus on preventing them. In addition, physicians must work in a system where they are connected to, and concerned about, their entire panel of patients every day. Many early efforts to reform the fee-for-service payment structure were just not drastic enough to change providers’ behavior, Stuart emphasizes. The payment models layered a performance bonus on top of the entrenched fee structure, so providers still earned most of their money based on the volume of services they performed, he adds. To quote Upton Sinclair, “It is difficult to get a man to understand something when his salary depends upon him not understanding it,” explains Stuart. “That’s where we are in healthcare.”
In Hawaii, Navvis is working with a leading health plan in the state on a program to change this dynamic by paying primary-care physicians a fixed dollar amount per month for each patient they serve. Physicians also earn bonus payments if they provide patients with sufficient access to high-quality healthcare services and control costs. Since many Hawaii-based physicians work in solo practices, Navvis organized them into care networks, allowing them to work together – with the appropriate personal and technology support - to reach the program’s goals.
But, payment structures are just the first step. David says social determinants of health — such as unreliable access to transportation or fresh food — create challenges in many consumers’ lives, making it difficult for them to take care of their health. “This is my 30th anniversary in practice as a primary care doctor. Now I’m learning, alongside colleagues who are interns and residents and are less than half my age, to ask patients, ‘Do you have trouble putting food on the table? How many buses did it take for you to get to our office? Is there a working refrigerator at home?’, That’s a powerful set of questions we were never taught in medical school to ask our patients,” David explains.
David says in a world of population health we will aspire to the blue ‘H’ sign for hospital meaning ‘health and healing’. Jefferson Health is taking steps in that direction. “We have to move away from the four walls. Our health system CEO, Dr. Stephen Klasko, says, ‘Jefferson will be everywhere.’ Just like your iPhone, when you need us, we’ll be there,” David says. For example, primary care practices could send text messages to encourage patients to improve their diet, establish new exercise goals, or remind them to take a medication.
“Here’s the punchline: You can’t have a healthy population, unless they’re engaged with you. We’ve never thought this way in the delivery system. We only wanted them engaged when they were sick.” David says.
Another important factor in the equation are social service resources, which can help people overcome issues related to social determinants of health. “There’s tremendous fragmentation of these services in the community. Many such service organizations don’t even know about other resources in their communities,” Stuart says. He recommends the creation of a central network resource for all social services in a community which would then be available to the medical community, so physicians could then connect those patients with the resources they need, including behavioral health, affordable housing, fresh produce, reliable transportation or other social issues. “That’s where you build an ecosystem,” Stuart emphasizes.
When health plans, physicians, hospitals, health systems and social service agencies, work with each other and with consumers, the result is a healthier population. As Stuart says, “The next generation of population health is about building systems that are connected and aligned. These aligned efforts will have an incredible, laser focus on the consumer, improving their healthcare experiences and outcomes in a way that matters to them.”
Five Key Takeaways
- Healthcare in the US is transitioning to a system that focuses on aggregate outcomes.
- Providers and health plans need to realign the economic incentives driving clinical behavior.
- Improving the health of populations is a challenge individual practitioners cannot solve alone.
- A well-structured population health ecosystem includes aligned networks, standardized processes, the right financial incentives, connected medical and social services resources to address social determinants, and physicians who are trained and educated on population health issues.
- Consumers, who want healthcare to be affordable, accessible, convenient, and connected, will help move the US healthcare system toward population health delivery.