On February 2, 2016, Dr. Andrew Albert, Chief Medical Officer at Fibroblast, Inc., led a webinar to discuss how quality measures can help health systems to improve upon their population health goals for today’s newly-chartered world of shifting payment and care delivery models. The webinar hosted approximately 100 listeners and featured speakers Dr. Nikhil Parikh, an Academic Internist, Mr. Robert Sehring, Central Region CEO of OSF Healthcare, and Dr. William Markey, a solo practitioner in the field of Gastroenterology and Internal Medicine. Providing a holistic discussion of population health, the webinar began with a patient interview and ended with perspectives on the future effects of population health on the healthcare industry at large. What follows are the key take-aways.

The status quo for patient care does not adequately promote effective population health management.

As speaker Dr. Nikhil Parikh noted, the job of a primary care physician (PCP) is extremely challenging. With patient routine appointments increasingly being pushed into 15-minute time blocks, PCPs do not have adequate time to ask every question or suggest every appropriate screening for a particular patient. Compounding the issue, many new patients for a given PCP are missing vital health information in their medical records which would have alerted the PCP to perform certain preventative care measures. These systemic frustrations engender a ripple effect from the PCP, to the patient, and onward to specialists and health system leadership. Take the example of the patient interviewed, Margaret, who was diagnosed with colon cancer at approximately 70 years old. Margaret never visited a GI doctor or underwent a colonoscopy until she presented to her PCP with some alarming symptoms. A colon cancer diagnosis is especially devastating since for many patients, it’s a detectable and preventable disease. What is needed are tools to ensure that patients are receiving their early detection screenings: preventative colonoscopy exams are suggested for patients beginning at the age of 45, a full 25 years sooner. The status quo of ignoring preventative care recommendations and presenting to PCPs only once symptoms arise allows patients to slip through the cracks. (For a more in-depth discussion about patients who have fallen through the cracks in the healthcare system, check out our recent blog post Missed Connections.)

It isn’t just patients who experience the status quo strain. Speaker Dr. William Markey described how specialists are inundated with late-term diagnoses for what could have been preventable cases. From his perspective, population health goals are not forced onto specialists per se; however, discussions around new and improved quality goals are now becoming more routine. As such, specialists and PCPs alike are playing increasingly involved roles in population health management, sometimes without even realizing their uniting objective. For Dr. Markey, patient education is at the root of population health. In his opinion, patients should be exposed to more teaching opportunities surrounding the topic of proper health care and disease prevention. Furthermore, he maintains that such teaching opportunities should occur along patients’ entire care continuums, regardless of the difficulty of finding proper tools to facilitate this knowledge transfer. The third undulation occurs at the administrative level. There is no doubt that setting quality goals to propel successful population health management can be daunting. Moreover, the impact of administrative decisions to align with Medicaid and other government program goals must be careful monitored given its flow down to care management practices.

The transition to new care delivery and payment models, coupled with focused measurement of quality goals, is necessary for the future sustainability of healthcare.

Whether taken from the perspective of the patient, PCP, specialist, or administrator, the healthcare market is changing drastically in the areas of delivery, payment, data privacy and security, technology, and beyond. In taking listeners quickly through highlights of the most important recent changes in the healthcare market, Dr. Albert elucidated that each stakeholder in the healthcare industry can feel the ‘ground shaking’ underneath her. One of the most poignant points was the vast difference in various stakeholder agendas. Commercial payors are drastically compressing provider reimbursement rates and upping the requirements and criteria for reimbursements. Government payors are calling for a complete overhaul of care delivery and payment models. Providers require better tools to manage to their business goals while simultaneously maintaining their provision of excellent clinical care; health system administrators are fighting to maintain sufficient margins to keep their doors open. Furthermore, the requirements associated with the ICD-10 transition and the burgeoning EHR interoperability challenges only stress health systems further. Yet progress is being made on the quest to achieve higher-quality, lower-cost patient care.

Quality measures will focus and drive efforts to achieve population health goals moving forward.

When asked, “Is there anyone who will not be affected [by population health goals]?” Mr. Sehring firmly answered, “No, not if we are going to be successful.” As healthcare delivery transitions from today’s emphasis on ‘sick care’ to high-quality preventative care, one hopes that scenarios like Margaret’s will disappear. Increased focus on population health management and quality metrics will benefit all healthcare industry stakeholders. According to Mr. Robert Sehring, a fee-for-service (FFS) payment system is an example of a “misaligned incentive.” From the payors’ perspective, FFS results in higher costs and not necessarily better patient health outcomes. To facilitate the transition to value-based care delivery and associated payment models and attainment of specific population health goals, Mr. Sehring suggests a team-based approach that includes other ancillary services such as health coaches. The linchpin of effective population health management is the delivery of quality care and the attainment of quality measures. Attainment of quality measure goals serves a dual purpose: support for reimbursements and cost management. Plainly speaking, care of specific patient populations cannot be effective without an astute focus on quality.

Fibroblast, Inc. would like to thank Dr. Nikhil Parikh, Dr. William Markey, and Mr. Robert Sehring for their participation as speakers. Fibroblast would also like to extend its gratitude and best wishes to Margaret and her family.