Population health management: the barriers, benefits and bridges
Taking a new look at health eco-systems
One of the topics at the 2016 HIMSS congress this month will be how the healthcare industry must transform itself in the face of major societal challenges. A glance at global disease statistics indicates to even the untrained eye that we are swiftly approaching an acute situation. Around the globe, we see aging and growing populations, combined with a fast-growing burden of chronic disease. Unfortunately, both my father and daughter are included in the statistics on people living with chronic conditions. Having hypertension, I also belong to the group of people at-risk. And we are a normal family.
Many healthcare providers in the US have embarked on population health programs to improve the health of people at-risk by moving care closer to patients and by transforming from a reactive to a proactive model focused on health and prevention, rather than just illness. It uses an approach that aims to empower people to manage their own health, to reduce hospital admissions and length-of-stay and to avoid re-admissions through ambulatory care programs. New programs also facilitate “aging in place,” allowing elderly people to live at home rather than in expensive Skilled Nursing Facilities.
One of the greatest barriers to successful population health management is the change management required to implement new ways of working. For instance, it will be necessary to work in multi-disciplinary teams, providing care remotely and deploying well-defined pathways across care settings. Adaptive change is always difficult because it requires shifting processes, roles and responsibilities, giving up previous incentives and starting out on a new learning curve. For good reason, the healthcare sector tends to rely on tried and tested, evidence-based practices in order to safeguard patient safety and quality of care. No matter how valuable they have been in the past, these practices must evolve in embracing the digital era if we are to make substantial progress.
As with any new initiative, we can only succeed here in making changes if there is a fundamental realignment in the organization’s thinking and capabilities. It requires that the appropriate guidance and expertise is brought on board and clear strategies are developed to maintain short-term results, while new models are also established for the long run.
The second barrier is the required changes in the reimbursement model. Current healthcare models date back to the fifties and sixties and are based on the principle of Fee-For-Service. They are primarily aimed at dealing with sickness, as opposed to promoting health. Under this model there is little incentive to implement preventative care strategies or prevent hospitalization, and there is less attention placed on engaging with patients and encouraging them to take charge of their own health.
The third barrier is to the transition to proactive, human-centric care. Engaging patients and their caregivers is vital for population health management (PHM) to be successful. Patients are the single most important factor in influencing their own health through their behaviors, followed by their immediate caregivers and then the health system providers. Effective PHM requires strategies to reach the individual consumer or patient at all stages of life – early childhood, adolescence, adulthood and old age – rather than simply when they become sick.
Once we have managed to effectively engage and empower people to take charge of their health (a trend that is already starting to make itself known, particularly within younger generations), we can help change behaviors for the better. Technology will undoubtedly have an immense role here, as organizations begin to adopt a combination of telehealth, connected devices, wearables and predictive data analytics. They will find the right balance between high tech and high touch.
One area where information technologies are already making a difference is the ICU. As health organizations seek to improve patient outcomes while lowering costs, healthcare leaders often look first at the ICU since it can account for 50% of mortality and a third of hospital costs. A connected ICU is one example of a program that connects doctors to a telehealth team of remote specialists, able to continuously monitor patients and proactively identify deterioration, intervening before they become significant problems. I am excited to say that last week we announced that another four leading US health systems signed on to improve care with our enterprise eICU programs.
Though millennials will likely quite easily adopt wearable monitoring tools and embrace patient engagement tools, one of the biggest challenges – and opportunities – is elderly patients with multiple chronic conditions. The “super-users” of healthcare are not only the most challenging population to manage, they are one of the most fragile – and by far the most costly. While they make up only 5% of patients, they account for up to 50% of all annual healthcare expenditure. It is here where even the smallest of behavioral changes for the better could help the organization see a dramatic cost-saving.
One can easily envision the virtual care center to monitor not only beds in remote ICUs or general wards, but also patients at home. We are currently looking into expanding access to care and connected health resources, bringing together seniors, caregivers and health systems onto a digital hub able to offer personalized offerings by accessing various data sources.
Ironically, it is this data that is both the final barrier and opportunity on the road to successful population health management. Today, more health data is available than ever before, yet health delivery organizations struggle to capture it, normalize it and turn it into reliable, actionable information. Data itself is meaningless without clinical insight, and quantifying patients isn't the same as helping them.
For population health management to be successful, organizations must be able to collect, combine, analyze and share data pertinent to all factors that influence a person’s health and from a growing number of connected applications and devices. Predictive analytics engines are one option that would enable health systems to better monitor and care for patients by combining actionable insights with wearable devices and monitoring.
The good news is that none of these barriers is insurmountable, but we do need to gradually remove them if we’re to make headway. The reality is that it will be a combination of impactful programs, enabling technology and data analytics and, most importantly, a human-centric approach that will hold the key to progress. Given the size and scope of the change no single party, brand, organization or otherwise will be able to complete the transition alone. It requires a new look at health ecosystems.
Ultimately, we must all take an honest look at ourselves and identify the concerns that are holding us back. In the long run I am convinced we’ll go farther if we face our fears and work collectively – HCPs, consumers, governments and business leaders – to be a part of the solution.
CEO, Connected Care and Health Informatics, Philips
Jeroen Tas, CEO of Connected Care & Health Informatics at Royal Philips, has more than 30 years of global experience as an entrepreneur and executive in the healthcare, information technology and financial services industries. He oversees Philips patient monitoring, personal and population health, clinical informatics and emerging business areas. At Philips, Jeroen advances the development of digital health solutions that provide connected patient-centric care and support providers, hospitals and our global health systems to achieve better outcomes from healthy living to home care. Jeroen’s stance is echoed in Philips’ commitment to improve access, lower cost and enhance quality across the health continuum.
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