Population Health Outcomes: 3 Keys to Systematic Improvement

Population Health Management (PHM) is one of the more popular buzz phrases in the healthcare industry right now. Media articles, vendor websites, and analyst papers are all talking about the current or future state of healthcare, which involves a lot of PHM.

Yet as straightforward as it might seem, PHM has actually become a catchall phrase that describes many different things.

  • The ability to manage the health outcomes of a population of patients with a similar condition.
  • Going at-risk with payers for the outcomes of a population of patients (otherwise known as fee-for-value or pay-for-performance).
  • Using care management to improve outcomes for high-risk, high-cost patients.
  • Engaging patients and communities to achieve better health outcomes.

The common thread between all of these, and PHM’s many other definitions, is the focus on outcomes. These can be quality outcomes (success in treating the patient), experience outcomes (the patient’s perception of the care that was provided), cost outcomes (reduction of factors such as waste or length of stay), or in most cases a combination of all three. The Institute for Healthcare Improvement’s Triple Aim puts is another way: delivering the highest quality care with an optimal care experience for a population of patients at the lowest appropriate cost.

The key question becomes how to systematically improve outcomes for a population of patients, one patient at a time? “Systematically” being the key word. Taking an ad-hoc approach to outcome improvement may result in short-term gains. But real, sustainable change across an entire organization requires a systematic, repeatable approach.

The Three Keys to Population Health

Many people in the healthcare industry equate PHM with technology or analytics. Analytics are important for measuring for measuring organizational performance. This information alone won’t improve outcomes. An evidence-based best practices system is required to determine improvement priorities. An adoption system to enable the implementation of best practices throughout the organization is vital to improving outcomes long-term.

Best Practices System

A best practices system represents the accumulated knowledge of the healthcare organization, such as evidence-based studies, industry best practices, and the organization’s own best practices for certain populations. These knowledge assets assist the organization in determining a plan of care with the best possibility for success, based on what has proven most successful in a large number of similar situations versus the practices of individual clinicians.

Building a best practices system standardizes the care provided across all providers, in all settings for a particular condition. This process encompasses utilization (who should deliver the care), order sets (what care should be included for this patient), and workflow (how the care can be delivered efficiently). Visualizations that create action, such as scorecards and dashboards, can be very valuable in providing guidance for this process.

For example, there are different antibiotics that can be administered in conjunction with an appendectomy. Some surgeons may order one antibiotic based on their training while others may order another. Without a best practice system it could be assumed that either is fine since they are both widely used.

A healthcare system with a best practices system in place may determine that one antibiotic is clearly more effective in delivering better clinical outcomes and is less expensive. This may lead to standardizing the use of this antibiotic and eliminate the other in all order sets created for appendectomy care.

Analytics System

Analytics allow improvement teams to measure their success. Creating a baseline at the beginning of the process enables teams to determine if improvement initiatives are improving outcomes. Analytics can also be used to identify patterns and determine causation and correlation. This ensures the most effective treatment is prescribed for an individual patient based on the success of using the same care plan with a population of patients.

Integrating disparate data from clinical, financial, patient satisfaction, claims administrative, along with other transactional systems, such as EHRs requires an enterprise data warehouse (EDW).

Analyzing data from each clinical area, and creating a visualization showing their variability and resource consumption exposes areas with the greatest opportunity to impact quality and financial outcomes. Outcome improvement opportunities are prioritized based on data as opposed to who is shouting the loudest.

Population Health Outcomes

The upper right quadrant provides a starting point. Comparing this data with the preparedness for change of the teams in that quadrant, enables identification of the best opportunities for immediate success. Early wins help generate excitement for future outcome improvement initiatives. Initiatives in the remaining quadrants, while important, will have little overall effect on the organization and should be tackled later.

Adoption System

The final piece is the adoption system. The adoption system empowers front line teams to implement best practices and transform the organization. The organization’s capacity to change, its governance structure, whether an improvement methodology such as LEAN or AGILE software development is in place, and the ability to train teams  on the improvement processes will determine the success of any outcome improvement initiative.

A key to success in this phase is to establish permanent, cross-functional teams, responsible for proposing and driving outcome improvements. Leadership team commitment is integral to ensure successful implementation of improvement initiatives. Guidance teams provide input for prioritizing improvement opportunities enabling small development teams to take action.

Organizational adoption can be the most difficult part of any improvement initiative and is essential in order to drive long-term, sustainable change. Key organizational influencers, physicians, nurses, and senior leaders should be responsible for leading the rollout of improvement processes as an outward sign of the organization’s commitment. Ensuring adoption, measuring the effectiveness of the initiative, and sharing this information with the rest of the organization will create a culture of continuous improvement.

Population Health Outcome Improvement Types

Driving population health outcomes improvement begins with the establishment of the best practices, analytics, and adoption systems and an understanding that not all outcomes are created equal.

Improvement Opportunity Identification

Improvement opportunity identification is the first, and can be the easiest, to achieve. Over time the teams will gain experience identifying opportunities for improvement—recognizing savings from reducing variation between providers or stemming leakage by encouraging providers to make in-network referrals—more quickly.

Process Improvement Measures

Process improvements, such as increasing the percentage of patients scheduling follow-up appointments with their primary care physician after discharge or the percent of heart failure patients whose ejection fraction is captured in the EHR, can be more difficult to achieve.

Outcome Improvements

Outcome improvements, reducing sepsis mortality or hard cost savings, can be difficult to achieve, but also pay the biggest dividend to the organization. Successful outcome improvement is dependent on the commitment and resources upstream.

Improving Population Health Outcomes

Population Health has many different definitions, but the one common element is the focus on outcomes—quality (successfully treating the patient), experience (the patient’s satisfaction with the care that was provided), or cost (reducing errors or a decline in length of stay).

A three-system approach is necessary to ensure improvement initiative outcomes are tangible, sustainable, and transferable. A best practices system (to determine what should be done), an analytic system (to tell the organization how it’s doing versus the goal), and an adoption system (to report the results to the organization) empowers the organization to deliver the highest quality care for patients at the lowest possible cost over and over again.

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