Governance Advice for Hospital Boards: Population Health

"For 60 or 90 days of post-discharge care?"

Writing in the April 26 issue of JAMA, Michael Jillinek of Lahey Health has some important advice for healthcare organization boards of directors.

As income shifts from fee-for-service to global payments, the insurance risk transfers that underlie much of "population health" are an important threat to these enterprises' viability.

After a compact and well-written summary of the growth of population health, he offers six suggestions for these boards:

1. Plan on having "forthright discussions" about the difficult tradeoffs between still-remunerative fee-for-service activities (such as high-dollar imaging, lucrative surgical services) and having to invest in the Triple Aim (care coordination personnel, improving quality measures for persons with chronic illness).

The Population Health Blog suspects most boards will ask why they can't have both the FFS cake and the global payment icing. If that's the case, these boards need to plan on having forthright and very lengthy discussions. It's organizationally difficult to have one mission on the 4th floor of the hospital and another in the emergency room.

2. If the organization's employees are enrolled in a "self-insured" health plan, bring them into a population health program sooner rather than later.

Not only is this an important opportunity for a board to understand the revenue versus savings versus expenses involved in driving the clinical and care experience outcomes of population health, its only right to take this for a personal test drive before subjecting your patients to it.

3. Look for common ground between old fee for service and new global payment arrangements.  The author suggests reducing readmissions is a good start.

The PHB suggests boards ask their management teams to also pursue the care coordination "chronic care management" payments offered by CMS.

4. Start demanding population health metrics from your management team, "such as details of total medical expenditures."

More details on the work of measurement can be found here.  The PHB has also humbly suggests here that health organizations should be prepared to invest significant resources - and discipline - into the process.

5. Invest in primary care, care coordination teamwork and pursue "population health pilot programs."

Since the PHB believes well-intentioned CMS' programs are star-crossed (see here and here), it suggests working with local commercial insurers for starters.  As it reviews resources like this, they seem to have a better track record. 

6.  Ask your management team to be open population health contracting.

Hear hear, says the PHB.  But it also cautions that the board needs to have individuals with the kind of industry knowledge necessary to provide oversight of these contracts.  

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The PHA Forum 2015. the Premier Population Health Meeting

If you have any interest in medical costs, outcomes and consumerism, you really should think about attending the Population Health Alliance Forum November 2-4 in Washington DC.

Why?

The PHA is an advocacy and education association dedicated to advancing population health as a component of health reform.  The Population Health Blog likes the PHA because its membership is made up of a wide range of experts who have worked to translate the theoretical and fiduciary interests of insurers, payers, government and other stakeholders into real-world and sustainable programs. 

After rubbing elbows with these guys in meetings, hallways and over beverages, the PHB always walks away a little bit smarter.  If you go, you will too.

Highlights:

Great keynotes that connect policy, theory and reality;

A debate between wellness skeptic Al Lewis and widely published Ron Goetzel.

Instructive case studies that you won't hear about anywhere else;

Insights about monitoring and communication technologies;

Continuing education credits;

You'll get to meet PHA CEO Fred Goldstein and the other outstanding PHA team members;

The PHB will be there!

Registration information here.

You Have A Great Population Health Program. Time to Tell the World About it. Here's How.

The Population Health Blog feels your pain.

You're the co-leader of a population health initiative.  It may involve an mHealth app, a new decision support tool, a novel care management nurse training program, a community-based intervention, a new type of telephonic outreach, a web-based messaging system, a new way of engaging high risk patients, relying on lay-persons for patient education, a different approach to predictive modeling, a better way to support the patient centered medical home or a report on the benefits of "big data."

You have outcomes.  They may be decreased costs, increased quality, higher levels of consumer satisfaction, lower absenteeism, better presenteeism, medication compliance, enhanced experience of care, lower utilization, better accuracy or something else.

You want to tell the world about it.  That's because it will help like-minded colleagues take better care of patients, convince policymakers that population health is beneficial, differentiate your company against the competition, generate some contructive feedback or get you an excuse to travel to a warmer climate.

And now you can. If any of the above applies to you, or even if it doesn't, you may want to check out The Population Health Alliance Forum.  In addition to its usual tradeshow networking, learning, dinners and fun, the PHA Forum is the place were programs get to strut their stuff.  As an added bonus, it's possible that you'll get to meet the PHB!

The Forum meets Dec. 10-12 in warm sunny Scottsdale AZ.
      
The link that leads that gives you the information you need is here. 

You have until April 8.

Ten Things to Know About the mHealth App Ecosystem.

A mHealth app walled garden:
enter at your own risk?

If, like the Population Health Blog, you're interested in the hand-held mHealth app ecosystem, you may want to check out this just published JAMA review article "In Search of a Few Good Apps." 

Naturally, for time-pressed readers who'd rather not read it all, your PHB is happy to provide this ten point summary.

1) There are more than 40,000 of mHealth apps and the industry is still in its infancy.

2) Despite their faddish sexiness, there is very little hard evidence that many of the commercially available apps to lead to measurable improvements in clinical or economic outcomes. However, some of the underlying technology (such as pedometers) does provide a benefit.

3) The Food and Drug Administration (FDA) will assert its regulatory authority if the app "acts" like a "medical device" or as an accessory to a "medical device." Logging data, retrieving content or communicating won't be regulated, but medication dosing guides or the provision of diagnostic information will be.

4) 3) Little is known about the physician prescribing patterns for apps.  We also haven't figured out if or how a patient's access to an app should depend on a licensed professional's approval/prescription.

5) There is a possibility that many currently available apps are putting users' privacy at risk.

6) Little is known about apps' compatibility with electronic health records (EHRs).  This may be less of an "ecosystem" and more a bunch of isolated "walled gardens."

7) One vulnerability to any app's usefulness is data overload. Hundreds of food entries, for example, may do little to increase user insight about his or her diet.

8) Other than the FDA and its fussing over apps' medical "deviceness", there is no agency or entity that provides certification for apps. Consumers are on their own, based largely on on-line reviews and word of mouth.  One organization tried to do it and conspicuously failed.

9) The time is right to create "guidelines" for app developers, such as how to provide useful data summaries as well as visual displays, maximize patient safety, ensure information accuracy and protect consumer privacy.

10) The time is also right for funding agencies to support research on apps, especially for persons with chronic illness.

Naturally, the PHB offers commentary:

It remains to be seen if the FDA can keep up, especially with apps that are in the "grey zone" between offering advice/possibilities vs. diagnosis/treatment. That shortcoming is vulnerable to overlawyering and regulatory overreach. That means prolonged time to market, increased uncertainty, hampered innovation and the threat of retroactive and potentially capricious reviews.

As you are reading this, many apps are undoubtedly being developed by the population health service providers.  It may be time for entities like the Population Health Alliance or stakeholder organized medicine organizations to take the lead in establishing app benchmarks, best practices and guidelines.  If they don't lead on this, someone will do it to them. 

While vendors that offer apps along with their coaching may be inclined to regard them as proprietary and shield them from the scrutiny of peer review research, apps that are proven to improve outcomes will ultimately rise to the top.  It's not just the funding agencies but the companies that offer these apps that have a stake in "proving it," while also advancing medical knowledge for the betterment of all of us.

Finally, wouldn't it be neat if there was a generic mHealth app that could be used by medical homes to facilitate nurse-patient coaching, link the patient to the EHR and enhance communication with providers?  If there is one that the PHB isn't aware of, it wants to know about it.

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