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Crossing the chasm for population health management – from pilot to enterprise scale

This article first appeared in Health Data Management

I recently came across a poll of population health stakeholders conducted by Population Health News that identified their key challenges. At the top of the list was justifying the cost, followed by other common challenges such as difficulty in coordinating efforts across participants, lack of resources and availability of staff.
Most population health programs face similar challenges when trying to scale up to an enterprise level from a pilot-sized program. As a pilot, programs are often driven by the individual initiative of a leader. At enterprise scale, successful programs need a team of people aligned to drive the systems and business processes together towards achieving a shared goal. Some examples of successful enterprise programs are the leading Pioneer ACOs, such as Montefiore Medical Center.
So how does a leader go about establishing a scalable program?

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Define the Strategy

There are many common challenges that healthcare organizations face nationally – an aging population, increased incidence of chronic conditions, and greater focus on healthcare quality and pressure on reimbursements. These national challenges are the stimulus behind population health programs and any related strategy should reflect that. In addition, strategy will need to be tailored to meet local factors such as demographics, competition in the market and current competitive positioning, local issues affecting healthcare, the state-level regulatory environment, other players in the healthcare ecosystem and the extent to which collaboration is possible.
Many payer and provider organizations find that they need a multi-program strategy to address the needs of their populations. As a result, they develop multiple targeted programs, either focused on specific population segments like the elderly, or on specific health conditions like diabetes or asthma.
Some providers, particularly those that focus on a single niche within healthcare, find that concentrating on a single program is to their advantage. Some examples of a single program approach are accountable care models for orthopedic surgeries, particularly hip and knee replacements.

Design the structure for people, processes and technology

Population health management programs are often underpinned by specific technology solutions, such as risk stratification tools without fully taking into account the people, organizational culture or the operational processes that support the business. By merely focusing on one or two aspects, these programs run the risk of not being scalable and often fail to achieve the quality, clinical, or financial goals that are sought.
An alternative approach is to consider the people, process and technology elements together as operational capabilities for the organization. By effectively designing a structure that makes the most effective use of these elements and by aligning incentives for the entire organization to the achievement of financial results, leaders can create an organization that delivers success to their population health management programs.
Implement and adapt constantly
The healthcare landscape over the next few years will continue to stay in a state of flux. As a result, even strongly established players in the population health space need to stay alert to rapidly emerging threats and adapt their business constantly.
One effective mechanism is to establish key performance indicators with a balance between historical performance and forward looking indicators. Such KPIs can quickly provide insight into potential problems that need to be addressed by adapting the organizational structure as needed.
Another effective technique is to institutionalize a culture and a program around continuous improvement. A well implemented continuous improvement program can deliver significant value over the years.
In conclusion, these are exciting times to be a part of the healthcare industry. The industry is undergoing significant transformation and the parallel advent of disruptive technology and increasing incidence of chronic conditions makes the need for effectively scaling up a multitude of population health programs a national priority. I hope the above described approach helps in that journey and I am interested in hearing your comments and feedback from the frontlines of implementing population health.


Nilesh Chandra is a healthcare expert at PA Consulting Group

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  • Nilesh Chandra

    Nilesh Chandra

    PA healthcare expert

    Nilesh is a leader in PA?s healthcare business focused on helping provider industry clients develop new business models for an industry shifting towards value-based payments.

    Insights by Nilesh Chandra

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