Population health management is very much in vogue. The collaborative strategy between payers and providers to enhance care delivery and control cost is not a new concept, but has earned a lot of industry attention and media coverage following the implementation of the Affordable Care Act.
Many examples exist of successful pilot programs that have effectively reduced costs and improved patient care for specific conditions, such as joint and knee replacements, diabetes, and asthma, just to name a few. These successes offer tremendous potential to improve the healthcare system at a national level, leveraging previous experience and taking advantage of data gathered by pioneers and innovators.
However, it’s not unusual for organizations to stumble when they try to replicate the success of small pilot programs at an enterprise level. More is involved than trying to mimic approaches, information systems, and forms and structures.
Replicating success is a tricky task because of a variety of factors, including geography, socio-economic conditions, incentives for clinicians, the relationships between payers and providers and organizational culture. For example, a major national provider tried to duplicate a successful capitated model for a joint replacement surgery program, but it failed to achieve most of its key objectives. A postmortem analysis of the results revealed that poor alignment of financial metrics led to the program failing in one region, despite the fact that it was successful in another.
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So how can executives achieve the tricky task of replicating successful programs across their enterprise? Drawing on our experience, we recommend a three-pronged approach that focuses on aligning incentives, considering local conditions and providing the correct support structure.
There is no denying incentives drive behavior, and some of the best techniques include individual actions and targets for all those involved. This will ensure the entire organization is aligned and agrees on goals to be achieved.
Incentives can be targeted to encourage a series of key actions that are vital to the program’s success or may be used to encourage the development of vital skills or accept increased responsibility, including promotion or career advancement.
An example of an organization that has successfully achieved this outcome is Montefiore Medical Center in New York, which was the top financial performer in the first year of the Pioneer (Accountable Care Organization) ACO program, according to CMS. Montefiore has achieved its success in part by ensuring that the incentives for everyone in the organization are aligned to the success of its ACO program.
Consider local issues
Every region is different, with a range of socio-economic and geographical factors affecting health outcomes. These factors need to be taken into consideration – what works well in an affluent New York neighborhood for instance may not be successful in a rural community in the Midwest.
A great example of a program that focuses on local factors is HICCup –a not-for-profit organization that aims to demonstrate how collective investment and action can return healthy dividends for communities – and their investors.
HICCup is sponsoring “The Way to Wellville,” which aims to bring better food, quality childhood education and a host of other positive health initiatives into five American communities in five years. By focusing on local issues and taking a community approach, HICCup is creating programs that are relevant and applicable to the local environment, while ensuring alignment to the broader national goal of improving health indicators.
Provide the right supporting structure
Most healthcare providers are in the midst of their journey to transition from fee-for-service to value-based care delivery models. As a result, innovative value-based programs often go against the status quo, which was designed for a fee-for-service era. Measuring innovative programs by the same yardstick used for traditional programs, places them at a disadvantage.
And yet, we often see healthcare organizations do exactly that by setting ROI targets or requirements for achieving budgetary self-sufficiency in a short period of time. Every program – especially one that is challenging the status quo within an organization – needs to be given the necessary support to allow it to grow and breathe. Strong sponsorship from senior leadership will send a clear message that the program is critical to future success and will help drive support across the enterprise.
IT is an area where the right supporting structure can be a key differentiator. The IT support needed to enable programs to scale up rapidly, and this requires agile approaches and close interaction with customers. And yet, corporate IT groups often tend to take a “one size fits all” approach in providing support, which may hinder an innovative program’s ability to adjust quickly in the market. IT executives need to recognize this and tailor the support their departments provide.
Another technique executives can use is to physically move the program’s base to a separate location, away from the rest of the corporation, thus releasing them from organizational friction. Sufficient investment also needs to be given, whether by providing clinicians with the necessary technology, administrative support or marketing. Without this, success is unlikely.
Healthcare organizations need to reassess how they are implementing their population health management programs if they want these programs to grow beyond pilot stage. Replicating the tremendous success of pilot programs across the healthcare system offers significant opportunities for improving outcomes and reducing the cost of healthcare. It is only by taking action along the approaches detailed above that organizations will start realizing these opportunities and become successful in their population health management initiatives.
Nilesh Chandra is a healthcare expert at PA Consulting Group