- The Centers for Medicare and Medicaid Services is committed to population health management for its beneficiaries as well as the public at large, CMS authors state in a perspective piece published this month in the New England Journal of Medicine. Through grants, innovation models, a greater investment in data analytics infrastructure, and collaborations with partner organizations, CMS hopes to leverage its Quality Strategy to bring more accountable care to patients in their communities and foster better health for all.
“For medical practices, which are structured around individual, face-to-face encounters, pursuing a population-based approach means considering what happens between visits; using patient registries and other tools to improve the use of preventive care services; addressing health disparities by considering social, economic, and cultural factors; and referring patients to a wider range of community services,” write William J. Kassler, MD, MPH, Naomi Tomoyasu, PhD, and Patrick H. Conway, MD.
While the agency is, by necessity, primary focused on its own patient pool, the positive impacts of population health management for Medicare and Medicaid beneficiaries extend to the privately insured as physicians retool their workflows, reorganize into patient-centered care teams, and leverage health IT to improve quality. CMS is encouraging these changes through its Innovation Center, which provides grant funding to test new strategies for care coordination, value-based reimbursements, and the expansion of preventive care.
While the State Innovation Model (SIM) schema has been effective in bringing population health management techniques to patients on a regional level, including the development of patient education about chronic disease management and healthy lifestyle choices, community health assessments, and the furthering of risk sharing to encourage outcomes-based medicine, there are limits to what CMS can do on its own.
“CMS faces several challenges in catalyzing improvement in total population health,” the authors state. “Though the agency has authority to test new approaches, evaluation of their effectiveness is ongoing, and questions remain about how best to scale up successful models. Because of the longer time horizon needed for population-based interventions than for clinical interventions, current actuarial methods used to evaluate return on investment may underestimate potential savings.”
“CMS will not be able to cover the full range of needed population health services, particularly those that are more removed from the clinical care of beneficiaries,” they continue. “The agency can address this limitation by aligning our incentives with those of private-sector payers, supporting infrastructure building, and collaborating with public health and social programs.”
Understanding and accounting for patient lifestyle choices that primarily occur outside of the healthcare provider’s scope of influence is one of the most challenging aspects of population health management, the article continues. Healthcare organizations must develop shared and standardized best practices that not only reach across the care continuum, but also impact community resources and services that support patients throughout their lives.
“Although many investments that will be required to ameliorate social determinants of poor health must come from outside the delivery system, we see CMS as playing a catalytic role,” the article concludes. “By embedding population-based strategies in our programs and policies, CMS can help drive transformation that aligns health care systems with public health and social service systems and thereby accelerate progress toward improved health for our whole country.”