- Population health management and accountable care organizations (ACOs) have always been close allies in the battle to reduce extraneous healthcare spending, manage chronic diseases, and improve data-driven care coordination.
ACOs have seen great success and significant cost savings by leveraging population health management techniques to provide more preventative care and proactive treatment for emerging health problems, using innovative patient engagement strategies and a foundation of clinical analytics to keep patients healthier for longer.
At Trinity Health and Heritage Provider Network, two very large and complex care delivery systems, population health management and care coordination are at the center of a new partnership that will increase the scope of full-risk, capitated arrangements, spread data analytics capabilities to providers of all sizes, and strive to achieve the principles of the Triple Aim.
Mark Wagar, President of Heritage Medical Systems, spoke to HealthITAnalytics.com about the innovative agreement between Heritage and Trinity Health and how such collaborations can help the healthcare industry move forward with quality-based reforms.
Why are Heritage and Trinity embarking on this partnership?
We don’t want to be stuck in any market for any of our patients practicing 20th century medicine. And that’s really the key here. If we keep continuing to focus on the way we’ve always done things, we won’t be able to get better value and quality for the dollars we’re already spending. We won’t be able to make things more affordable for the patients and their families. We should be getting more and better for the dollars we spend, and the cost trends should moderate.
Both Heritage and Trinity are committed to that. This joint venture is designed to help build networks and provide the infrastructure and training and focus on best practices that will allow Trinity to achieve results, ultimately, in all of their markets. We’ll identify a few to start with and work at expanding this over time.
How are Heritage and Trinity planning to develop clinical analytics to improve the population health management experience?
Obviously, it’s very important to be providing the right kind of data in a timely and accurate fashion to physicians and other providers. They don’t just need to understand the patient who comes in the door because they feel so badly today they think they need help. They need data for whole populations of people across a hospital service area and across the population that a payer may contract for.
So, on the data analytics side, we expect the use of some of Heritage’s proprietary, in-house systems for population health management and risk stratification that our physicians use so successfully with our traditional HMO practices with Medicare, and Medicaid, our commercial patients, and also for our success with ACOs. We intend to bring that piece, but I would expect also that Trinity will add to that with their own data. They have 80 or 90 hospitals across the market with vast amounts of information, and thousands of physicians beyond Heritage’s traditional base that will have clinical and administrative data as well.
So, yes, it’s a massive enterprise. But we already take care of over a million patients in Heritage with these kinds of systems, and we believe we have the capability to add those pieces to the equation and bring them to scale with Trinity.
How important is the ACO structure to providing coordinated care across an entire region?
The ACO piece is a good interim step for providers who may just be starting out with the idea of assuming risk in global payment or value-based payment systems. It gives them a chance to begin to use those methods. It also allows payers to introduce populations of people that aren’t fixed on a particular network yet.
So, our Pioneer ACO is the largest in the country, I believe. I think we’re up to about 123,000 members now. Patients can access services wherever a provider accepts Medicare, but we work directly with them to help them and we add additional services on behalf of their physician offices that are helpful to them and help them focus more on the participating physicians in our ACO network.
It allows those physicians to experience what it’s like to have different kinds of population health management and clinical analytics on hand. They can experience what it’s like to have additional services outreached to the home or other things that they might not normally have as a part of their smaller practices.
How will Secretary Burwell’s commitment to increasing accountable care impact reimbursement and population health management across the healthcare system?
I think that announcement is a positive in terms of creating a receptive audience at the regulatory level when you want to start doing these things. But you also have private payers across the country doing this. Everyone is interested in more physicians moving that way.
I also think – and you hear lots of different things about timing on this – but things like the SGR fix are an important piece to this equation, because if you change the underlying payment structures and the flaws in the SGR calculation and you start to engage physicians to participate in organized approaches to accountable care, it’ll help all boats rise. Because it takes resources. It takes money to create this change. You have to provide a different kind of value-based payment environment so that providers know that if they spend the money up front to make these changes, their practice can be sustained.
And it really isn’t just the federal government that’s moving in this direction. You have private payers who are also very interested in moving this direction. It takes work. You have different benefit plans; you have different types of group customers. You’ve got the state and federal health insurance exchanges. But there’s a way to move management of care for all patients in this direction. And we think it’ll be positive.
How can healthcare organizations learn from previous successful accountable care agreements to adopt best practices for population health management?
I think the key to the Heritage approach is a smaller physician group or practice can get the best of both worlds. You don’t have to become employed by Heritage or the Trinity joint venture in order to participate. You can continue to manage your office your way, but you can also take advantage of the clinical analytics and population health IT systems. We’ll surround you with those capabilities to engage in outreach and other alternative services that wouldn’t normally be a part of your practice.
But the key to population management is managing all of your patients, even though they’re not coming through your door. You can’t just treat them well when they decide to come in. You want to be in a position to offer the best possible diagnosis and care with someone with congestive heart failure, for example. But if you’ve got a service area where there’s a million patients that you’re responsible for through various ACOs and provider contracts and so on…if there’s a hundred thousand seniors in that population, ten thousand of them or more might have congestive heart failure at one stage or another.
And you don’t want to wait until they feel so bad that they come in to see you, because there are many things you can do to avoid the need for acute care, to delay the onset of more serious advance of their disease, or to reduce the severity of those complications when they do have an event. And all patients and families will appreciate that.
It’s a different kind of intervention that keeps people at home and healthier, and in the long run it actually costs less. You want to know those people. If you have somebody who hasn’t seen their physician in 24 months, but you can tell from their medications and their periodic visits to urgent care centers or emergency rooms that they’re having some difficulty, you don’t want to wait for them to come see you. You want to make sure you reach out to them and engage with them in their setting. And that’s the kind of thing that we expect the joint venture to do, and that’s how Heritage has, so far, seen a lot of success.