Dr. Charlie Miraglia is the Chief Medical Officer at hc1.com.
In this 2009 Sandra Bullock film based on a true story, the Tuohy family, led by Bullock’s character Lee Anne Tuohy, take in a homeless young man, Michael Oher, who goes on to become a successful college football player, and later an NFL lineman for the Baltimore Ravens. The underlying moral of the story, however, is about identifying someone in need and reaching out to help them, quite literally changing their life in the process.
In a very significant way, isn’t that what population health management (PHM) is all about? Isn’t the goal of PHM to identify people who need help, or more specifically, medical attention or intervention, and take steps to keep them healthy or help them get well? It shouldn’t be difficult to answer this simple question with anything but the simplest answer: “Of course.” It turns out, however, that the reality of PHM is a bit more daunting than it first appears.
There are challenges associated with PHM that must be overcome to successfully accomplish the primary goals of keeping the healthy as well as possible, and preventing those who are chronically ill from getting worse. First, and perhaps most important, is the need for improved communication – provider to provider, provider to each individual patient, and provider to specific populations of patients. Second, health systems need the technological capability to identify those populations at higher risk of developing or worsening conditions. And last, providers need to create more comprehensive clinical pathways, monitor and adjust them over time, and ensure that patient outcomes continue to improve.
By refocusing efforts on the well instead of just the sick, and keeping even chronically ill people as healthy as possible, the need for the major expenses associated with healthcare such as diagnostic tests and procedures, emergency room visits, and even hospitalizations and readmissions can be reduced. The time has come for hospitals and health systems to embrace the collection and sharing of live and predictive analytics to enhance the prevention of disease and diminish the adverse consequences of chronic conditions. The data required is currently available, albeit stored in multiple information system silos throughout the healthcare landscape, but ultimately needs to get to the right person at the right place and the right time to have the greatest impact.
Obviously, in addition to the three challenges mentioned above, there are other hurdles that must be overcome to drive momentum in the right direction. Change is difficult for any organization, especially large and complex ones, so carefully constructed change management programs should be constructed to help shape the culture and values of the institution prior to embarking on the PHM journey. Also, there are many priorities on every hospital’s list, often competing for resources to be accomplished. Keeping the focus on reducing costs, while increasing quality and engaging patients, will be difficult for all but the most driven organizations to accomplish in the short term.
The entire healthcare delivery system is in a state of flux. As new models of reimbursement emerge and provider organizations evolve, PHM initiatives will continue to surface, bringing with them the growing need for data collection and analysis in real-time. Much as the e-commerce industry, led by companies like Amazon.com, has changed the way that people shop, so must healthcare continue to adapt to the needs of its customer base. Consumerism in healthcare is here to stay and will only increase the pressure on health systems to deliver higher quality and greater value through patient engagement and ultimately PHM.
The advancement of technology shows no signs of slowing down. Embracing it will be critical to facilitate the changes needed to pursue PHM in ways that will no doubt change the lives of millions for the better. It may be time to challenge the old idiom telling you to “Get your head out of the clouds.” For healthcare, at this particular point in history, getting their heads into the “clouds” may just keep them in the game. If they are slow to change, or resist change all together, they might just find themselves technologically “blindsided!"
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