Population health has gone from concept to buzzword over the past five years, and now it is maturing into a must have technology. There are as many implementation strategies as there are definitions which is why we sat down with Martha Thorne, Allscripts Senior Vice President and General Manager, Population Health for a discussion about population health.
Q: How do you define population health?
Thorne: Population health is about improving outcomes for a group of patients. It requires healthcare organizations to successfully manage three steps: identify patients, intervene appropriately, and measure effectiveness. The first step is finding groups of patients at all levels, from high-risk patients with complex conditions, to rising-risk patients, to those who are currently healthy. Next, providers can intervene with appropriate care and preventative measures for each cohort. The last step is measuring effectiveness of those efforts through cost and quality data, and adjusting program efforts as needed.
Q: What role does population health currently play in healthcare?
Thorne: Population health is currently driving down healthcare costs while improving quality and outcomes. Organizations define success in a variety of ways, depending on what each cohort needs. For example, for patients who receive total joint replacements, quality of life may mean returning to some level of activity they enjoyed before surgery. Measuring quality of life is different for hospice care, where outcomes are focused on compassionate end-of-life care. A wide range of measurements will ultimately play a role in reducing costs and improving quality and access to care across each population.
Q: What obstacles are standing in the way of effective use of population health?
Thorne: The biggest obstacle is to change the way we think about healthcare. Historically, healthcare has treated patients in an episodic way. Providers and systems are now recognizing the need to think more broadly about care, and not wait until patients have an acute need. For example, how do we help patients with chronic diseases better manage their conditions? How do we prevent at-risk patients from getting sick? How do we encourage healthier behaviors for all of our patients? These are all questions that providers are asking to effectively manage population health.
Q: What are some best practices for overcoming those obstacles?
Thorne: To really effect change, healthcare providers must design the health system around patients. They’ll need the right infrastructure in place to manage interventions for high-risk, rising-risk and healthy patients. Ironically, caring for entire populations requires providers to think more about individualized care. Adding staff to accomplish these goals would be too costly. This is where health IT can help. Technology can help caregivers identify patients, find the best interventions, and measure outcomes. Interoperability enables providers to connect beyond the four walls of their organization, which is imperative for thinking bigger. The right technology infrastructure can enable organizations to gain scale and think about their patients beyond traditional, episodic ways.
Q: How can properly administered population health improve outcomes and create healthier communities?
Thorne: With the right infrastructure, many of our clients have been able to focus efforts around specific cohorts and deliver improvements in overall scores. For example, Rochester Regional Health (Rochester, NY) implemented an interoperability platform to improve care for its patients and integrate with the Rochester Regional Health Information Organization. This infrastructure helped enable a state-funded population health program, the Community Diabetes Collaborative (CDC). Using capabilities from the population health platform Allscripts CareInMotion™, these targeted efforts helped more diabetic patients gain control of their disease, and do so much faster than national averages. This example shows how the right technology infrastructure can help an organization manage population health and help patients achieve positive clinical results.
Q: How are organizations applying population health today compared with five years ago?
Thorne: Five years ago, organizations were just beginning to think about population health. Financial incentives were primarily based on episodes of care, not risk-based contracts and bundled-payment models. As the industry shifts away from fee-for-service to value-based-care payment models — which will keep gaining momentum over the next two years — organizations are taking population health more seriously. They’re redesigning their entire infrastructure to increase the number of touchpoints with patients. Population health is maturing. Today, organizations understand that they need to reach their patients before they have an acute health crisis. They are making the wholesale changes they need to deliver more holistic care.
Q: How do you envision population health changing in the next 10 years?
Thorne: Over the next decade, we’re going to see organizations focus on improving health by reaching the patient sooner. We’ll see more efforts around health behavior in schools, and more efforts to help consumers make better healthcare choices. The patient, or consumer, is going to play a much more important role. Patient engagement won’t just be about using a portal, but it will be about offering true visibility into healthcare choices. Growth in health spending accounts will drive more consumer decisions, requiring providers to carefully balance financial and quality considerations. The whole economic picture is changing, and organizations must be able to justify their cost of care.
Q: Who is leading the charge to better population health management: patients, providers, the government?
Thorne: All of those stakeholders have a role, but when you look at the economics, it’s clear the consumer will lead the way to better population health management. Visibility about healthcare costs and outcomes will increase, enabling patients to make better-informed decisions. Providers need to be prepared for that transparency and the wholesale shift that’s underway in healthcare. Health IT companies have a pivotal role in the future of population health, too. It will be our job to provide the right technology solutions to enable this healthcare transformation. Truly open platforms must set new standards for interoperability, connecting providers and consumers in revolutionary new ways across all care settings.
About Martha Thorne
Martha Thorne, senior vice president, oversees the Population Health business unit, which provides a comprehensive portfolio of solutions to help clients coordinate care, engage patients, manage chronic diseases, and achieve operational excellence. Her vision for Allscripts CareInMotion™,the end-to-end suite of care coordination solutions, aligns with the healthcare industry’s evolution from fee-for-service to fee-for-value. Previously, Martha led the Performance & Care Logistics business unit of Allscripts, which included a suite of solutions for care coordination and management as well as post-acute care. Prior to this assignment, Martha served as Vice President for Solution Sales & Strategic Initiatives. In this role she directed strategic planning and go-to-market strategies for the Allscripts solution set and strategic partner solutions company-wide, across all venues of care.
