Dawn Edwards is the Consultant of Clinical Care and Quality for Healthcare Business Insights, Part of Clarivate. Dawn has expertise in population health management, value-based contracting, clinical integration, and payer-provider networks.
In the following Q&A, Edwards shares some key insights about value-based care and clinical integration by addressing common questions from HBI members.
What advice can you share for an organization looking to focus on population health?
Edwards: First and foremost, it is important for an organization to define “population health” in terms of what it means for the hospital and the population that it serves. As the healthcare landscape has continued to evolve and this topic has remained prominent, it has been coupled with an underlying element of vagueness. The areas of priority in a population health strategy will vary based on many factors—such as the system’s infrastructure, leadership’s priorities, and payer mix, as well as the organization’s patient population, acuity, and demographics. There is not a one-size-fits-all approach, which allows leadership to create a strategy that will best serve its patients and utilize its resources.
I would consider reaching out to any partner hospitals or personal contacts to learn about their approach, recommendations, and lessons learned surrounding this space. We’re all in this rapidly changing environment together, and I’ve found that most hospitals are willing to collaborate or share their experiences. This allows everyone to more intently and efficiently focus their resources, and it prevents reinventing the wheel wherever possible.
Finally, I would aim to identify two or three areas of initial priority. It is certainly important to define a vision for the comprehensive population health strategy, and I have seen the most success where organizations focus on only a few implementations at a time. This creates a focused, streamlined approach to those initiatives and allows for the results to be more accurately measured through the data.
Who should be involved in initial conversations about creating a population health strategy, a clinically integrated network, or an ACO?
Edwards: The most important aspect to me is to identify and involve your key players early, and to strive for a diverse and well-rounded group of representatives. While there is sometimes a tendency to create a taskforce that is administrator-heavy, you will not only be omitting important voices and perspectives, but you will also have a more difficult time getting buy-in on your initiatives further down the road.
Whether creating a new value-based care strategy or implementing a new model of clinical integration, I suggest identifying representatives across the continuum of care to be included as frequently and as early as possible. This could include the inpatient, ambulatory, and primary care perspectives, as well as insights from community programs, social work, or patient feedback groups, if possible.
One popular approach is a physician-led, administrator-supported structure when designing and implementing clinical initiatives. Physicians help effectively identify your organization’s greatest needs, prioritize your areas of focus, detect potential barriers early on, and encourage buy-in from other clinical team members. If time does not permit for a physician-led initiative, I would encourage identifying a physician partner and champion for the project.
What is a common challenge organizations are likely to encounter when working on population health or value-based care?
Edwards: One challenge that organizations face is the multiple components of data sharing. What platform and process will you use to share data across your organization? To what level can you analyze and share claims or patient data? How much anonymity is needed when showing performance data across numerous participants or physicians? These decisions will certainly vary on a case-by-case basis, and it is also important to note that your structure may evolve over time as well.
In terms of using data to track and measure the success of a population health initiative, most effective models identify at least three or four KPIs that are either readily available or easily accessible. This will create the baseline prior to implementation and will remain a constant throughout the project. These can also be used to pull historical data wherever possible, especially when looking at utilization or demographics.
If you have access to claims data or aim to share data across various organizations, such as in a clinically integrated model, I highly suggest looping in your legal partners early. They will help navigate the conversation and set realistic expectations for your stakeholders. This collaboration will also save your team a lot of time by identifying data sharing parameters early.
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