Not surprisingly, the Centers for Medicare & Medicaid Services (CMS) has become the lead agency for Obamacare, and, somewhat ironically, has spared no expense in the pursuit of saving money on health care. For example, CMS set aside more than $20 billion to encourage the development, deployment, and so-called "meaningful use" of electronic health records (EHR). While the overall blessings of EHRs have so far been mixed, it is expected that they will perform admirably, indeed, they will be essential in the continuing rollout of Accountable Care Organizations (ACO) and Population Health Management.
Here's some background: Per Section 3021 of the Affordable Care Act, the CMS Innovation Center was established, to "[T]est innovative payment and service delivery models to reduce program expenditures...while preserving or enhancing the quality of care furnished..."
Related to this are Shared Savings Programs (Section 3022), that promote accountability for a patient population, and encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery. As such, an ACO can be defined as a set of health care providers--including primary care physicians, specialists, and hospitals--that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients.
Note that key term "population of patients." In an article entitled "What Is Population Health?," which appeared in the March, 2003 issue of the American Journal of Public Health, authors David Kindig and Greg Stoddart proposed a definition that is widely accepted: "The health outcomes of a group of individuals, including the distribution of such outcomes within the group."
They further point out that the field of population health includes health outcomes and patterns of health determinants, along with policies and interventions that link those outcomes and determinants. In most cases, the populations will be geographic, but could also comprise other groupings such as employees, ethnicities, those with disabilities, or those incarcerated.
Of necessity, population health management involves a prodigious amount of data processing, as well as capabilities beyond an EHR package. Data must be aggregated from disparate sources, in order to be analyzed and used to effectively manage risk, provide appropriate levels of care, and reduce administrative costs. (Remember the ACO.)
I was recently introduced to Caradigm, a population health company based in Bellevue, WA. A joint venture of Microsoft and GE Healthcare, Caradigm is ideally positioned to meet the aims of the Institute of Healthcare Improvement's Triple Aim Initiative: Improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care.
According to Michael Simpson, Caradigm's President & CEO: "Hospital systems will have to now regenerate and rebuild many of the systems that payers have traditionally used to manage risk. Historically, hospitals have been focused upon EMRs and the digitization of what's happening in the hospital realm. Fortunately or unfortunately, depending on your vantage point, that's only about one to ten percent of care that's delivered."
Brian Drozdowicz, VP Population Health & Analytics adds: "In order to serve a population appropriately, you need to be able to pull in data from every point in the community."
Caradigm notes that its customers represent a wide range of organizations including large integrated delivery networks, academic medical centers, government facilities, and community hospitals. Caradigm solutions are in operation in over 1400 hospitals worldwide.
To the extent that ACOs prosper, the theme of health care rather than disease care will be proven out. ACOs incentivize the notion of keeping people healthy, rather than simply running up fees, and population health management is a big part of getting this right.
Michael D. Shaw
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