Currently Viewing:
National Association of Managed Care Physicians Fall Forum 2019

Leveraging an Integrated Population Health Model to Improve Costs, Quality, and Satisfaction

Jaime Rosenberg
During a session on population health management at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada, Cary Shames, DO, CHCQM, ABQAURP, vice president and chief medical officer, Sharp Health Plan, discussed using an integrated population health model to drive better quality and satisfaction of care while lowering costs.
“Looking at cost versus quality as it relates to life expectancy, we are number 1 in one thing, and that is cost,” said Cary Shames, DO, CHCQM, ABQAURP vice president and chief medical officer, Sharp Health Plan, during a session on population health management at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.

Shames began by outlining the well-known problem that the US healthcare system faces: Healthcare in the United States comes with a higher cost but not always with better outcomes. In fact, according to Shames, healthcare in the United States is 2 to 3 times more expensive than that in any other industrialized country. At the same time, life expectancy is considerably worse than those countries, he added.

For example, a colonoscopy in the United States comes with a price tag of $1185 and costs nearly half that ($655) in Switzerland. It’s also well-known that the issue carries over to drugs, as well. Lipitor in the United States costs $124 while it costs just $6 in New Zealand.

Additionally, the United States, compared with other industrialized countries, has a problem with medical, medication, and lab errors, said Shames.

According to Shames, taken together, these factors underscore the need for a population health management model that encompasses 3 pillars, which offer a health system the ability to analyze big data of a population in order to best manage the individuals within that population:
  1. Know what is happening and predict what will happen
  2. Engage providers and patients in the health and care delivery
  3. Manage health and care to improve the quality of lives
“Simple, but not as easy to do,” said Shames, who took a step back and said that the idea of moving to a population health strategy is a seismic change in how health systems view and deliver healthcare.

But, the strategy reaps benefits, he said. For example, a 2018 survey from the Healthcare Intelligence Network found that 71% of responding organizations said patient satisfaction has increased as a result; 64% of organizations said that medication adherence has improved; and 61% of organizations attribute a decrease in emergency room visits to population health management initiatives.

Before digging deeper into the different aspects of such a strategy, Shames emphasized the need for these efforts to focus on healthy and at-risk patients the same way they focus on the sickest patients that account for the majority of healthcare costs, because as time goes on, if efforts are not spent on these healthy and at-risk patients, they will move toward the sicker end of the spectrum, and their costs will accrue significantly.

Shames then offered a look into the population health management model implemented by Sharp Health Plan, which offers health insurance to more than 149,000 people in San Diego, California. The model is built on an approach that encompasses data aggregation, comprehensive care, and measuring performance, all of which is based on a value-based reimbursement model.


 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up