Currently Viewing:
The American Journal of Accountable Care September 2018
Currently Reading
Improving Population Health Through Multistakeholder Partnerships
Nicole Sweeney, BA; Sarika Aggarwal, MD, MHCM; Peter Aran, MD; Deb Dahl, MBA; Joseph Manganelli, PharmD, MPA; Steven Peskin, MD, MBA; Emily Allinder Scott, MHA; David Parker, PhD; Joseph Conoshenti, RPh, MBA; and Anupam B. Jena, MD, PhD
Team Functioning and Clinical Quality, Patient Satisfaction, and Patient Portal Implementation Among Patient-Centered Medical Homes
Deirdre A. Shires, PhD; Amir Alishahi Tabriz, PhD, MD, MPH; Carrie A. Miller, MPH; and Jennifer Elston Lafata, PhD
“Lean” Improvement in the Quality of Patient Care in the Hospital Admissions Process
Patricia Bonachela Solás, BSc; José Bernabéu-Wittel, MD; M. Nieves Romero Rodríguez, MD; Antonio Castro Torres, MD; and Diego Núñez García, MD
Patient Complexity Characteristics in the Hospital Setting
Baptiste Crelier, MMed; Sven Streit, MD; and Jacques D. Donzé, MD, MSc
Trends in Healthcare Payments: Focus on Consumer Experience as the New Normal
Chris Seib, BS
Effectiveness of Enhanced Primary Care on Preventive Health Services
Sarah L. Goff, MD; Lorna Murphy, MA, MPH; Alexander Knee, MS; Haley Guhn-Knight, BS; Audrey Guhn, MD; and Peter K. Lindenauer, MD, MSc

Improving Population Health Through Multistakeholder Partnerships

Nicole Sweeney, BA; Sarika Aggarwal, MD, MHCM; Peter Aran, MD; Deb Dahl, MBA; Joseph Manganelli, PharmD, MPA; Steven Peskin, MD, MBA; Emily Allinder Scott, MHA; David Parker, PhD; Joseph Conoshenti, RPh, MBA; and Anupam B. Jena, MD, PhD
Improving population health requires developing innovative multistakeholder partnerships to enable mining and cross-leveraging data sets, creating patient touchpoint “ecosystems,” and aligning investments with each stakeholder’s returns.
ABSTRACT

Although recent payment and delivery reforms have shown some effectiveness, challenges remain in achieving the “quadruple aim” of better health of populations, improved quality care, lower costs, and sustained health of providers and caregivers. A working group of payer, provider, academic, and pharmaceutical industry stakeholders was convened to provide insight into these challenges and identify barriers to and opportunities for collaboration to address them. A series of structured discussions was conducted among workgroup members over several months in 2017. As the challenges were discussed, stakeholders identified 4 key areas for improvement and collaboration: to (1) better manage touchpoints of healthcare, (2) identify and focus on patients most likely to benefit from interventions, (3) better incorporate social determinants of health into population health interventions, and (4) better measure return on investment among interventions and improve its alignment with stakeholders. The working group further identified several major themes to enhance the frequency and impact of collaborative population health initiatives: Stakeholders should (1) seek to mine and cross-leverage the increasing volume of health-related data that they each develop independently, (2) collaborate to create patient touchpoint “ecosystems” in which patients are maximally engaged through a diverse and complementary set of contact channels and technologies, and (3) collectively determine the investments required for high-impact population health initiatives and how to allocate them, so that individual returns on the various investments can be estimated and calibrated according to the stakeholders’ needs.

Am J Accountable Care. 2018;6(3):e8-e11
The US healthcare system has struggled to achieve high-quality, accessible care at affordable cost. Recent efforts to improve quality of care, expand access, and reduce costs have included insurance market reforms as well as novel payment and delivery system reforms that attempt to shift financial risk across key stakeholders while improving population health, particularly for the sickest and highest-cost patients.

Although recent payment and delivery reforms have shown some effectiveness, challenges remain in achieving the “quadruple aim” of better health of populations, improved quality care, lower costs, and sustained health of healthcare providers and/or caregivers. Consistently delivered high-value care remains elusive, and by some estimates, low-value care is estimated to cost the United States $340 billion each year.1

In our view, an important contributor to limited progress is the lack of consistent communication and collaboration among key healthcare stakeholders. Patients, healthcare providers, drug and device manufacturers, and payers (eg, traditional managed care organizations, integrated delivery networks, pharmacy benefit managers) all have different perspectives and incentives that make the reality of high-quality care at affordable cost challenging to achieve.

To provide multistakeholder insight into these challenges, Novartis Pharmaceuticals convened a working group of payer, provider, academic, and pharmaceutical industry stakeholders. Providers represented integrated health systems and accountable care organizations, and payers represented commercial managed care organizations. The working group had the following objectives: to (1) bring together diverse healthcare stakeholders; (2) discuss the critical issues and challenges arising from the transforming healthcare environment, in particular related to population health; (3) brainstorm approaches to address current problems and future needs related to population health; and (4) identify barriers to multistakeholder collaboration and improved care.

Prior to convening the working group, we conducted comprehensive discussions with payers and providers to identify priorities of these stakeholders and inform selection of topics for working group meetings. Three separate meetings were held that focused on the following topics: (1) multistakeholder approaches to population health and wellness, (2) promoting medication compliance through patient engagement and education, and (3) building creative solutions to improve population health and patient engagement. Through these meetings, common priorities and challenges emerged.

Overall, all stakeholders are currently implementing their own population health programs with the key goals of improving quality of and access to care, preventing disease, decreasing avoidable healthcare utilization, and ensuring healthcare provider job satisfaction. However, there are significant challenges to the success of these population health programs, including fragmentation in their implementation and delivery and gaps in communication and collaboration.

For example, population health programs tend to be fragmented, as approaches are typically executed under 1 stakeholder’s umbrella (eg, all population health activities occurring under the purview of the provider organization as opposed to collaboratively with payers and/or pharmaceutical industry partners). All working group members agreed that cross-stakeholder collaboration could leverage strengths of individual stakeholders, but there has been limited precedent for this collaboration. This inherent fragmentation leads to communication and collaboration gaps.

Although there are multiple payer-, provider-, and community-driven programs that all touch the patient, there is limited communication among programs, resulting in both the reduction of individual programs’ effectiveness and duplicative overlap in some programs’ services.

The working group also identified a key unmet need of identifying which stakeholders are best suited to manage certain components of care and leveraging those strengths to achieve improved overall outcomes. For example, 1 component of improving heart failure care requires more local efforts by providers that can shift social determinants of health. A health plan may have strategies to improve heart failure management (eg, lowering co-pays, deploying nurse managers, notifying providers of heart failure hospitalizations, etc), but it may not have the on-the-ground capabilities to affect social determinants of health. Ideally, it could leverage the provider’s influence in the community to meet these needs, resulting in an optimal approach of complementing payer and provider strategies. This level of collaboration is not broadly achieved today. These communication and collaboration gaps can impact both the patient experience and the ability to achieve positive health outcomes.

As these challenges were discussed, stakeholders identified 4 key areas for improvement and collaboration: to (1) better manage touchpoints of healthcare, (2) identify and focus on patients most likely to benefit from interventions, (3) better incorporate social determinants of health into population health interventions, and (4) better measure return on investment (ROI) among interventions and improve its alignment with stakeholders.


 
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