A panel discussion at the 70th Annual Roy A. Bowers Pharmaceutical Conference addressed recent care delivery initiatives in New Jersey that aim to address health inequities and other population health concerns.
Fostering equitable health care access and quality across patient populations warrants innovation at multiple levels of care delivery. At the 70th Annual Roy A. Bowers Pharmaceutical Conference: Innovation Through Crisis—Redefining Health Care Delivery, health care leaders spoke on key considerations to advance population health, with physical/behavioral health integration, accessibility of care, and insurance type among the factors influencing health disparities nationwide.
Describing the lack of research on population health, moderator Ethan Halm, MD, MPH, inaugural vice chancellor for population health at Rutgers Biomedical and Health Sciences, said recent years have seen growing interest on the topic, specifically the impact that social determinants of health (SDOH) and other potential care gaps have in leading to poor health outcomes.
“In terms of goals and approaches, the aim is to improve the health of all members of a group, not just those right in front of you in the clinic, office, or in a hospital bed. And that's, I think, the biggest conceptual jump,” said Halm. “The idea is to measure how well we're doing, identify gaps, and then close those gaps and intervene.”
The focus on measurement is noteworthy, he said, with data and predictive analytics of significant importance in developing interventions that are appropriate for each population, whether it is at the patient, community, or health system level.
Stratifying these interventions into inreach and outreach, in which the former describes the care strategies executed when patients are in direct proximity (eg, outpatient, telehealth, hospital visits), the latter was explained by Halm as initiatives aiming to proactively reach out to people in between visits or those who are not engaged in care. As the pandemic led to the deferral of preventive and potentially life-saving health care services, outreach strategies aim to reengage patients and providers in value-based health care, he said.
“Population health really is an important facilitated step in all of the evolution that I think people in this room are looking to see happen in health care, whether people are looking for better alignment of payment systems for fee-for-service, thinking more about total cost of care, shared risk capitation, or innovation of care delivery models,” said Halm.
Managing complex care needs was further discussed by Thomas McCarrick, MD, chief medical officer and chief medical informatics officer, Vanguard Medical Group, who spoke on his organization’s experiences in developing outreach programs for older Medicare populations who often present with SDOH issues such as food and housing insecurity and social isolation.
With COVID-19 exacerbating access to care disparities for many community-dwelling older adults, McCarrick said that a major focus for Vanguard Medical Group was ensuring these populations were properly informed and educated on their respective health risks and locations for vaccination and testing clinics.
“That was a population that we identified for us as having the greatest need and the greatest opportunity to innovate,” he said. “During the pandemic, we realized while we were trying to do telehealth visits that even though all the providers were properly trained, these homebound patients don't have a smartphone and they [often rely] on their kids to help them—so it can be a low-quality visit.”
McCarrick said they then created a new program last year through which specialty trained medical assistants go to patients’ homes with technological devices, such as iPads or a digital stethoscope, and set up the visit in a similar way to that done in the clinic. Medical information is collected prior to the visit, he explained, and the medical assistants can see the type of home environment patients are residing in.
“We are expanding this type of visit because we think that it can actually broaden outreach to a larger population; not just the homebound, but many older patients who may become transiently homebound either because they're acutely sick or they recently were discharged from the hospital.”
Along with physical health, Suzanne Kunis, vice president of behavioral health, Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), addressed the access and accessibility issues affecting mental health care, which she said continues to be burdened by lack of investment and fragmented care systems.
“In the mental health and substance use space, people fall through the cracks every day,” stressed Kunis. “The message we keep trying to tell our folks is, if we do the right thing, the money's going to follow because if we take care of people with these issues, it can affect up to 20% of the total cost of care. The other piece of it is it can no longer be diabetics to the right and schizophrenics to the left. The fact is, many times they're the same person.”
Through their recently developed integrated system of care program designed specifically for beneficiaries with mental illnesses and substance abuse disorders, Horizon BCBSNJ aims to integrate physical and behavioral health care in a value-based framework that also accounts for the SDOH challenges associated with adverse health outcomes and subsequent cost burden.
The model places greater responsibility on community-based providers to be the “quarterback” in managing the holistic care plan and directing patients to needed care services, said Kunis. After 6 months of implementation, she highlighted the significant impact the model has shown on care outcomes, including a 21% decrease in emergency department visits and 27% lower costs of care.
“We didn't want to wait and say, 'Let's see this out for a year and a half—we have enough faith in this model that we began to roll it out across the state of New Jersey. So, in every county in the state by the end of this year, we will have this model up and running.”
As risk sharing is being shifted through value-based frameworks from health systems to individual physicians, Myoung Kim, PhD, vice president, Population Health Account Management & Health Economics and Outcomes Research, Novartis, noted the impact this will have on the pharmaceutical industry whose role is to translate how innovative medicines affect health outcomes.
The process of health care delivery, including payment and financing, is key in this process of translation, said Kim. “If we're going to be held accountable for outcomes, we have to be given the opportunity to learn the delivery system and the opportunity to be at the table to figure out the better solutions as to how to better deliver care to patients at the population level,” she added.
The need for greater use of real-world evidence and diversified study cohorts was also referenced by Kim to promote equitable health care and to reduce the lag time created when these factors are not accounted for at the onset of clinical research.
“We know a lot about the drug when it was used in an ideal setting, but we [may] have no clue as to whether it delivers [for all populations] and the disadvantages or advantages it has, where it has to be used, and all these things have to be rapidly learned. The faster we learn, the better off we would be,” she concluded.
“The better we can align innovation resources with the true global health burden, including health care delivery gaps and payment—I think we all win together.”