As we continue to analyze key elements of the evolving healthcare landscape, this series of posts explores payers’ and health systems’ approaches to achieving the Quadruple Aim of health system performance.
WHAT IS THE QUADRUPLE AIM?
The Quadruple Aim is an extension of the Triple Aim conceptual framework developed in 2008 by the Institute for Healthcare Improvement (IHI) to optimize health system performance. In 2010, the IHI’s original Triple Aim goals became part of the US National Strategy for tackling healthcare issues. In 2014, a fourth objective – care team well-being was adopted. The four layers of the Quadruple Aim of health system performance are presented as:
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of healthcare
- Reducing physician burnout
This post will discuss the second pillar – the imperative of improving population health management.
POPULATION HEALTH MANAGEMENT
Like many new terms related to healthcare innovation, population health management (or population health) can be defined in a number of ways. An article from the Institute of Healthcare Improvement defines population health as:
The health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group.
Other practical definitions of population health management can be found in the Organized Customer setting, and often focus on patient data aggregation and analysis in the implementation of positive changes to care delivery.
Despite nuanced differences in how they define population health management, all stakeholders face practical challenges in the effective management of populations.
One key challenge concerns the patient care continuum. Patient management goes well beyond the clinic, but the point at which proactive patient management ends is unclear. Many medical directors have described hospitalization as “a failure,” and have proposed that population health management is never discharging a patient. Effectively extending care into the community is a crucial element of population health management that requires a reengineering of the care delivery model.
CHANGING THE PARADIGM
This new perspective on population health management has required some recalibration of the principal domains of healthcare quality – frameworks that are critical in guiding quality assessments and measuring development initiatives.
Care teams must do more than treat, they need to problem solve for their patients.
Physicians are not only responsible for their diabetes patients’ A1C levels, but they must also address the social determinants that present barriers to effective patient self-management. With this new perspective, needs assessments are now placing almost as much importance on non-clinical domains of care as they do on clinical domains. Specific care team members are now responsible for managing each patient as a person possessing an individual (and medically relevant) history and circumstances. This concept – as part of a population health management framework – represents a new paradigm in patient care. Effective population health management requires an extension of care into the community and a direction of service that presents Organized Customers with major operational challenges that will need to be addressed.
POPULATION HEALTH MANAGEMENT AND PAYERS
The current state of the US healthcare system is average at best. In fact, the Bloomberg Healthcare Efficiency Index has ranked the US healthcare system as one of the least efficient in the world. We are spending a far greater percentage of our GDP on healthcare than other nations (18%), yet our population’s morbidity and mortality health statistics remain sub-optimal. New approaches to population health seek to reverse this trend.
While most individuals primarily associate population health management with care delivery, health plans have intentionally invested in infrastructure and reimbursement measures to support a more comprehensive population health management effort. Payers may invest in population health management efforts as a means of controlling the healthcare spend risk assumed by employers, state- and federally-funded members, and members who have enrolled via the individual exchange. Payers may also proactively invest upstream; to support care transformation and the shift toward value-based outcomes, as well as to prevent unnecessary utilization. Focusing on population health management also directly impacts payers’ own rankings (ie, CMS Star Ratings, NCQA, HEDIS), so they are fully invested in ensuring that the members they cover have access to high-quality, affordable healthcare that produces the best possible health outcomes.
POPULATION HEALTH MANAGEMENT AND LIFE SCIENCE
Life science organizations are beginning to take an active role in population health management by supporting a number of therapeutic areas. Typically, life science companies provide best practice guides and patient tools that enable more effective population health management. Because healthcare stakeholders are already invested in population health management, life science commercial organizations have an opportunity to provide a greater degree of sophistication to their efforts by providing valuable tools, data and messaging that can help foster strong and lasting partnerships.
Healthcare is extremely complex, and it will take a community approach to improve the US healthcare system and the people it serves. Providers, hospitals, payers, and the life sciences industry are some of the critical stakeholders that will play an important role in the ongoing and innovative efforts needed to improve overall health in the US.
The next post in this series will explore the third objective of the Quadruple Aim – Reducing the Per Capita Cost of Healthcare.