Towards population health management in 5 steps

Healthcare systems across the globe await a massive challenge. There is an explosive growth in healthcare costs. If we want to continue to offer good, affordable healthcare, we need to reform. One way to do this, is to re-design healthcare services at a population level. We call this population health management or Community Based Healthcare (CBHC). To make population health management a success, it is essential to create networks.

What is population health management?

Population health management is working on the health of a population defined on the basis of set criteria, for example people in a neighborhood with a specific care need. Like the group of vulnerable elderly in the South-East of Amsterdam. A starting point for population health management is what this defined population needs to stay healthy. It is essential for population health management that healthcare continues to be customized for each individual patient.

Why do we need population health management?

Financing at a population level leads to better healthcare. Healthcare providers receive a fixed amount per patient within the population. It does not matter how many times they use a healthcare service. This way, healthcare providers are more encouraged to make sure healthcare is well organized for the entire population. This leads to a more efficient spending of the available budget. That makes population health management, healthcare according to the Triple Aim goal.

Importance of organizational networks

In order to organize healthcare for a defined population, we need interorganizational networks. An interorganizational network can achieve results that none of the individual organizations can, since organizations can complement each other when it comes to knowledge, expertise and specializations.

Steps towards population health management

Population health management cannot be implemented overnight. To create a well-functioning organizational network, organizations need to go through a number of steps. We will present these below.

Step 1: Investigate the willingness to change

Organizations have to want to change off course. They have to feel the urgency to develop a common vision and strategy. This can prove difficult in practice. The fact of the matter is that the parties can have major differences and will look at issues from their own perspective and interests.

Step 2: Include patients

Patients’ input is invaluable for effective prevention and healthcare. This is becoming easier and easier thanks to new developments in medical and information technology. For example, through biomarkers or big data. Include the patient in the process according to the 4P principle:

1. Personal

Providers customize the care to the patient. They do not only take into account their health situation, but also their wishes, preferences and personal situation.

2. Predictive

Data supplied by patients should be combined. The image that is created can help predict health risks in the future.

3. Preventative

If we map all the health risks, we can prevent diseases effectively and in a timely manner.

4. Participative

The patient is an active party to the healthcare process. They can take control of their own health. Healthcare professionals and organizations have a supporting role.

Step 3: Predictive modelling

IT is a vital element of successful population health management. IT allows us to use patient data to create risk assessment models. We call this ‘predictive modelling’. These predictive tools allow us to assess how big the chance is that someone faces an unplanned hospitalization or needs to visit the Emergency Room. It makes it easier to focus on prevention instead of curing it after it has already happened.

All of this is done based on the following sub steps:

1. Setting a uniform goal and definitions.

Example of a goal: better health related quality of life experience for vulnerable elderly in South-East Amsterdam. Definition: we consider a health related quality of life experience to be ‘better’ when…, we define ‘vulnerable elderly’ as…

2. Data collection, storage and management.

In the example mentioned we collect data about the inhabitants of South-East Amsterdam.

3. Risk assessment population.

We analyze the data. Are there many vulnerable elderly people in South-East Amsterdam? How do they experience their health?

4. Identification of risk groups.

Are there vulnerable elderly in South-East Amsterdam that experience significantly more health problems than other groups? Single or lonely elsewhere for example?

5. Intervention for high risk groups.

We organize interventions for vulnerable elders that experience a lot of health problems. We monitor them more often, for example.

6. Measuring and monitoring outcomes.

Did the intervention work? Are the vulnerable elsewhere experiencing fewer problems?

Step 4: Form an organizational network

As we’ve said before: it is important that organizations work together closely and form a network for population health management to be a success. This network should have an official legal form, so they can collectively finance their healthcare. But what is the best way to make this happen? We can distinguish between three types of organizational networks:

1. The self-regulating network

This is the simplest form. It consists of different organizations that work together collectively, but do not have a separate managerial body. The network members themselves are the managers. This form is least suitable for population health management.

2. Leader and organizational network

In this type of network, the members share one common goal and there is cooperation and interaction. One of the members has a managerial function. This member coordinates the decisions of the network and is a part of it at the same time.

3. Network administrative organization

This is a network with an integrated autonomous unit that has the task of coordinating the network and its activities. This so-called network administrative organization is not an active party in the network itself. Its job is to manage the network separately from the other parties. International research has concluded that this is the most suitable network form for population health management.

Step 5: Outcome Financing

The last step is financing. This should be done on the basis of value based payment models. Healthcare providers and networks receive a fixed amount per inhabitant or insured person in their population, whether this person makes use of care or not. Since there is a set amount per citizen, they will not have to access healthcare as much. This encourages professionals to work on the basis of shared goals instead of worrying about individual costs. To make this happen, the healthcare provision needs to be as efficient as possible. It is essential to have a well-functioning network of healthcare organizations in order to make this happen.

Masterclass Working Together on Value-based Healthcare

Good cooperation is essential for good population health management. There are certain obstacles that need to be overcome in order to achieve this. That is why Essenburgh Research & Consultancy is organizing a masterclass Working Together on Value-based Healthcare. Here you will learn to recognize and overcome obstacles to cooperation within your organization and with other organizations. This masterclass is meant for managers, directors and other healthcare professionals. For more information, click here or click the banner for the brochure.

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dr. Pim Valentijn

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