What is the first step for providers seeking to implement population health

The organization found that two metrics were being reported for at least three of the four programs, although a formal process of analyzing data and implementing methods to improve metrics did not yet exist. Because all of its clinics were reporting these two metrics, the health system decided that the best way to develop a performance improvement structure for all clinics—and avoid overwhelming its IT and reporting staff—would be to focus the efforts on only the two metrics. Removing the burden on staff of a focus on more comprehensive reporting enabled practice leadership also to implement formal training for staff in quality improvement methodologies.

Provider buy-in is an important consideration in selecting metrics, especially for organizations that have issues with data reporting from their EHR and receive complaints about the validity of data. To mitigate provider pushback, a health system should consider holding off on reporting performance metrics at the provider and/or staff level until any reporting issues have been resolved. Tracking performance metrics at the practice level will ensure that improvement efforts focus on changes in processes rather than on the practice choices of specific individuals.

Optimize Teams Within Primary Care

Primary care serves as the lynchpin for population health management. Unfortunately, primary care providers often do not feel they have the resources to deliver on the growing expectations of patients and health systems, which include increasingly convenient care and more robust patient-provider relationships. One result is physician burnout, reported to affect nearly half of U.S. physicians. c To combat burnout, primary care experts recommend that a fourth aim be added to the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing per capita cost—improving the work life of healthcare providers. d

This new “quadruple aim” can be best achieved by developing high-functioning teams within primary care to reduce the burden on primary care providers. Several studies have shown that even nonclinical staff can play a key role in carrying out many of the activities that need to occur with a patient-centered care model.

At Kaiser Southern California, for example, medical assistants review care gaps in the patient’s record and can place orders to fill care gaps based on protocols. This practice has allowed the health system to improve outcomes, including timeliness of diabetes care and cancer screenings. e

A study of patient-centered medical homes within the Veterans Health Administration found that front-office staff served a vital role in collecting patient information and communicating it to the rest of the care team. Care teams were better informed about patient preferences and socio-economic and demographic determinants of health care, which also contributed to improved patient satisfaction. f

Creating high-performing primary care teams does not necessarily mean making big changes to staffing. In fact, the opposite is often true. By optimizing each team member’s role and eliminating inefficiencies, systems can attain peak performance without additional staff. Applying the following four steps can help practices maximize team contributions and overall performance.

Map all tasks that need to happen before, during, and after a patient visit. These tasks may include, for example, answering patient calls, notifying patients of normal lab results, taking vitals, reconciling medications, conducting patient education, and following up with patients after a hospitalization.

It is critical that front-line staff be involved in this conversation. During this process, it may be found that many tasks are being performed inefficiently or do not need to be performed at all. Examples include writing down phone messages when patients call, rather than resolving the issue over the phone, or requiring patients to check in multiple times for their appointments. Identifying and reducing such inefficiencies can help free time for team members to perform more essential tasks.

Determine who should perform each role. Tasks should be assigned based on licensure, skill level, and practicality. In a high-performing practice, all staff should be practicing at the top of their license to ensure that each task is being carried out as cost-effectively as possible. For example, nurses should spend most of their time performing tasks that require a nursing degree.

Redesign workflows as needed. Workflows should be adapted to close gaps and eliminate duplication, ensure equitable workload balance, and create patient-friendly processes. As in any transformation effort, workflows should be tested and evaluated within one care team before being scaled across multiple practices.

Although additional staff may be necessary to perform tasks such as providing care management for patients, optimizing existing roles is an important first step toward increasing efficiency within a practice and reducing the burden on providers.

Small Steps, Big Changes

Population health management is far too big a challenge to take on all at once. But it also is an effort that should not be put off. Health systems that wait to transform care delivery until they no longer have a choice will find themselves in an uncomfortable and untenable position. Forward-thinking organizations, on the other hand, will recognize the opportunity to make small and achievable steps toward population health management meaningfully and sustainably. By starting with these three basic steps—developing a population health strategy, creating a culture of continuous performance improvement, and optimizing primary care teams—health systems can better position their organizations to achieve the essential goal of value-based care: delivering care in a way that helps improve and sustain the health of their overall patient populations.

Reema Shah is senior manager at ECG Management Consultants, San Francisco.

Footnotes

a. Kotter, J.P., “Leading Change: Why Transformation Efforts Fail,” Harvard Business Review, January 2007.

b. Casalino, L.P., Gans, D., Weber, R., et al., “US Physician Practices Spend More Than $15.4 Billion Annually to Report on Quality Measures,” Health Affairs, March 2016.

c. Peckham, C., “Physician Burnout: It Just Keeps Getting Worse,” Medscape, Jan. 26, 2015.

d. Bodenheimer T., and Sinsky C., “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider,” Annals of Family Medicine, November/December 2014.

e. Kanter, M., Martinez, O., Lindsay, G., Andrews, K., and Denver, C., “Proactive Office Encounter: a Systematic Approach to Preventive and Chronic Care at Every Patient Encounter,” The Permanente Journal, Fall 2010.

f. Solimeo, S., Stewart, G., and Rosenthal, G., “The Critical Role of Clerks in the Patient-Centered Medical Home,” Annals of Family Medicine, July/August 2016.

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