The foundational requirements that I believe are necessary for successfully population health management are:
Strategy and culture
Our strategy for transformation is to provide accountable care, but it’s been said that culture will eat strategy for lunch every time.
Cultural alignment and commitment to transformation among our internal stakeholders is the key to success. Here’s a link to our physician compact, which lays out expectations of St. Luke’s and aligned providers.
Integrated electronic health records
We have implemented integrated electronic health records in our outpatient settings. This has required a large financial commitment from our organization and a tremendous work effort from our providers and staff. We should be very proud of the work that has been done with the goal of providing integrated, seamless and patient-centered care.
The next phase will be installing the system across the remainder of our locations and working to find ways to integrate information flow with other aligned providers.
Enterprise data warehouse
The enterprise data warehouse is necessary to aggregate clinical and financial data that can be used to guide and monitor care initiatives. The data also supports internal and external validation of performance and documentation for financial remuneration from programs like MSSP, meaningful use, and other gauges and reports. Our partnership with Whitecloud Analytics has been invaluable in making this warehouse a functional reality.
Standardized work flows through TEAMwork, based on lean principles, are our approach to the elimination of waste and irrational variation and are the key to developing processes that are efficient, effective, and reproducible.
By establishing shared baselines and protocols, we can identify best practices and take them to scale across our organization. Examples include standardized approaches to ambulatory workflows, medication reconciliation, and chronic disease management.
Once we have identified a standardized process with a documented protocol, our data analytics department can assist in determining whether there is an outcome benefit. This is critical, because if we can’t measure outcomes, we can’t reliably improve processes.
Our clinical integration scorecards and population management module are industry-leading capabilities that put St. Luke’s in the forefront of healthcare transformation under the management of Dr. Geoff Swanson working with Whitecloud Analytics. They analyze large amounts of data that can be presented in actionable forms for performance improvement purposes.
Aligned clinical and business incentives
As we develop increasing proficiency in population management, it will be important that we have business model alignment with payers and other stakeholders.
SelectHealth was the first health plan to partner with us in an innovative value-based business model, and we now have risk-sharing relationships with other major payers, including Regence Blue Shield of Idaho and Blue Cross of Idaho.
A major benefit of risked-based contracts is access to financial and claims data, which is necessary for cost-efficient population management. These contractual arrangements are helping us learn the skill sets and competencies necessary to succeed in managing population-based budgets. And while they represent only a small portion of our patient population, we expect rapid growth in this area over the next few years.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.