“Population health” is the result of pushing health systems to be clinically and financially responsible for their communities. This is a significant shift from simply being focused on the volume of services delivered within the hospital.
The focus on population health represents a movement for pharma from the past (targeting physicians due to their control of prescriptions) to managed care organizations during the heydays of HMOs to our current time of health system domination of the control of therapy selection. Each of these treatment controls focused on a different element of the Triple Aim: from patient care to cost to the current focus on population health.
As health systems become more prevalent, they are having increasing levels of control over treatment decisions, in coordination with physicians and managed care organizations. As a result of this increased level of control, health systems are in a unique position to improve the health of their covered lives and the experiences of care while lowering costs, thus meeting all parts of the Triple Aim. At the same time, the changing landscape offers pharmaceutical manufacturers new opportunities to demonstrate their products’ value at the population health level.
For pharma, supporting population efforts starts with the segmentation of health systems and payers, especially those payers acquiring providers in an effort to look more like health systems. Segmentation is the starting point, as this identifies the targets and their objectives. A shift here is that combining payers and providers into “payviders” will continue, but this practice will be initiated by payers rather than health systems. Health systems are focusing on fee for service (FFS) because of COVID, while payers are acquiring providers to extend their reach. As such, these efforts should include payers and providers in addition to health systems. So segmenting health systems and payers by their objectives is critical to develop an approach to each.
A means to segmentation for health systems can start with an examination of their Community Health Needs Assessment (CHNA). The CHNA is a requirement for all nonprofit health systems to complete every three years. Health systems are required to assess the health needs of its community; specifically, a hospital facility must identify the significant health needs of the community. It must also prioritize those health needs, as well as identify resources potentially available to address them, including organizations, facilities and programs in the community, including those of the hospital facility. Resources can also come through partnerships such as those with pharma.
As required under the IRS rules, the health needs of a community should include requisites for the improvement or maintenance of health status both in the community at large and in particular parts of the community, such as particular neighborhoods or populations experiencing health disparities. These disparities came through in those populations most impacted by COVID-19. The gaps can include, for example, the need to:
- Address financial and other barriers to accessing care,
- Prevent illness,
- Ensure adequate nutrition, or
- Address social, behavioral, and environmental factors that influence health in the community.
Pharma may benefit from assisting in these areas, especially prevention of illnesses as well as the social determinants of health that have been a major focus recently. A hospital facility may determine how significant a health need is based on all the facts and circumstances present in the community it serves. Additionally, a hospital facility may use any criteria to prioritize the significant health needs it identifies, including (but not limited to) the:
- Burden, scope, severity or urgency of the health need;
- Estimated feasibility and effectiveness of possible interventions;
- Health disparities associated with the need or
- Importance the community places on addressing the need.
These identified population health needs by each health system can be used by pharma to develop health system–specific approaches. Once segmented, the pharma strategy needs to provide three critical questions: Why, what and how… and all too often pharma focuses solely on the what. This misses gaining support through the articulation of why in terms that matter to each individual stakeholder. Also, the how is needed, as stakeholders will most often not execute well without guidance and support.
This focus on why, what and how is detailed further through application of the six vowels, especially in the focus of the how element. How requires identification of the “right” patient, engagement of all the key stakeholders and action needed to accomplish the outcomes. This focus on the how is needed, as so often the what is lost in a failure of the execution, or the how.
The business model for health care in the United States is evolving from a volume-driven model to a consumer-centric, value-driven model. As such, there are new competencies required of hospitals and health systems to effectively manage a population’s health across the continuum of care. Many hospitals and health systems will need to partner with other organizations to gain the capabilities and efficiencies required to provide services under new care delivery and payment arrangements. This article by the Journal of Clinical Pathways discusses the why, what, and how of creating and implementing a population health project with partners.
The focus and delivery on population health will endear pharmaceutical companies to health systems and payers as a driver toward improving health outcomes … which is ultimately where everyone is aiming.
Richard has focused his career on improving health outcomes, especially for some of the most vulnerable populations. This has been achieved through several avenues, beginning with his continued active role as a treating internist/geriatrician.…