Jul 10, 2018

Road to Risk: 6 Rules For Population Health Success

Like every other U.S. healthcare provider, we are facing up to the challenge of keeping a lid on costs for our organization and our patients. If you want to succeed in this healthcare environment, population health is no longer a question of “if”, but “when”.

Fortunately, we’ve proved that we’re good at this. In 2017, Austin Regional Clinic’s Medicare and Medicaid savings totaled $4.5 million.

It wasn’t an easy road. Austin Regional Clinic’s journey started more than a dozen years ago, when the term “population health” was barely on anyone’s radar. Yet, being early adopters has earned us the respect of Central Texas payers that we work with – and been a differentiator for us with medium and large employers in our community.

Manage the Population, Not the Contract

It was a gamble 15-plus years ago to jump in and attempt a value model when the system was (and often still is) volume-driven. It was a risk that few organizations at the time were willing to take and, as such, with so many years “under our belt”, we’ve built a robust and successful medical home program.

Today, the program serves a variety of health plans, private employer and governmental (MSSP ACO, Medicaid, CHIP, Exchange) contracts. The general framework for each contract is the same: pre-defined quality targets; a negotiated care management fee (typically a PMPM amount); total cost of care targets for shared savings; currently no downside risk; and an attributed patient population.

ARC Medical Home has grown to 65 people and an annual budget of approximately $6 million. Today, the entire program (case managers, nurse navigators, support staff and more) is paid for by the negotiated care management fees received from payers.

Two numbers help tell the story:

235,000 – the total number of patients under contract for value-based management at year end 2017 (up 11 percent year over year).

$16.5 million – net aggregate shared savings collected since program inception.

Yet, it’s not just a business story, it’s also a people story. Our patients with multiple chronic conditions, cognitive and/or behavioral issues, functional limitations and socioeconomic or sociodemographic challenges are having their care managed successfully via the medical home.

How We Did It

Behind the numbers are six ‘ rules that organizations must double down on to succeed on this road to risk.

  1. Develop robust EMRs.
  2. Set a high bar for clinical quality.
  3. Invest in nurse navigation.
  4. Relentlessly reach out to patients with care gaps.
  5. Place a strong focus on analytics and IT development.
  6. Make your organization hyper-focused on access to care.

Ultimately, it takes steady commitment from executive leadership on down, hard work and a willingness to embrace new, more effective methods to fully care for patients. It also requires an aspirational approach that sets – and meets – meaningful goals which is reflected in the metrics.

So Much More To Do

There are plenty of other places where we can and will improve. Gaps can be narrowed and ultimately eliminated in areas such as colon cancer and mammogram screenings — areas where we must do better.

As a large multi-specialty clinic responsible for the care of more than 475,000 Central Texans, we will continue to focus where there are the greatest opportunities for improvement.

It’s worth the risk.

Lucy Sumner serves as Austin Regional Clinic’s Vice President – Population Health/Clinical Quality Programs.