“The dream of reason did not take power into account.” – Paul Stark
For decades we have been facing a health care crisis. Payment imbalances, lagging educational reform, physician shortages, you name it, the health care landscape has been ignoring the inevitable for a long time.
When the Association of American Medical Centers (AAMC) met this week in Philadelphia to discuss health care reform, two primary care advocates took the stage to discuss the challenges Academic Medical Centers (AMC’s) face in delivering population health.
Sheila Burke, RN, MPA, FAAN, the adjunct lecturer in public policy at the Harvard Kennedy School and Michael Magill, MD, chair of the department of family and preventive medicine at the University of Utah, put the daunting task into perspective.
Why do we need to do population health? Because we have to.
“We are trying to provide primary care through a system designed for acute care,” said Burke. “New payment models will dictate a need to manage care differently.”
In a constrained payment world, acute care revenue may move over into hospitals and health systems' expense columns. This shift demands the creation of a system that keeps patients out of the hospital.
“The solution has to be uniquely designed to deal with the population in question. Population health care is local,” said Burke
So how do we deliver population health?
First, Magill suggests AMC’s must create a virtuous cycle in which their three core missions of clinical delivery, education and research align in their initiatives and serve to reinforce each other. Clinically, this means that AMC’s need to embrace a strategy of keeping patients out of the hospital for as long as possible. They must then innovate and research how to deliver care better and more effectively and efficiently. And finally, AMC’s must turn to their educational curriculum to start training providers who know how to work in and manage teams and systems.
The challenges of delivering population health are many. But ultimately, Magill suggested, AMC’s must embrace the concept that “While we are liable only for care delivered in our hospitals and clinics, we are ultimately responsible for care from cradle to grave.”
If patients in a capitated system enter the system because of poor population health and wellness, then preventive measures are a primary provider’s first line of defense. Similarly if discharged patients land in a poorly managed system of home health, skilled nursing or assisted living they will be right back in our system well before 30 days is up.
So what can AMC systems do to align tertiary and primary care delivery?
To be successful in any brave new world of population health care delivery systems need to construct efficient and effective care pathways that serve our own neighborhoods with care designed for our communities.