Executive Interview Series
Welcome back to Optimum Healthcare IT’s “4 Questions with…” executive interview series, where we interview top executives in the Healthcare IT space. We search for the leaders with track records of service excellence, who are passionate about their work and make patient safety their top priority. In this installment, we talk with Renee Broadbent, AVP, Population Health, UMass Memorial Healthcare.
OHIT: What do you see in the marketplace regarding the growth of Population Health programs?
Renee Broadbent: Initially many organizations entered into population health programs by participating in a track one Medicare Shared Savings Program (MSSP). Because there is no downside risk to a track one program, it allows organizations to participate in the population health space without incurring risk. The primary purpose was to ‘retrain’ how physicians and others delivered health care, focusing on value vs. volume and in some cases was difficult to obtain savings. Over time, however, the distribution mix has started to shift, and organizations are participating in more risk-based programs. Often organizations will create a portfolio of programs not only to spread the risk but to also capitalize on the potential increase in funds, risk sharing, improvements in quality and reduction in total medical expense. A strategy including commercial risk, Medicare Advantage, some bundle programs, and an ACO is not unusual. Another area that is gaining speed and influencing programs is infusing social determinants in the patient care continuum. What is fascinating about the growth of population health is that it’s evolved in a very short period; the trajectory has been extraordinary.
OHIT: What does an effective Population Health program look like?
Renee Broadbent: An effective program has various components that make help make it successful. Critical is the correct structure to support the various programs and initiatives, including regulatory, clinical and financial. It’s critical to have it strategically centralize in the organization so that it can be delivered and managed effectively. For example, in a large IDN, having many areas deliver population health programs or strategies will not be successful. Rather a central function within the organization responsible at a system level for delivering care management, physician support, technology, and program management and compliance is more effective. Some organization has created separate LLC’s like a managed services organization (MSO) to deliver the services.
OHIT: What should an organization consider when designing the structure for their Population Health program?
Renee Broadbent: The most important thing to consider is whether this program fits into the organization’s strategic plan and that it has widespread support from both the board level and the senior executive level. Another equally important factor is the organization’s readiness in accepting the risk. Risk programs tend to have a higher return on investment but also present more significant financial challenges if not done effectively. Absent of these critical factors, any programs will falter and run the risk of not being successful.
OHIT: What are the biggest challenges organizations face in implementing the infrastructure for Population Health?
Renee Broadbent: There are several challenges when implementing the infrastructure for a population health program:
- Funding - It costs time, money and resources to build out an effective program. Resources are often specialized, for example, a Care Manager, and they are usually expensive. Also, the technology required to create the necessary data integration from multiple data points can be costly. Seldom does one solution generate the needed information and platforms to establish a Clinically Integrated Network (CIN)? That said the technology market is rapidly evolving and new, more advanced functioning and cost-effective approaches are being offered to help with establishing the programs, for example, risk sharing arrangements.
- Changing regulatory environment - The regulatory environment continues to change and evolve. That is why when establishing your programs; it’s important to have compliance, legal and regulatory on your team to keep current so that the organization can respond appropriately. In the cases where programs span multiple states, it’s important that there is a clear understanding of the variances in state laws that may supersede federal law. These things evolve and are moving targets which make developing and managing these programs challenging.
- Executive and system level buy into the strategic value proposition of population health - If population health management isn’t part of an organization’s strategic efforts and doesn’t have executive buy-in, it’s dead in the water and will likely have limited success, if any at all.
- Organizational Readiness - How prepared is the organization and its participants to dive in and make the necessary changes to support the program? Often organizations decide to proceed down the population health road without determining the readiness of the organization to take on the necessary changes to support it. Performing a readiness assessment can identify potential areas that need reinforcement in preparation for establishing programs. Education and creating an understanding around population health is necessary.