Wednesday, November 2, 2016

Population Health, Community Health & Who’s Going to Make Transformative Changes?

GuideWell Insights Lounge - Oliver Innovation Conference
Here's another 'transcripted synopsis' of an interview by Kate Warnock, GuideWell Social Media Manager and Healthcare Inquisitor Extraordinaire, from the GuideWell Insights Lounge at the 2016 Oliver Wyman Health Innovation Summit.

The following are questions from Kate's interviews with Josh Michelsen, Health & Life Science Practices partner at Oliver Wyman and Director of the #OWHIC Leaders Alliance for Oliver Wyman.

Kate quizzes Josh talk about population health, its differences from 'community health,' and how Josh believes a group effort targeted at a 'community microcosm' might effectively improve the population health of that defined population.

Here We Go!

Kate: How would you describe population health and how is it different from Community Health?

Josh: That’s a good question. You know it’s certainly a buzz word - both are buzz words in the industry.

And they’re linked but I do draw a little bit of a distinction between the two. So when I think of population health, at least as the industry thinks about population help, it’s four pieces:

Four Parts of Population Health

First Piece: it’s about actually improving the Triple Aim; so quality, cost and the experience.

Second Piece: It’s for a defined population. So you are trying to improve those pieces for a specific population. It could be quite micro; so it could be around Medicaid or Medicare, commercial or could be all-encompassing.

I think population health also has a Third Piece which is much more of a holistic approach to health care: you’re not just receiving the patient but you're proactively trying to improve their health.

And the Fourth Piece is that whatever organization is responsible for that population, they’re actively at risk for it - financially at risk.

So that's kind of how I think about population health, at least from an industry standpoint.  And so community health is similar but I think it’s a little bit different in that it’s the foundation on which people are trying to improve the health of a specific population.

Community Health

Josh: So in a community, it’s about all the social determinants of that community. It’s about economic vitality. It’s about some of the structural impediments and it’s about social impediments. And so, while I think in a given community, take Chicago. In a pocket of Chicago, if you were trying to improve the community health and really lay the foundation for that, you might take a specific cell population and laser in. And have a provider or payer organization responsible for the cost quality and experience (of that specific cell population.)

But I think the community health is a much broader and more public health oriented ambition.

Kate: Is it fair to say this 'community health cell' is more location-based? Is it more about a geographic region versus population health? which doesn’t necessarily have the same quarters? (Clarify at 3:02)

Josh: Yeah, you know, that's probably a fair way to think about it. Most organizations here [At OWHIC] and we were studying a little bit of what’s in the mission. So we've looked at the mission statement of payers and providers and health IT organizations. And what we found was that organizations that had roots in a specific community, or a specific market, tended to gravitate to words like 'improve the health of their community and the individuals that they serve.' Versus those [organizations] that are location independent; those that are more location independent didn’t quite draw that same connection.

So I do think being able to put your arms around a geography or micro geography is certainly an important attribute.

Kate: Ok. Alright. Fair enough. Next question for you Josh:

Who are the constituents required to drive better health for a community?  Who's really going to make a transformative change we all want to see?

Josh: Well, we have many organizations here that happen to be some of the largest employers in their market. So whether it’s hospitals or payers, they tend to be in the top, you know, two or three organizations in terms of employing individuals. So they’re naturally an anchor and then there’s this notion of an anchor in the community that you can rally around. But I think it’s a lot broader than that.

First Steps - Per Josh

So some of the first steps in transforming the health of the community are connecting the organizations that are responsible for care. It’s not just the hospitals and it’s not just the physicians. It’s the safety nets. It’s the FQHCs. It’s social services. And you start to orient around that anchor.

Next Steps  - Per Josh

Then you broaden it. You start to say: “Well, who else is there?” It’s the retailers that have a role. It’s education that has a role. It’s the churches that have a role. And religious affiliations. And what we've observed is that some organizations are you really saying: “What could we do to connect the care and other communities?" 

And other organizations are starting to say: “Wait a second. If we’re thinking about social determinants, who plays a role in these social determinants?"

Community Health Improvement Initiatives

And then the third layer is many Community Health Improvement Initiatives (CHII) really start with organizations that have a physical presence. And what we’re seeing is that there's an opportunity to pull in innovators and technology companies to actually assemble the supply side of these CHII's a little bit differently.

So it’s not just a provider in a market that has a new care model; it’s what would happen if you actually incorporated the provider with consumer tech and engagement around specific populations? And we think there's a lot of promise and actually attracting innovators to test their models and refine their models through Community Health Improvement Initiatives.

Who's Your Anchor?  - Per Josh

So it’s quite broad but we do think it’s important to have an anchor that can serve as a facilitator and really help rally investment and energy across multiple organizations.  

Back to You Kate...

Kate: You know, as you respond Josh, you can' t help but think that, with so many players involved in this, really just speaks to the complexity of managing true health and helping people focus not just on episodic care but on that holistic vision that you painted for us in the beginning. So just one of the challenges, but so many opportunities too, when you have the right people involved.

So one more question Josh.

What new business models or collaborations are you seeing emerge as a result of organizations wanting to make a substantial impact on the health of their communities?

Josh: I guess a couple things. One is, we’re seeing organizations rally around a major cause. So whether it’s something like hunger or employment we’re seeing some healthcare organizations say “You know what? We’re going to find an issue and rally around that issue and be quite systemic about it.” So take hunger as an example. You know the role of a provider could actually be creating, as part of their care pathways, nutrition plans and then tying into what restaurants are doing in the community. And addressing food deserts.

Marble the Solution Set

And so, taking an issue like that and actually marbling a set of solutions around a specific issue. We’re seeing other instances where it’s actually city lead and so the government is going to come in. Chicago is an example of this. They have invested in a healthy community or Healthy Chicago 2.0. They are inciting or are asking multiple constituents in a market to rally around multiple issues.  So it’s a much more diverse set of issues that they’re taking.

Preventive, Proactive Care Engagement

And the third thing which I haven't seen take place but I would love too is and we’re here talking about it is this idea of health and wellness. We have sick care and we have preventive, proactive care engagement. And we think there’s an opportunity for organizations in a market in a specific geography to create a new marketplace: a marketplace for health and wellness. If a community were actually able to, it would build up demand at scale; have employers or multiple employers rally around a new supply side.

So not just by the traditional provider and the traditional network and the traditional plan of benefits, but have a payer or an employer wrap a product around the new supplies. So creative assembly of the supply and have traditional organizations actually integrate their solutions with some of that; innovators that we have in the room and then have a new marketplace around that and have that sit side-by-side with the traditional. And hopefully you’ll build up demand and show that this alternative model is possible. So that's where we’re hoping this goes or at least personally where I hope this goes.

How Long is this Going to Take?

Kate: I gotta ask. So, timeline for something like that is this something a year out or are we looking 3 to 5 years? Because that sounds, I mean it’s a very…love the idea of that kind of model. Realistically how long would it take to really get something like that to begin to build traction?

Josh: Well. So what we've observed in the market is anytime you're trying to bring a new product, even… take a payer that’s moving into Medicare Advantage space and trying to build adoption. You don't go from zero lives to tens of thousands of lives or hundreds of thousands. That can take a while. What we’re hoping is that transparency around the effectiveness of those solutions is something that helps influence it.

Kate: It’s its own best marketing. (Transparency)

Josh: And then, we are seeing examples of smaller communities, maybe not large metropolitan communities, but with smaller communities bring government, public health providers, banking, transportation, all kinds of all sectors together.

And in that smaller microcosm they’ve been able to do it; in part because they control many of the levers. Whereas in a market place like Chicago, it’s a lot harder to do that. So we’re hoping that, at least in pockets, were able to see that kind of new supply rise where it’s many organizations coming together and then buying that in a for package way.

That's All Folks!

Kate: Okay Josh you paint a really, really fascinating look ahead into the future of healthcare and I appreciate you spending your time and your insights with us here at the Guidewell Insights Lounge.

Thank you. My name is Kate Warnock. Thank you so much for watching. 

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