Medical home must-dos for population health management
Think like the other guy
The continuing shift toward PCMHs, ACOs and integrated care delivery can be seen in Humana's recent transition from a traditional insurer that just pays out checks to a health company actively involved in helping members with their health, according to Humana Chief Medical Officer Roy Beveridge, M.D., (pictured right).
The Louisville, Ky.-based insurer recognized the need to marry providers' clinical expertise with Humana's business views to drive integrated care, Beveridge told FierceHealthPayer in an exclusive interview.
Along with provider and payer points of views, healthcare organizations must not ignore what the consumer wants. "Unless you really look at it from the patient standpoint, member standpoint, doctor standpoint, business standpoint, you really can't be successful," Beveridge said.
Population health also has forced hospitals and health systems to think like insurers, as evidenced by MedStar Health, the largest health system in the Baltimore-Washington, D.C., metropolitan area. MedStar has its own health plan offering called MedStar Select, as well as a medical home project with CareFirst Blue Cross Blue Shield and quality-based incentive payment arrangements with other insurance companies.
"You actually have to be thinking that you want to transform healthcare delivery and use the knowledge that you have from a health plan perspective as well as from a provider perspective to do that better," Eric Wagner (pictured left), MedStar's executive vice president of external affairs, told FierceHealthPayer in a previous interview.
"You actually have to run it as a health plan and not just as something that pays every claim that comes in the door," he explained.
Target the right members
A key factor to medical home success is targeting the right people, such as those patients who are likely to continue to have problems, Scott Sarran, chief medical officer of Health Care Service Corporation's government programs, told FierceHealthPayer in a previous interview. Chicago-based HCSC looks at cost, quality and utilization issues to generate a list of appropriate members, and then has physicians validate the data and contact eligible members about the medical home program.
"We've seen a persistent, relatively small percent--maybe 10 percent of members in a commercial population--who are really challenging and who, despite our existing programs, need more help," Sarran (pictured right) said about designing an intensive medical home model around high-risk, high-cost members.
With similar targets, Philadelphia's Independence Blue Cross also found a PCMH directed at high-risk members lowered costs and utilization rates, FierceHealthPayer recently reported.
Related Articles:
Providers address hunger to improve patient population health
Population health a top concern among healthcare leaders
Study: Medical homes cut costs for chronically ill members
HCSC Exclusive: Intensive medical home cuts high-risk patient costs
Comments