From 3M Health Information Systems
Three questions with Dr. Melissa Clarke: Can population health reduce physician burnout?
I sat down with 3M Health Information Systems Senior Medical Director of Health Care Transformation and Health Equity Dr. Melissa Clarke to talk about population health and how, through technology, it could reduce physician burnout by giving them more time with patients.
Let’s talk population health. Is it just one more thing for physicians to worry about? How could it improve a patient’s outcome, and also make a physician’s life easier?
Population health isn’t just another burden. There are actually many potential benefits to the provider and the patient. A population health approach, supported by a value-based care (VBC) payment model, is actually better aligned with our intrinsic motivation as doctors to deliver the best care possible. It allows for greater focus on preventative care, helps us establish a stronger relationship with our patients, and allows more time and resources to be devoted to interacting with the patient, which can lead to better patient retention and outcomes. As such, it can allow for us as physicians to get more satisfaction from our work, which ultimately reduces burnout.
Besides physician and patient satisfaction, there are also compensation-related factors. For a primary care provider (PCP), even under a fee-for-service (FFS) billing model, The Quality Payment Program has opportunities for participating physicians to receive additional payments for attaining program targets. In addition, the complexity of medical decision-making for outpatient/office evaluation and management (E/M) services is now enhanced by documenting and coding social determinants of health (SDoH) through Z codes.
In value-based care, there are many models where additional compensation is linked to achieving certain quality measures. Under certain accountable care organization (ACO) models, like ACO REACH, practices are compensated additionally for working with a population that has adverse social risk, in recognition of the additional resources needed to achieve benchmarked measures.
We saw the contrast in practices that were functioning under a VBC model during the early days of the COVID-19 pandemic. In those early days, when non-emergency services were delayed or deferred, those practices still using an FFS model saw their revenue streams disappear. In contrast, those health systems and physician practices operating under a VBC model continued to get paid a per member per month premium and weren’t as impacted by fluctuations in patient volume.
How can technology support and advance population health?
Technology is crucial to population health management, specifically because it enables seamless data communication and data analytics at scale. Large health systems have adapted to this need by increasing internal capacity, but other smaller hospitals or Federally Qualified Health Centers (FQHCs) have hired vendors to help. Health care has an inordinate amount of data. The need for integrated platforms that enable data collection, communication and large-scale analytics are necessary for several population health management functions, starting with attribution of a population.
Assigning patients to a provider so they know for which individuals they are accountable must be done by performing an analysis of encounter data over a one to two-year look-back period. In addition, collecting both clinical and non-clinical data allows the assessment of practice performance against quality measures; aggregating that data to understand utilization patterns; and reporting that data back to the physicians so they can understand how they are performing against peers, are all roles that require technology platforms and sophisticated data analytics. And finally, data analytics are required for risk adjustment that allows one to compare outcomes across populations that may have different levels of complexity; and to develop and execute a value-based compensation structure that recognizes attaining performance goals.
How is technology currently being used for population health management and what does the future look like?
All of those areas I mentioned above: attribution, quality measurement, aggregation of both clinical and non-clinical (social) data, insights to identify care gaps, care management, reporting and risk adjustment—are all ways technology-enabled data analytics is currently being used.
3M HIS has a long history of clinical classification. In population health, grouping individuals by clinical risk can be an effective tool for risk adjustment, measuring disease burden across populations and offering insight into the overall operation of a population health management program.
Similar to that, episodes of care define events like pregnancy or hip replacement, to reflect a patient’s total burden of illness, severity level and utilization patterns associated with each. As such, they can provide benchmarks for expected utilization and cost based on a person’s medical complexity, as well as variation from these benchmarks.
For a given episode of care, like knee replacement, analysis can reveal whether an organization is meeting utilization expectations for ancillary services, post-acute care, ED visits, readmissions, and even complications. These variables can be analyzed by facility, physician or managed care organization. Another level of analysis can include overlaying social risk data on either episodes of care or clinical risk groups to gain further insight into variation in care and outcomes. Taken together, these methodologies can serve as a guidepost for organizations who are seeking to define and improve performance in meeting population health benchmarks.
We are still on the health care transformation journey. Future steps include infusing health equity into every population health management program through better collection, standardization and integration of social risk data. In addition, we need to enhance adoption of population health management down to the level of individual physician practices. In order to achieve this, the software and services have to evolve to be better integrated into physician workflows to make their life easier, and at the same time deliver insights that aid decision-making in a meaningful way.
Kelli Christman is senior marketing communications and strategic communications specialist at 3M Health Information Systems.
Melissa E. Clarke, MD, CMQ, is senior medical director, health care transformation and health equity, at 3M Health Information Systems.