In my last two blog posts, I talked about analytics in the real world of healthcare. The first post discussed how hospitals can reduce quality variation to lower costs, and the second post discussed how hospitals can use analytics to improve surgical outcomes. In the last post of this series, I profile two outstanding examples of how analytics can play an important supporting role in both guiding strategy and achieving operational excellence. Bellin Health of Wisconsin and Atrius Health of Massachusetts are two healthcare providers that have embedded a disciplined, measurement-oriented approach to population health in the operations of their organizations. And both have achieved impressive results to show for it.
Atrius and Bellin are among the success stories of the Pioneer ACO (Accountable Care Organization) program. Each ranks among the 10 Pioneer ACOs that delivered statistically significant savings in both of the first two program years. Even more significantly, they together represent two of the three organizations that accounted for 70% of the Pioneer program’s overall savings. But the Pioneer ACO is just one of many examples of populations that Bellin and Atrius manage.
So how have these providers achieved success in migrating to population management models while so many others have struggled? The answer lies in clearly defined strategies based on the Triple Aim goals of improving health, lowering costs, and ensuring positive care experiences. It also lies in having a culture that is unwaveringly dedicated to achieving those goals.
Interestingly, the two organizations are different in many respects. Atrius is a large multispecialty physician group in a primarily urban region, while Bellin is an integrated delivery network that serves a more rural population. What they share is a disciplined approach to defining, managing and measuring populations, coupled with a focus on continually refining and improving their processes.
Four keys to success in population health
The fundamental approach is quite similar between the two organizations:
1) Segment populations into groups of individuals with similar characteristics.
Atrius divides populations into:
- The 5% who are acutely ill with advanced conditions or multiple chronic diseases that are expensive to treat
- The 15% who require chronic care or who have a rising risk profile
- The remaining 80% who are essentially healthy and less expensive to care for
Bellin, on the other hand, uses a four quadrant segmentation with axes of per capita cost of care and clinical risk. The quadrant that is low for both cost and clinical risk represents healthy individuals. Those individuals with low clinical risk and high costs are considered “high utilizers”. Those with high clinical risk and low cost are “rising risk”. And the quadrant high on both counts consists of the most acutely ill individuals.
2) Identify gaps in care and opportunities to improve.
Atrius convenes clinical and operational leaders to seek out improvement opportunities using the data available for each of the segments.
Bellin evaluates population opportunities using a set of metrics organized into categories of cost, care experience and quality.
3) Formulate evidence-based practices and implement processes to apply them.
Atrius draws on their extensive experience managing populations to create additional evidence-based processes which are implemented within a patient centered medical home (PCMH) model. All of their primary care practices are NCQA level 3 certified for PCMH.
Bellin uses the Total Production System model — a continuous improvement methodology developed by Toyota — to operationalize processes. The system outlines improvement initiatives and defines objectives for six “primary driver” areas which include high functioning patient care, medical utilization management and engaged and activated consumers.
4) Track compliance with processes and measure outcomes.
Both organizations use rigorous measurement programs to establish target performance levels, monitor fidelity to processes and assess the impact on outcomes. Information compiled through the measurement process also provides a basis for identifying additional improvement opportunities.
This approach by itself may not seem particularly novel. However, the formula for successfully executing it lies in leadership and culture. The leaders of Bellin and Atrius believe that transforming their organizations to thrive in a world of risk-based, population focused contracts is essential to ensuring their long term viability. And the cultures of their organizations reflect a passion for realizing the goals of the Triple Aim. Information, measurement and analysis serve as the foundation that makes it all possible.
Read the rest of the series
- Analytics in the Real World of Healthcare: Reducing Quality Variation to Lower Costs
- Analytics in the Real World of Healthcare: Improving Surgical Outcomes
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