Blue Cross Blue Shield of Michigan senior vice president and chief medical officer, Dr. Thomas Simmer, M.D., recently joined a panel of local health care executives to talk about how population health management is being addressed in Michigan.
But what exactly is population health management? In simple terms, it’s exactly what it sounds like: managing the health of a group (population) of patients. Hospitals and doctors take accountability for a specific patient population, and work to help those people meet certain health goals. For example, the Detroit Medical Center’s Make Your Date program works to reduce infant mortality in the Detroit region.
For Dr. Simmer, the nature of population health management was illustrated when he attended a conference and learned about a population health goal for a county in Sweden.
“One of the goals for the county was to increase the number of people who turned 21 years of age who had never had a cavity,” Dr. Simmer said. “That really shocked me. What position are we in to create goals for our population? We don’t even know who the people are who’ve reached 21 years of age and have been to the dentist.”
His point? Until you have the right infrastructure and information available, you can’t connect the care of individual patients to the health goals you set for the population.
But why should you care if fewer people have cavities? The fact is, everyone wins when providers can effectively manage populations of patients. Patients have better care experiences because their care is delivered in a more organized, personalized and proactive way. It helps reduce unnecessary tests and treatments – which means safer, quicker and less costly care.
In talking with other physicians, Dr. Simmer found that most were solely focused on taking care of one patient at a time.
“To me, population health is a way of taking better care of patients one at a time, because you understand the goals you want to meet overall,” said Dr. Simmer. “What we usually find is that takes a different model of care that what we’ve been doing.”
Michigan has made many strides towards an improved model of health care. Blue Cross Blue Shield of Michigan has award-winning initiatives, called Value Partnerships, which are associated with improving care quality while lowering spending. Value Partnerships programs have improved cancer screening rates and emergency care, transformed hospital reimbursement, reduced unnecessary use of health care services and saved millions in health care costs. But we still have a long way to go.
“What we don’t know is how to measure health in a global, more holistic way,” said Dr. Simmer.
In order to succeed in this new model of care, providers need to identify a population, collect specific information about patients across points of care (different doctor’s offices) and be able to act on the data we receive.
In essence, we need to build a foundation that enables population health management. A big part of ensuring the financial success of health care providers is linked to the quality – not quantity – of care.
“Part of population health is building a payment model that actually supports a better care model,” said Dr. Simmer. “It’s not fair to criticize people for practicing in the only way that’s economically viable.”
While Blue Cross Blue Shield of Michigan has been leading payment transformation in Michigan for years, there’s still more work to be done.
Dr. Simmer compared the challenge of change to learning a new dance.
“If you want to change the dance you have to change the tune,” he said. “It’s one thing to change the tune, but that leaves two choices: either dance to the new tune or leave the dance floor.”
Payers like Blue Cross not only have to change the payment model, but also facilitate and enable the transition.
“I think a lot of people are leaving the dance floor because they don’t know what to do,” added Dr. Simmer.
Read more insights from Modern Healthcare’s Detroit Issue Briefing in Crain’s Detroit. To learn more about how Blue Cross Blue Shield of Michigan is transforming Michigan’s healthcare landscape visit valuepartnerships.com.
Interested in health care quality news? You may be interested in these articles:
- Blue Cross Blue Shield of Michigan and University of Michigan Health System Launch Initiative to Improve Emergency Care Quality Statewide
- Cancer Screening Rates Improve, Disparities Shrink for Patients With Blue Cross Blue Shield of Michigan Patient-Centered Medical Home Doctors
- Blue Cross Blue Shield of Michigan and University of Michigan Health System Launch Statewide Initiative to Evaluate and Improve Genetic Testing