Time to Refocus on Population Health Strategies

By John N. Kastanis, FACHE, MBA

As we continue to navigate the unknowns of the current pandemic, it appears we are still a long way off from living in a true post-COVID-19 era. Only when we are equipped with the knowledge and resources needed to deal with new types of SARS viruses, including effective new treatments and vaccines, will we truly move forward.  But until that time, improved health outcomes can still be realized through effective population health strategies, providing adequate financial resources are available. 

As health care providers, many lessons and observations have already resulted from the COVID-19 pandemic.  One glaring reality to come out of this shared experience is that the U.S. health care system’s finances are too heavily focused on elective surgeries, urgent and emergent care, and not on public health.

It is safe to say that we aren’t out of the woods yet, by any means. The COVID-19 pandemic will likely sink financial margins further, pushing half of U.S. hospitals into the red through the second half of 2020, according to a recent analysis from Kaufman Hall & Associates. In fact, it’s highly probable that most health care organization’s strategies will be upended, particularly for population health, which will have a waterfall effect throughout the communities they serve.

That is why there couldn’t be a more critical time for population health programs to prevail.  Population health programs encompass all the determinants of health in communities, including social, behavioral and environmental factors.  

Some health providers have observed that individuals with underlying conditions, especially from lower-income neighborhoods and communities whose main demographic encompasses monitories, are more likely to face adverse effects of COVID-19 and be at higher risk for serious outcomes. 

In fact, at the height of the pandemic in New York City, it was reported by the Department of Health that comorbidities had proven the overriding rule in coronavirus-related cases, with 86% of reported COVID-19 deaths reporting at least one comorbidity as a contributing factor.  This suggests, at the very least, those who are able to access primary and/or preventative care to manage certain adverse health conditions are better able to rebound from the disease and experience better outcomes. 

However, an effective population health strategy offers much more when it comes to improving the overall health status and lowering the costs of care for a defined group or geographic area. This is especially true when social determinants, such as adequate nutrition, proper housing, transportation, education and institutional racism are addressed in partnership with other community-based organizations working toward a common goal.

True population health programs have four fundamental building blocks, According to Jon Burroughs, MD, in “Essential Operational Components for High Performing Healthcare Enterprises.” These fundamental components include health providers aligned with at-risk contracts; integrated health networks (IHNs); health information exchanges (IHEs) and enterprise data warehouses (EDWs); and appropriate infrastructure which includes palliative care, disease management, post-acute care, retail medicine, and e-health.  It takes all of these components working together in a coordinated and strategic manner to truly make fundamental and lasting impacts on the populations these programs serve.

Needless to say, all four components require many resources and fortitude for financially struggling hospitals and health systems to begin embracing value-based care, instead of volume-based care.  Risk contracting, the cost of IHNs, HIEs and population health infrastructure will be daunting. 

At the present time, most hospitals are calling out for new financial support due to COVID-19-related cost overruns and significant revenue shortfalls with the onset of the pandemic.  To get effective population health programs back on track amid the current financial landscape will be even more challenging, and therefore, new incentives should be considered by the CMS (Centers for Medicare and Medicaid Services) and state-based Departments of Health to provide additional support.

As health care providers, we can no longer delay focusing on more equitable access of health care services to those with the greatest needs, the overall health of patient populations being served, and all at a reasonable cost.  Despite all that the industry, and workforce has experience during this unprecedented year, if we can continue to make population health programs a priority for our communities, the return on these investments will be incalculable.