Before We Reward, We Must Measure: Tracking Population Health Management by US Hospitals

For the amount of money the United States spends on healthcare—the largest percentage of GDP of any nation—the return on investment is not very good. The U.S. does not perform well in terms of a number of outcomes; notably, it ranks 36th in infant mortality and 39th in lifespan.

Hospitals, which account for the largest proportion of healthcare expenditures at nearly 32%, are key to any effort to reduce costs and improve quality. As part of this effort, experts increasingly recommend that hospitals adopt a population health management focus, which shifts emphasis from reacting exclusively to illness to engaging proactively to coordinate community health and disease prevention. Many companies have created strategic plans for hospitals looking to adopt a population health management model, emphasizing the benefits and need, given shifts in payment models. But there is little data on how successfully hospitals are making the change nor is there consensus on how to track this shift towards a population health focus.

Accurately measuring and documenting hospitals and health systems making this transition from a focus solely on treatment to including prevention in their model is imperative both to appropriately reward improvements and better understand the impact on health outcomes. To do this, we take inspiration from a recent white paper that outlines four key metrics for recognizing hospital-based population health management:

  1. Does the hospital partner with other non-health organizations in the community to target social determinants of health?
  2. Does the hospital understand the health needs and social/economic circumstance of its patient population and the communities from which the patients come?
  3. To what extent are hospital reimbursements or finances tied to the health of the patient population or post-hospital discharge outcomes?
  4. Is care effectively coordinated within and outside the hospital?

Data to measure these four metrics already exist in one form or another.

Does the hospital partner with other non-health organizations in the community to target social determinants of health?

Data to assess this question can be found in the Community Health Needs Assessment (CHNA), which is completed at least every three years by hospitals seeking to maintain non-profit status. This assessment documents the health needs of the community, enumerates existing resources to provide for those needs, and, often times, looks back at the previous implementation strategy informed by the health needs assessment. In these assessments, such as this example by Kaiser-Los Angeles, the hospital lists all of its partnerships initiated in the previous implementation plan, the goals of these partnerships, and their success.

Using this data, which is available across hospitals, is a good place to start in piecing together a picture of the non-health related partnerships, which is an important component of a successful population health model.

Does the hospital understand the health needs and social/economic circumstance of its patient population and the communities from which the patients come?

The second metric can be measured using CHNA interviews with residents and local experts on the community’s health and social needs (the positions and names of those interviewed are also provided). These interviews with community members and stakeholders focus on healthcare accessibility, existing community partnerships, and disease burden within the community. Since the hospitals know the demographics of who is being interviewed, this data can be used to understand what perspectives are being shared with the hospital and how they might represent the community more broadly. Ideally, hospitals would be seeking diverse input to better understand their community’s health and related social needs.

To what extent are hospital reimbursements or finances tied to the health of the patient population or post-hospital discharge outcomes?

Data to assess this metric is attainable from Medicaid and Medicare payment data. In order to incentivize and support hospitals that adopt population health management models, payment schemes tied to the value of care rather than simply to the volume of service must be in place. Publicly available data on payment schemes for each hospital can help us understand the financial underpinning of population health management strategies and see if the payment structures are in place to incentives hospitals to invest in the long-term health of their communities.

Is care effectively coordinated within and outside the hospital?

Finally, in efforts to reduce cost, care coordination is paramount. The extent to which hospitals use electronic health records and software programs (Pop IQ, Azara DRVS) to organize information tracking and to transfer information between different providers and caregivers can serve as a proxy to the level of coordination.

Furthermore, the National Association of Community Health Centers has several other metrics to measure the outcomes of coordinated care, such as the percentage of patients receiving care coordination who showed improved outcomes and the percentage of patients who adhere to treatment plans.

To make our healthcare expenditure more cost-effective, we must reward hospitals that effectively manage population health. But, before we can reward, we must measure. The data is available to begin measuring this shift, and by consolidating the information from CHNAs and payment data into a unified metric, we gain a more holistic view—one that merges community outreach efforts from CHNA, with care coordination and payment plans.