RobFromberg_2012_r1On game days in Chicago, the area surrounding Wrigley Field is filled with people offering places to park.

 

Wrigley Field is in a mixed residential and business area, and as you drive down the street, everyone from parking lot attendants to home owners stand on the street waving authoritatively toward a parking space.

A friend of mine—new to Chicago—was driving near the ballpark one game day. He wasn’t going to the game or even anything in the neighborhood. Yet when an attendant confidently signaled my friend to turn into a parking lot, he complied. Then, embarrassed that he had followed directions so gullibly, he actually paid to park his car and walked around the neighborhood for a while before resuming his drive.

Most people are not quite so malleable. But healthcare finance professionals are constantly subjected to people confidently waving them toward one approach or another. Surely, it’s difficult to judge, among all those competing for your attention, which recommendation fits a particular organization and situation. 

This month’s hfm cover story, “A New Model for Care: Population Management,” highlights how three organizations are developing the capabilities to manage the health of a defined population. That goal is dauntingly complex, and the potential approaches seem infinite, from choosing the population to setting up metrics to determining risk sharing to identifying partners. Yet the three organizations in this story have been able to work through the options and complexities because they have a clear sense of destination. 

For example, in a joint effort between Advocate Health Care and Blue Cross Blue Shield of Illinois, the organizations’ goal was “not only to improve quality of care and outcomes, but also to reduce the total cost of care for Blue Cross patients—particularly for high-risk ... patients.”

In 2009, Fairview Health set a strategic goal of becoming a population health management company by 2012. “We recognized that we were going to have to deliver value in a different way, by managing the health of populations and improving quality of care while reducing costs.”

Dean Health began with a focus on “providing the right care at the right time in the right place for patients—not only patients in the health plan, but for all patients,” with a goal to “enhance quality of care, improve outcomes, and achieve higher levels of satisfaction among patients, physicians, and staff.” 

These goals allowed each health system to forge a clear route. For example, Dean Health “developed a medical value program in which clinicians and staff across the continuum of care work with data analysts to identify opportunities to improve clinical processes and care management.” The program used claims data from Dean Health’s health plan “as well as data from electronic health records maintained by Dean Health and hospitals in the … area owned by SSM Health Care.” As a result of such initiatives, Dean Health has been able to accept performance risk for almost 70 percent of its business.

The traffic and distractions around Wrigley Field are intense, but nowhere near as intense as the complexity and uncertainty of health care. Clear goals help avoid unintended side trips.

Publication Date: Friday, March 01, 2013

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