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Jonathan Niloff, M.D., is vice president and chief medical officer of McKesson Corporation's Connected Care and Analytics unit. In this Q&A,Niloff, a former longtime Harvard Medical School associate professor and founder of a population health company acquired by McKesson, explained population health strategies that can best produce good outcomes in the first part of this two-part series. Among them are teamwork among caregivers and care coordination.
What are the most critical elements in establishing effective population health strategies and producing better outcomes?
Jonathan Niloff: The first priority is that the leadership of the organization has to achieve alignment among both the executive team and all of the key constituents of a population health approach. And that usually means that they're going to be doing some type of value-based contracts. Once you have successfully done that, then you need to recognize the challenges associated with making the transition to a population health approach. And that's recognizing that there are conflicting incentives with respect to the fee-for-service model, which means that you're now going to be focused on outcomes, and that the [historical] incentive for volume will no longer be in place. That requires certain accommodations and certain mitigation strategies to survive the transition to a population health model.
What are the overarching benefits of better population health strategies, and outcomes, for the whole healthcare system?
Niloff: I think our current healthcare system, and the way it's financed, is not sustainable. Inflation in healthcare costs can't go on at its present rate and have America be competitive in a global economy. And if we look at healthcare outcomes in the United States and compare those with the rest of the western or industrialized world, or other countries with advanced economies, we find that we are spending much more money per capita without a commensurate difference or improvement in health outcomes. So with that, there's the opportunity with a population health approach to actually drive better outcomes for a population at large. And this is while decreasing costs, which will be better for employers, better for insurers and better for the population. Clearly, if we can spend less money on healthcare and get better outcomes, then everybody benefits.
How can physician practices, as well as larger healthcare systems practice population health? You usually think of the bigger providers doing population health. But can you scale it down to smaller providers as well?
Jonathan Niloff, M.D.vice president and chief medical officer, McKesson Corporation Connected Care and Analytics
Niloff: Absolutely, population health is, at its core, focused on coordinating care across the continuum for patients, and for doing good, preventive health and proactive care. That can be done on a system-wide scale, or down at the practice level. Indeed, even among health systems, much of the implementation of a successful population health program is at the practice level. And it's associated with implementing what's often been referred to as a primary care-centered medical home approach, where the practice is organized as a team. Each member of the team practices at the top of their license. And that team is responsible for coordinating the care of patients across the continuum, assuring good access to care 24/7 and assuring that gaps in care are identified and practice guidelines are followed. Not just when the patient comes in for a visit, but in a proactive fashion. It involves implementing a program for patients who are sickest, have chronic conditions, and are undergoing transitions in care -- the patients who typically are the most vulnerable.
A member of the team [is] assigned to them, monitors them, and helps keep them healthy and out of the hospital. In some bigger systems, some of that care management is done centrally with specialized teams. Then in other systems, that's done exclusively at the practice level, and sometimes you see [a] hybrid-model. But the principles remain the same, regardless of the implementation model.
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