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Population Health is defined by Wikipedia as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. The concept sounds new but in reality, the idea has been around for awhile. Most of us in healthcare are always giving thought to projections regarding future needs. Remember Ken Dyctwald’s “Age Wave”? It prompted many developers to get into the Assisted living industry. We were all awash in anticipation for the ”baby boomers” to come of age. Huge waiting lists were forecasted for SNF. Hoteliers immediately started building hospitality oriented retirement communities. Many of the Not for Profit providers set about strategic plans that helped them to project and prepare for the needs of their aging residents, offering more options to remain in the campus community by bringing services to the people vs. bringing the people to the services. But Population Health is less about building places and creating services and more about delivering outcomes and payments models that support collaborative care relationships.
To an increasing degree, LTPAC leadership is no longer referencing their customer base into one large generic group termed “seniors, elders, elderly, etc”. Today, we are more keenly aware of the specific needs of the subsets of categories that comprise the generic reference of “senior”. We know that the needs of a patient in his 60s may be very different than the needs of a patient in his 90s. The Sub-Acute Rehab units today focus on 12-16 day stays in an environment with Flat Screen TVs, Business Centers, Meals on Demand and other amenities that younger customers want. The needs of a dementia patient may be very different than the needs of a short term rehab patient. The needs of a patient with chronic illness such as diabetes and the related co-morbidities may be considerably more complicated than the needs of someone with a hip replacement. Population Health gets providers to segment the users of care by their individualized needs for care, projected outcomes and costs for the care provided.
You’ve heard that advertising phrase from the past…”It’s not your father’s Buick” right? Well, it’s not your father’s healthcare anymore. While providers care for one patient at a time, they must consider the needs of all patients as a whole. Providers and government entities are charged with the responsibility of projecting the future health care needs of the population at large. Population Health is a global concept and encompasses the needs of multiple populations in multiple geographic areas. As LTPAC providers in the U.S. already know full well, the government via CMS (The Centers for Medicare and Medicaid) has initiated multiple audit programs to examine potential improper payments to providers. This is just one approach of the government to prepare for the needs of an aging population.
“Preserving the Medicare Trust” is the ultimate goal of the numerous federal audit programs such as Recovery Audit, ZPIC, etc. Another avenue to help prepare for the care of the growing demographic of those over 65 involves Population Health. Looking at many factors such as current expenditures, health care utilization trends and statistics helps both the government and providers begin to focus on the future needs of specific groups. The MDS is an example of another tool developed to help project the needs of an aging population and prepare for the Baby Boomer Bubble. Originally voluntary, the MDS is now a requirement for SNF providers. Analytics such as those resulting from the MDS play a significant role in Population Health. This may lead to new policies as well as new programs.
Reimbursement for LTPAC providers is shifting to a different model based on quality outcomes. The 5-Star Quality Ratings for SNFs are on everyone’s radar. Medicare is transitioning from a traditional payment methodology to a value based model with tiered projections for each year going forward. Reduction in hospital re-admission rates is a key goal today, being accomplished through joint efforts of acute and post-acute providers. Most often, this is taking the form of ACOs or Accountable Care Organizations where all providers have a vested financial interest in optimizing care outcomes. Provider members of an ACO manage their components of care and expense with a shared goal of providing optimal care and outcomes but at a profit-oriented cost. This is all part of the Population Health Concept. Factors such as race, geography, gender, individual behavior, genetics, social and physical environment can have a direct impact on one’s health and give both access to and outcomes of care. These factors impact individual health and the health of specific populations as a whole.
Population Health is going to continue to impact all providers, and in particular LTPAC providers, increasingly over the next few years. Astute providers will open their eyes and ears to learning all that they can about value based care models and reimbursement methodology. They will align with other providers who offer quality clinical and financial outcomes and together they will provide evidence based optimal care at a manageable cost. “It’s not your father’s healthcare anymore.”
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