UPMC Health Plan: How population health management delivers better, lower cost outcomes

Population health management is becoming an increasingly popular concept for health care organizations. Population health management — defined as an approach to health that aims to improve the health of an entire population — goes far beyond the concept of only treating patients in need of immediate care.

“Population health management helps health care delivery organizations better manage all aspects of health, from wellness to complex care,” says Dr. Marc Manley, vice president of Population Health Management for UPMC Health Plan. “Population health management has the ability to deliver better health outcomes at a lower cost.”

Smart Business spoke with Manley about population health management and how it will affect health care results and costs.

Why is population health management getting more attention now?

Population health management is gaining more attention because the fee-for-service model is going away. Hospitals, health care systems and physicians understand that they are living in a world that increasingly rewards those who meet quality objectives for their entire population, not just those who present themselves for care.

Population health management also shows the promise of delivering better health at a lower cost by creating an integrated system of care, rather than forcing consumers to figure out how to make their own way through the current health care system.

Aren’t many factors that influence the health of a population beyond the scope of any care organization?

There are many factors that influence the health of a region: environmental factors, economic factors, the social structure, etc. But many health care organizations are already involved in community efforts to improve health. In a lot of ways, population health management complements these organized efforts by addressing factors that impact an entire population. Population health management also puts added emphasis on reducing health care delivery inequities.

How does population health management impact providers?  

Most clinicians already recognize the limitations of traditional care in keeping people healthy, and they’re looking for ways to be more effective. But preparing for population health management requires a significant change for providers.

Providers will no longer be rewarded for doing more, but rather for producing quality outcomes more efficiently. Providers need to assess the health of their entire population across the entire spectrum of health — that includes those who are well, and who can stay well by getting appropriate preventive services. Those who have health risks need help changing their health behaviors in order not to develop the diseases for which they are at risk. For those with chronic conditions, providers can prevent further complications by closing care gaps and working on health behaviors.

Technology will have a key role in population health management, as it can help to assess and stratify patients and target interventions to the right people.

What are the objectives of population health management?

Population health management strives to keep a patient population as healthy as possible, thereby minimizing the need for costly interventions such as emergency department visits, hospitalizations, imaging tests and procedures. In addition to being less costly, it redefines health care as being more than just reactive sick care. By considering the needs of an entire population, population health management systematically addresses the preventive and chronic care needs of every patient.  

What is essential to make this work?

First of all, it will require those of us involved with health care to think in new ways and be willing to try new things. It will also require new financial arrangements in health care that reward positive health outcomes, not more services. And there must be a strong technology foundation, including Web-based tools for patients and providers, and data systems that support analytics across a wide spectrum of inpatient, outpatient, post-acute and community services.

Dr. Marc Manley, M.P.H., is a vice president, Population Health Management, UPMC Insurance Services Division, at UPMC Health Plan. Reach him at (412) 454-0892 or [email protected].

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