Population-Based Health Care Central to New Payment Models
New health care payment models are holding physicians and their care teams accountable for their population of patients. This approach is called population-based health care and it involves taking care of the patients you see regularly in your office and those that you don't.
Population-based health care is central to new payment models for accountable care organizations and for payments that reward Patient Centered Medical Homes. It also is a foundation for most pay-for-performance payment models.
Health insurers in Pennsylvania increasingly are adopting payment models based on population-based health care. Population-based health care also is called for in the "Health Care Innovation Plan" Pennsylvania is preparing as a road map to achieving the Triple Aim of better health, better health care, and lower costs. Nearly 300 stakeholders have helped to develop Pennsylvania's plan over the past 6 months as part of a federal State Innovation Model planning grant.
A brief published by the Tufts Managed Care Institute defines population-based health care and notes the value of this approach to care. The authors call population-based care "a positive force for both treating individual patients and caring for populations."
As the brief describes, populations of patients can be defined broadly (e.g., all of the patients assigned to or choosing the practice for their care) and more narrowly (e.g., all of the female patients over age 50 or all of the patients with diabetes).
By identifying populations of patients, providers can most effectively and efficiently ensure patients are receiving the care they need according to evidence-based guidelines-both individually and as an entire population.
Performance is measured using numerators and denominators. The denominator is the defined population. The numerator is the number of patients in that population receiving the service or meeting the parameters being measured.
Proactive population-based care focuses on increasing (or in some cases, decreasing) the numerator to improve overall outcomes for the population. Good clinical information systems (e.g., registries, EMRs) allow you to identify the patients not counted in the numerator so you can reach out to them to schedule an appointment to fill any gaps in care or intensify treatment (e.g., add or change a medicine, offer more self-management support, follow up more frequently.)
As the Tufts brief notes, population-based health care is best implemented in a team-based approach, where everyone in the office is assigned a role-and is clear on that role and accountable for doing it-in improving both patient- and population-level outcomes.
For more information on how to manage your population of patients, check out the instructional materials, tools, and resources on the PA SPREAD website .