Population Health: A Home Care ‘Unicorn’

Home health care providers may be feeling pressure to improve “population health,” but they might not know what that phrase means. And they’re not to blame: While better population health is a stated goal of many new policies and models under the Affordable Care Act, there is no clear, widely accepted definition of the term, industry leaders say.

“I think of population health management like a unicorn; everyone can describe it but no one’s seen it,” said Lynn Simon, M.D., president of clinical services and chief quality officer for Community Health Systems, a Tennessee-based national hospital system with a home care and hospice division. She spoke at the National Association for Home Care & Hospice Financial Management Conference & Expo in Nashville on Monday.

The way that Community Health Systems approaches population health management is through initiatives to identify gaps in patient care — for example, by looking at electronic medical record data to find patients who haven’t been receiving regular care for their diabetes.

While doing interventions for these patients might not rise to the level of what might be considered population health management by some, it is a way of providing more coordinated care for Community Health Systems patients, Simon said.

“I think coordination is the word,” said Keith G. Myers, chairman, CEO and co-founder of LHC Group, one of the nation’s largest home health providers. “For me, I don’t know how population management is defined, if there’s a generally accepted definition, but if it’s not coordination of care that leads to higher quality outcomes with a lower cost, then I don’t know what the point is.”

Barbara Knott, regional executive director of home care services for health system Kaiser Permanente in Southern California, took a bigger picture view in offering her definition.

“From my perspective, it’s a combination of different factors,” she said. “There’s the health care, there’s individual behavior, there’s social environment, physical environment, there’s genetics. All of that combines to really determine the population of a community, or the health of any given population.”

Understanding and managing those factors is what health care providers, including those in home health, are being called upon to do, she said. And doing so requires action on multiple fronts, including risk stratification and targeted screenings/outreach for subgroups that are at risk for certain health issues, as well as models for utilization and cost to ensure that health care remains affordable for everyone in a specific community.

Yet another take on population health: It’s not worth getting too hung up on what it means, because it’s become a catch-all term for health care reform generally.

“My cynic’s going to come out,” said Paul Babinski, president at Liberty Healthcare & Rehabilitation Services, a privately owned organization out of North Carolina operating 21 skilled nursing facilities and 24 home care/hospice offices. “I think population health management is just a politically correct [phrase] … It’s the new way of health care delivery … It sounds a little George Orwellian to me, but it’s the label we’ve put on it.”

Pick a Population

Part of the confusion surrounding the term might be its vagueness about what “population” is being discussed. Home health providers might be wise to consider how they can help manage the health of — and reduce the costs of care for — specific populations. LHC’s Myers offered an example illustrating this point.

The chief financial officer of a hospital partner called LHC with a pain point: 17 specific indigent patients costing the hospital nearly $300,000 on a cash basis a year.

The hospital executive asked LHC, as one of the hospital’s joint venture partners, to devise a plan to keep these patients out of the acute-care setting.

“We put together a plan to manage those patients, and were able to reduce costs about 40% annually,” he said. “That’s the best population health success story we have to date.”

The issue stems from the fact that indigent patients often have multiple chronic conditions yet are sent home from the hospital without support services, because they cannot afford them, Myers told HHCN.

By forging personalized care plans and affording 24-hour availability to caregivers, a home health provider can both keep conditions in check and do interventions — often in the middle of the night — when there are exacerbations, preventing emergency department visits and other hospital utilization, he said.

The story suggests that hospitals and health systems might have a particular pain point with indigent patients, and that in-home care can be a key part of the solution.

But home health providers need to be sure they have an arrangement by which they still can receive appropriate payment for this type of care, such as through a joint venture or another model, Myers cautioned.

Still, he is bullish on home health’s ability to serve this patient population.

“Home care can definitely reduce the cost of managing these patients,” he said.

Written by Tim Mullaney