Population Health Management and the Journey to Medical Home Certification in a Rural Community

Abstract

WHY ADOPT POPULATION HEALTH MANAGEMENT?Population health management has been the focus of many studies and articles as a critical strategy for success as the healthcare delivery system changes in response to government regulations and insurance industry shifts. It also is frequently cited as a tool to manage costs. Zenty and Bieber's feature article discusses how University Hospitals Health System's (UH) population health management initiative evolved through the experience of its various accountable care organizations (ACOs), which were formed to address the rising costs of their self-insured plans.In the other feature article for this issue, Kindig and Isham discuss the need to improve the health of our communities and close the lag in health outcomes across the United States compared to most developed countries. I believe their message that the challenge of population health improvement cannot be the sole responsibility of the healthcare industry is critical to understanding how we move forward.A recent article in the Journal of the American Medical Association, by Friedberg and colleagues (2014), complicates this discussion, however. Those authors suggest that the care offered in a patient-centered medical home (PCMH) environment, which is designed to coordinate resources to improve patient care, offers little benefit to the outcomes experienced by the patient or in reducing the cost of care. One might conclude from Friedberg and colleagues' findings that if a PCMH or another population health management tool produces no cost management or patient outcome benefits, why invest in the effort?These authors directly or indirecuy link population health management to the Triple Aim as articulated by the Institute for Healthcare Improvement (IHI): improvement of individuals' experience of care, improvement of the health of populations, and reduction of per capita cost of care for populations. Of these, in my opinion, that improvement of the individual experience of care could be the most significant factor influencing the achievement of health improvement and, eventually, cost management.The Perspective of a Critical Access Hospital/Rural Health ClinicYuma District Hospital and Clinics (YDHC) consists of a 12-bed critical access hospital and two rural health clinics offering family medicine, a specialty clinic that brings a variety of medical and surgical specialists to the community throughout the month, and a PhD-degreed psychologist and licensed professional counselor. We offer post-acute care through our swing-bed program and a home health agency. Our ten primary care providers are employees of the organization. Consider us a micro-integrated healthcare delivery system serving a population of approximately 14,000 people spread across a wide geographic area.In 2008, YDHC was invited to participate in an initiative led by the Commonwealth Fund, Qualis Health, and the MacCoil Center for Health Care Innovation at the Group Health Research Institute. The objective of the initiative was to develop and demonstrate a sustainable model to transform primary care safety net practices into PCMHs, thereby achieving the IHI Triple Aim goals. (For more detail about the initiative, refer to www.safetynet medicalhome.org.) We eagerly agreed to participate, with the simple thought that this would be a tool to improve patient care in our rural health clinic. The timing seemed right: We had recently moved into a newly constructed replacement facility to house our hospital and our main clinic, and we were midway through the rebuilding of our medical staff. It was our feeling that this would not be a long journey and that the care provided in our facilities was already close to that of a medical home environment. It did not take long for us to realize that we were just beginning.At the same time as we were moving forward with this initiative, we were faced with a population of patients who believed that their experience of care was not satisfactory. …