10 Jan Change Management Within Population Health Management
The concept of population health is daunting when you consider its very definition – “an approach that aims to improve the health of an entire human population.” Yes, the definition is aspirational. However, I want to share how it can be made achievable through change management.
Our rapidly changing healthcare environment has pushed every healthcare delivery organization to quickly adapt to new technology, new partnerships, new customers, and most importantly new regulations. As patients become more informed and consumer focused, healthcare providers will be further challenged to provide better quality at a lower cost. In doing so providers will need to master a range of capabilities and processes which could be non-existent or underdeveloped, including developing a structured approach to the management of variable costs and quality at the lowest level; they will need to build the clinical and financial capabilities to mitigate risk; they will need to develop feedback mechanisms within the clinical teams to address cost and quality outliers; and need to create more capabilities to demonstrate and communicate value to key stakeholders, such as downstream provider partners as well as to patients.
Our System Today
Let’s examine further why population health management is daunting. For example, the fee-for- service (FFS) payment model that has driven healthcare delivery for decades has created a pay as you treat culture, in which major players operate in silos and simply focus on profitable treatments and services. In acute
care organizations, the clinical departments and service lines quite often default to managing care in such a way to optimize patient flow and volume while minimizing demands upon physicians. This causes care transitioning and discharge planning decisions to often be delayed until the last minute, resulting in poorer care, higher costs, and longer patient stays.
Additionally, there are unnecessary costs and outcomes due to a lack of coordination and communication across providers in the preventative, acute and post-acute settings. For example, the existing payment and incentive models reward providers for delivering additional services to patients in the acute care setting even when they could be offered for far less in other settings. Because of incentives like these, providers don’t develop capabilities for care coordination with other provider partners.
Lastly, clinical decision making is divorced from the financial implications and from health care outcomes. These boundaries will need to be removed, as a fundamental principle within population health is that payment is linked to both cost of care and quality outcomes. Physicians must have insight into the cost implications of their clinical decision making and hospital leaders must understand how clinical outcomes are related to expenditures.
Change Management to the Rescue
Change Management refers to an approach to transition individuals, teams, and organizations toward using methods intended to re-direct the use of resources, business processes, budget allocations, or other modes of operation that significantly reshape a company or organization. Making the transition to population health will challenge and strain many organizations’ leadership to build accountability, redefine expectations, and guide change across the management team.
There are five critical factors that impact organizational behavior which require critical and careful examination. This is not a quick fix, nor will change happen overnight. However, identifying areas that need to be revamped and by incorporating feedback as the organization adjusts is critical to the success of change management within the population health journey.
1. Evaluation of organizational structure, goals and objectives – Reviewing the organizational structure, reporting relationships, short-medium-long term goals, and how they are being operationalized are critical in determining if they are aligned with the goals of population health. A major question every organization must ask itself is whether their structure and processes support the change required to transition to population health management. For example, if an organization wants to manage variation in cost and quality, it must create collaborative opportunities and processes which involve clinical and financial-administrative stakeholders.
2. Technology (data analysis) – Today, most organizations believe that they need a new data platform before they can begin to answer tough questions about cost and quality when in reality, the information they need most is already available. The matter of develop- ing a disciplined and coordinated approach to using data is typically grounded in cultural trust issues and is not an information technology issue. So, staff having the right analytical capabilities, and leadership creating processes to involve them in answering key analytic questions and holding clinical and administrative management responsible for data-based solutions, is the challenge in moving toward population health.
3. Leadership style – The ability to convey a vision, define context, focus the team on the big picture is key to maintaining alignment and requires continuous commitment and sustained effort. Because goals must be carefully defined and consistently communicated, leaders must truly understand the concept of value and how to make the concept come alive throughout the organization via their daily actions.
4. Incentive and reward mechanisms – Job descriptions, performance review criterion and bonuses will all need to be combed through to ensure that they are significant enough to make a difference and
driving the right behaviors to support population health management. Highlighting the behaviors and values required for managing population health, and in turn also celebrating successes, helps the organization adapt much faster.
5. Team collaboration and cohesion – How teams define themselves and align around their goals can be used to encourage new behaviors. To truly be effective, focus must be placed on actionable outcomes, authentic communication and the encouragement of follow- through behaviors. Strategically using retreats, seminars and celebrations will keep everyone on the same page and promote cohesion.
Moving your organization through its journey of population health is a daunting task and all five factors discussed must be aligned to support sustainable change. Understand that your investment toward taking your organization down this change management path toward population health will lead to the outcome of your having built a new company focused on ensuring its long-term success. This is how health population management becomes achievable.