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A Q&A with Pop Health Pundit, Kaley Penington

Kaley Penington, one of Bluetree Network’s Clinical Optimization Specialists, recently sat down with Bluetree’s Brand Ambassador & Events Coordinator, Ryan Hill, for a Q&A session on population health, its role today, and its future.

RYAN: Let’s start easy…how long have you been with Bluetree and what does it mean to be a Blueleaf?

Kaley: I have been a proud Blueleaf since last fall. Prior to joining Bluetree, I had worked with a lot of Bluetree consultants and was always impressed with their dedication and knowledge. To me, being a Blueleaf means I get to dedicate my focus to what is truly best for my customer. In doing so, I get to think critically and work creatively, and I have the confidence of knowing that I am supported by a great team.

RYAN: What’s your favorite thing about population health?

Kaley: As a nurse, I love that population health approaches a patient’s care more comprehensively and with improved continuity. A decade ago when I was in nursing school, I remember thinking, ‘Someone needs be assigned to follow these patients after they leave the hospital to make sure they actually get better.’ I hadn’t been exposed to the ideas of population health and care management at that time and, in my mind, there was a clear gap in care.

As an IT professional, my favorite thing about population health is coming up with solutions in the EHR system that make population health management easier for the providers on the care team. The happier and more efficient the care team, the better their care will be for their patients.

RYAN: Let’s get to the root of why population health is so huge right now. I’m assuming it’s been a sort of a natural progression or even a product of this whole idea of “big data” and how everyone is so thirsty for analytics. But what are the other reasons?

Kaley: That’s a really good question, and I think there are a combination of factors.

First, from a clinical perspective, we have an aging population. Baby Boomers are hitting retirement age. As we get older, we have more health issues, and we need more care. So quantity is the first big thing. There are more patients that need more care than we’ve ever had. And we’re such an efficiency-focused society, that one piece of population health is really just trying to provide that care in an efficient manner. And one way to do that is to focus on the population, to kind of break it down to a population level instead of just treating every single patient on an individual basis. Population health takes a step back, evaluates a population, and says, ‘Hey, let’s look at standardized interventions that will result in better outcomes for the individuals in this entire population of patients.' So that’s one piece of it.

The other piece—that is not the fun piece to talk about—is the financial and insurance-related piece of it. Providers are being put under more pressure to provide metric-driven care, so it’s not just the fee-for-service world anymore. Insurance reimbursement, or penalties, factor heavily into value-based care. It’s not just treating the patient, it’s ensuring that you do ‘x,’ ‘y,’ and ‘z’ when you treat the patient. For example, I’m a primary care provider in today's system, and when I used to have a patient come in for a sinus infection, I would treat the sinus infection, bill for it, and get paid. And to some degree, that’s still the same. But now a patient comes in for a sinus infection, I see the patient has Medicare, and I have a whole slew of quality measures that I need to meet because this patient is also diabetic. So I need to make sure they go to the ophthalmologist for their diabetic eye screening. I need to make sure I have a HbA1c on file in the last ‘x’ amount of time and make sure it’s within range. If I don't, I'm not meeting the expectations for value-based medicine.

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So that ties to what I talked about early on, in that if we target patients as a population and look at the care they need based on the population, we’d provide care more efficiently. That’s the idea, so it’s almost like the industrial revolution or the conveyor belt. If we can provide standardized care, as clinically appropriate, the idea is that it will be more efficient and high quality if we approach it from a population standpoint where we’re looking at the data for the population and measuring which interventions produce the best outcomes for those patients.

And then of course, like you alluded to, there’s the big data thing. We’re all in this rat race in healthcare, and everybody wants to be the best and everybody wants to cut their costs the most. Population health is so reliant on data. Once we get the data that everyone is hungry for, that’s a natural place to focus. Saying, ‘OK, let’s look at the analytics, let’s look at predictive modeling.’ Risk stratification is a huge one right now. Being able to stratify your population based on risk, in theory, can help you identify patients that maybe don’t have a disease process right now, but are at greatest risk for it. Then you can intervene early and try to keep that population healthy for longer.

RYAN: You just talked through all the goals of pop health. But for some initially, they might think they’re just doing pop health by getting Epic’s Healthy Planet. What do you tell to the people who maybe even acknowledge that they don’t have an overarching goal with pop health? What are your first steps in talking through that with them?

Kaley: Yeah, so it’s not that uncommon. It’s just with any trend you hear about, and it’s like, ‘Oh, sounds like we should be doing that.’ It’s obviously more than that, but for organizations that are like, ‘Oh, we are late to this pop health game, we don’t know where to start,’ I would sit down with their thought leaders for the organization and ask what their other goals are and what other areas they’re focusing on. Because, more than likely, there’s going to be something related to pop health in there, but they might not have labeled it ‘pop health.’ They may say, ‘We want to be able to negotiate our payor contracts,’ or ‘We want to be more competitive.’ OK, well that’s totally population health, because you want to improve your performance on quality measures for whatever your specific payor population is.

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There’s pretty much a little bit of population health in most operational goal or vision planning that is going on. But sometimes it’s kind of hidden in there and you have to extract it. It’s tempting to sit down and say, ‘OK, who are your sickest patients,’ or, ‘Where are you losing the most money,’ but I think if you can align it with goals that are already taking place, you have a better chance for success.

RYAN: And it sounds like, more often than not, there is that lack of an overarching goal. Would you agree with that or is it rare for people to be completely lacking that? Have you seen it improve over time?

Kaley: It’s hard to say. I still think there is quite a bit of lack in having a focused, very well-defined population health strategy. There are so many needs. Healthcare organization are being pulled into so many different directions right now, that I think it is still on the rarer side to see organizations that have a very well-designed and very well-executed population health strategy. I think we’re moving the needle in that direction, but I wouldn’t say it’s the majority at this point.

RYAN: I want to spin off of Pavel’s blog from a few weeks back. In pop health, there’s a big need to prove certain outcomes and measures, but population health efforts are often led by revenue cycle leaders or contract management teams. But shouldn’t it really be the clinical leaders or care management teams owning that process? What are the challenges in getting that point across, and is it always a challenge to get buy-in on this?

Kaley: To break that down a little bit further, you have your quality management department that is saying, ‘Hey, we need to do better on our payor contracts or meeting our measures, so we need to implement these workflows.’ They may be the sponsors of a project that is focused on optimizing workflows, but it’s not quality management that’s carrying out those workflows. And unless you have clinical—particularly physician—leadership at the table to say, ‘Yes, this is a realistic workflow,’ or ‘No, this is not a realistic workflow,’ it’s going to be really hard to get buy-in. 

Providers do not like being told how to do their jobs, and rightfully so. So when we come in and we say that we’ve implemented this suite of best practice advisories that alert you when you need to give a flu shot or you need to do a foot exam, the reception isn't always warm. If they can be involved in that process and realize that, ‘Hey, we’re IT, not CMS, we’re the people that want to help you be successful when CMS is holding you accountable.’ If it can be more of a partnership in that way, I think that it leads to a lot better understanding of why we’re doing what we’re doing. It just leads to better workflows, because unless you’re a physician or an MA in the clinic—unless you’re a clinical person, you don’t really, fully grasp the workflow. So we need those people at the table to make the tools the best they can be.

RYAN: There’s a lot of ambiguity in population health and I’m assuming it can make it harder to articulate needs from an HCO perspective. How does Bluetree quickly recognize customer needs?

Kaley: I think we really draw on a lot of the fundamental Bluetree principles. We listen, we don’t actively sell really. And that works really well with population health because there is no straight out-of-the-box solution that is going to work for everyone. And there are companies out there that are trying to sell very standardized approaches to population health that may work for some organizations, but it’s not going to be a tailored approach that speaks to an organization on an individual level where they really need help.

I think just really listening and seeing where we can identify opportunities to help our customers in a more tailored approach, rather than a, ‘This is how we do population health,’ blanket approach. That’s why population health is so hard. There isn’t a blanket approach that’s going to work with everyone. So we don’t try to force that blanket approach over everyone. It’s not going to lead to the best outcomes for our customers. We want to really hone in on tailored solutions they actually need and are going to be of real value, rather than just saying we can do something with population health. We want to provide a real solution that is measurable and impactful.

RYAN: A theme in a lot of this is harnessing all this data. When you think of the future of population health, it’s hard not to think about how the data is going to keep growing and growing. Is it going to just keep getting harder to use all of it in effective ways?

Kaley: There are tools being developed and I think that’s important. One area that I think we’re all still really learning is how to best use our resources in population health. I think that’s a big area of opportunity and a big area of growth for population health in the future. It’s how we use our resources.

I think a really good example of this is that we already have a lot of tools and we keep developing more and more that can aid with population health. But if we don’t think about our resourcing and staffing models differently, a lot of those tools won’t be leveraged as well as they could be when doing population health. It’s a big transition from the traditional model of healthcare, so a lot of organizations think, ‘Oh, I need new resources to do these workflows.’ But I would argue otherwise. I think there’s a lot we can do with existing resources if we do some overhauling of workflows and tools that are more focused on population health.

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