Laying Strong Foundations for a Population Health Focus

At the National Association of Managed Care Physicians Fall Managed Care Forum 2017, James J. Bleicher, MD, MHCM, regional president of SSM Health, discussed the foundational steps necessary for healthcare organizations looking to transform their business to focus on population health.

When Bleicher first entered the large, not-for-profit SSM Health system, he was confronted with the challenge of getting many disparate medical groups to overcome their inertia and begin a journey towards value-based health. Providers were generally paid based on net revenue, and very few were rewarded for performance. However, the system saw the benefits of adopting a population health focus and wanted to learn about the foundational steps it needed to take to move forward.

First, Bleicher helped SSM evaluate the levels of engagement among its physicians and found disappointingly low results. There was no communication across groups and they lacked shared goals, with each trying to maintain their own status quo. The organization was paying for an expensive analytic tool that was just “spitting out reports” that no one actually used.

He explained that his team had to start with the end in mind. Instead of having administrators issue mandates to the providers, they educated them on the end goal and why it mattered, and relied on the physicians to brainstorm ways to achieve those goals. For instance, they explained that providing evidence-based medicine would reduce variations in care and lead to better outcomes for patients. While this would also eventually produce cost savings, “cost isn’t what wins hearts and minds,” Bleicher acknowledged.

This cultural change in the providers’ mindset was one of the foundational steps that was necessary to move towards a population health focus, along with shifting away from volume-based compensation formulas. The organization also had to restructure the governance of the physician groups and redesign the primary care processes to be more “lean.”

The 2-year transformational timeline at SSM began with creating the strategic vision for change and continued to add more complex steps, like engaging the physicians and aligning incentives. “To undertake these changes was difficult,” Bleicher said, adding that sometimes it felt like taking a step back instead of forward.

Still, the transformation persisted, and countless weekly meetings resulted in a new hierarchical structure of departments across practices, which allowed providers to maintain a feeling of ownership while learning from the various solutions offered by those from different offices.

Next, Bleicher described, it was time to “test the waters” by taking on financial risk for performance, as it was difficult to get the organization’s stakeholders to buy in until money was at stake. “Once we had a contract that we were at risk for, it was much easier to focus everybody on 'this is where we need to go and this is how we’re going to get there,'” he said.

Another initiative that met resistance was the primary care redesign that involved forming partnerships with retail clinics; it was shunned at first until providers realized that healthcare is now a retail business catering to patients who want expanded access to care. Similarly, some physicians were resistant to the pivot towards telehealth until they realized that the idea was here to stay. “There’s no turning the clock back” on these ideas, Bleicher said.

As advice for any health systems looking to move towards value-based care by focusing on population health, Bleicher recommended they become familiar with their metrics by tracking data before the change, so they can anticipate the level of risk they will be taking on and communicate the changes to providers.

Bleicher highlighted some promising results SSM Health had observed after its switch to risk-bearing contracts, including a lower medical loss ratio and high rates of members receiving recommended services like glycated hemoglobin tests. Through the care management program it had implemented, the organization had changed the way its providers care for patients, and Bleicher emphasized the fundamentals that had made this transformation possible.

“Without the foundational steps that we went through, there’s no way we would have gotten here,” he concluded.