Population Health: Chasing Outcome Alignment

Answering the question, “is our population health program successful?” is difficult. It’s next to impossible if we can’t answer, “what should our population health program drive toward?” first.

Today, a group of over 60 provider, payer, and vendor leaders gathered to lay the groundwork needed to answer those questions.

“One man’s wasteful healthcare spending is another man’s main revenue stream.” This quote, by Shawn Stinson from Blue Cross Blue Shield, stuck out in my mind as I sat listening to him in a conference room in downtown Salt Lake City.

He spoke about population health, and how we can drive toward better outcomes. The question is, "what are those better outcomes?"

“Reducing costs!” was my response, when asked that very question last night at dinner. But Kathleen, a vendor representative in town for the conference, quickly replied, “Ah, but whose costs will we reduce?”

Which, of course, is why Shawn’s quote has sat center-stage in my mind all day. The very costs we want to reduce represent revenue for some key stakeholder in the healthcare puzzle. Making procedures less expensive means providers are paid less.

Beyond that, lowering healthcare premiums chips away at the bottom line for payers. Ultimately, it’s easy to say costs should be reduced until we talk about the costs that keep your lights on.

Shawn proceeded to tear into all the ways that US healthcare is broken. None of the information he presented was new and intentionally so. He didn’t want to educate, so much as set the stage for a discussion around tangible outcomes.

Instead, Shawn brought these healthcare-cost data points to highlight the fact that population health has an outcomes alignment problem. Shawn explained, “every system is perfectly designed to get the exact results it produces.”

With the US spending 18% of its GDP on healthcare, and outspending the GDP of all but the four largest economies – what exactly are the outcomes we’re driving towards?

That, of course, is the multi-billion-dollar question.

Most providers agree that the healthcare model should shift from fee-for-service to value-based care (see below). Still, many are unsure how to measure success when going at-risk with payers or developing a capitation model for payment.

I’ve had conversations with several vendors in attendance at this Cornerstone Summit. Each time, I’ve asked “what are you hoping to accomplish here today?”

Inevitably, their responses come back to outcomes. “I want this summit to clearly define what provider are looking for from my solution.” Or “How can I tout my company as ‘perfect for their needs’ if providers don’t know what they need?” were common sentiments.

Similarly, providers are hungry to share what they feel is most important, and have their ideas challenged and aligned with other industry stakeholders. At KLAS' conference today, they’ve had the opportunity to do just that.

As in years past, this conference will result in a white paper on population health. (You can find the first and second iterations of these summit efforts here.)

KLAS, not satisfied with just giving a definition to these outcomes, will use the results of today’s summit going forward in measurement. The agreed-upon definitions and goals stated today will direct the laser-focus of KLAS’ research into population health going forward.

In the coming year, we will publish reports that measure vendors up against the expectations set by payers and providers today. While this exercise won’t solve every problem in population health – and I never expected it would – it represents another step forward in the decades-long discussion of how we improve our healthcare.