Population Health: A Real World View

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In an era of escalating costs and increasing customer expectations, healthcare systems are struggling to supply ever-increasing demands for high-quality, patient-facing health and social care.

By Professor Ben Bridgewater, Director of Healthcare Strategy, CSC, and former cardiac surgeon

The challenges are clear. And, to a large extent, so are the solutions. These include: changing productivity by steps across the health and care ecosystem; moving care out of expensive hospital settings whenever possible; reaping the benefits of scale in both quality and efficiency in hospitals and across hospitals chains; standardising care to eliminate unnecessary variation; and empowering patients to move from re-active to pro-active healthcare to keep an aging population in the pre-clinical states of its diseases for as long as possible.

These solutions need to be driven by novel operating and payment models.

As digital transformation — and disruption — change all industries, so it is with healthcare. Bringing data and insights to the heart of the health and care business is changing operational efficiency, organisational structures and the “products” delivered by healthcare businesses. CSC has been at the forefront of a number of these initiatives around the world with its approach to population health management.

One example is the Trafford NHS Clinical Commissioning Group (CCG) in Manchester. This is an organisation that commissions healthcare on behalf of an urban population of 220,000 residents. The CCG had been working to support a small district general hospital in its catchment area and had commissioned multiple local and community services to take pressure off the hospital, which was struggling to deliver its targets. Despite the CCG’s best efforts, nothing it did seemed to help the hospital, and it found it was layering complexity upon complexity, affecting healthcare professionals and citizens as well. Its response was to engage CSC, a transformational and technology partner, to redesign and support its systems, and the result was a co-created care coordination centre.

The coordination centre is based on a technology platform that provides data integration from 40 oganisations, data analytics and customer relationship management. Layered on top of this are business processes to support better care for the patients across the health and care economy of Trafford. The service began a staged go-live in January 2016 and is now delivering benefits. The technology CSC provides to Trafford is a best-of-breed approach, and many of the lessons learned from this implementation have fed into our innovative Open Health Connect platform.

Key target areas in population health management include the way the budget is spent, the operational efficiency of the current systems, the effectiveness of delivery of care, and a move towards proactive rather than reactive care. Put simply, this maps to the value disciplines of supply chain management, product leadership and customer intimacy. The care coordination centre CSC has delivered for Trafford has the ability to point towards any of these areas.

The low-hanging fruit in Trafford was operational efficiency, and this is what was targeted by the first phase of the programme.

An important area is minimising inconsistencies and inefficiencies in referrals from family doctors to secondary care. Our technology-supported approach to standardisation and optimisation of referrals has already led to projected savings (based on extrapolation of the effects we have seen from implementation) of over £1 million per year.

We are also enrolling Trafford residents in care coordination programmes, where the objective is to avoid high-risk residents being admitted or re-admitted to an acute hospital, and to maintain their care in the home or community. This is not about radical pathway redesign, simply about better coordination in a steady state. The projected savings from care coordination are approximately £1.7 million per year. These approaches are based on digital and business process optimisation within the constraints of the existing payment and operating model.

We are now embarking on the next phases, where we plan to pivot to greater clinical effectiveness. This will require a different approach, particularly around rapid implementation and evaluation of new pathways. We plan to focus on unscheduled care management, which will require a truly collaborative approach across the health and care economy. It also needs advanced analytics to segment and target the existing population on the basis of need and ability to benefit.

Much of the technology to support this is built into the current model, and the challenges now are around organisational and payment model changes. The potential benefits to patients and the health economy are substantial, with estimated savings across diabetes, atrial fibrillation and chronic obstructive pulmonary disease alone dwarfing manyfold our current benefits.

Population health needs technology, but in many ways that is the easy part. Next-generation technology supporting new operating and payment models is what is required to address current health and care challenges. Changing operating models and pooling budgets across health and social care require political will and a shared desire to improve outcomes for citizens. This will undoubtedly mean turbulence and may well require legislation. The reward, though, will be seamless delivery of services, more efficient use of resources and improved clinical outcomes.

Professor Bridgewater will be at HIMSS17, February 19-23 in Orlando, CSC – Booth 2773.

Related:

Connecting the Health Ecosystem: A Doctor’s View

Predictive Analytics in Healthcare: A Doctor’s View

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