Population Health Proposal
Population Health Proposal
In today’s changing healthcare landscape, health systems will need to become population health managers and remain financially viable. In order to accomplish this, the leadership team will have to attain a comprehensive economic perspective. This requires integration of payer, physician, health system and patient considerations to understand the financial impact on the system as a whole. Economic awareness and understanding means that health systems will need to initiate population health management initiatives according to targeted financial net impact including expected return on investment. Components needed to arrive at the realization of the net impact include understanding key spending and utilization metrics against benchmarks, determining critical points of focus for interventions, evaluation of care outside of the organization’s network, and becoming accountable for primary care. Identification of key efficiencies, in conjunction with the overall organizational strategy, allows for reigning in unwanted frequency and variability. Containment, along with integration of cost data to identify variation and the impact of preventative utilization has been reported to protect hospital margins. (Advisory Board 2014). Background and Needs Assessment
Care Hope Medical Center (CHMC) is a 450 bed not-for-profit, full service community hospital located in Baytown, Louisiana, residing on more than 20 acres from downtown Storyville. Situated south of the Mississippi River and near vast industrial and maritime corridors, CH Medical serves area industry as well as the citizens of Dorr parish and the region. CHMC is the regional leader in acute, preventative, and rehabilitative healthcare services for south side of Dorr parish and its surrounding communities. CHMC owns and operates a fitness center, which is located on the hospital’s campus. Among the many features are an aquatic center with a multipurpose exercise pool, whirlpool and SwimEX aquatic therapy pool. The CHMC’s Fitness Center (CHFC) is located within the Wellness Complex, which also houses primary care practices and out-patient rehabilitation services. The medical center manages its own health and benefit plan through collaboration with a regional insurer. CHMC shares some of the performance and financial risk for their population of employees. Therefore, relevant payer, provider, and patient variables of those participating in the plan are routinely assessed. Annually, CHMC receives a detailed health plan analysis of their Major Diagnostic Categories (MDC), high cost claimants, claims by service, cost per member per month, participation and utilization demographics summaries, and claims analysis of charges. There is also insight rendered on key physician, market, patient access, and care management considerations. The organization has approximately 2000 employees with close to 1500 covered employees and an additional 1200 members on their health plan, equating to 2700 total covered lives. Operating cost of the health plan averages between ten to twelve million annually. Following the 2012 annual report, CHMC began to make changes to their benefit plan and employee wellness programs to engage their participants and to secure financial viability for the organization’s future in light of the declining reimbursement landscape and the full on implementation of the Affordable Care Act. Based on outcomes from the 2013 health plan report, a set of realistic assumptions for reducing unnecessary utilization and gaps in health management were devised to guide leadership at CHMC to determine and trend activity for the organization to make adjustments and plans for future services and benefits. Estimation of infrastructure investment, operating expenses and other financial implications are made along with comparisons of multiple scenarios of program implementation and...