Patient-Centered Care and Population Health Management at Scale

Our April workshop was a great success. With our Roadmap to 2025 in place, the Oliver Wyman Health Innovation Center (OWHIC) teamed with more than 20 healthcare leaders to capture the best new thinking on how to implement patient-centered care at scale. (The full agenda can be found here.) The group learned how to implement the best clinical models, avoid critical mistakes in building infrastructure and new competencies, and debated the optimal paths for organizational and financial migration. With our advisors co-facilitating, we also brainstormed how to create a consumer and employer market for population health management – a market where population health models are chosen over open-access PPOs. The session included senior leaders from across the healthcare spectrum: health plans, health systems, capital markets, HIT, and emerging technologies. Their work demonstrated the impact of collaboration and the need for the industry to rethink the existing compete/collaborate framework. Here are some takeaways from our attendees:

Tsunami of tools coming 2 facilitate #patientengagement in #health issues & care plan predicts @bcbsla CEO Mike Reitz bit.ly/1017twz — Oliver Wyman (@OliverWyman) May 15, 2013

Clinical, IT & ops need active dialog to move in same direction, says @cornerstonehcnc's @gracet22 #carecoordination cot.ag/TKdJpy — Oliver Wyman (@OliverWyman) May 15, 2013

@mckesson_mhs Pres. Emad Rizk: When commercializing product, pick partners carefully to align incentives & ensure trust #OWHIC #pophealth — Oliver Wyman (@OliverWyman) May 14, 2013

@deancare CEO Samitt on shift to value: Start w/ top 5 diagnoses w/ respect to spend, then invest in rest of pyramid cot.ag/15tTGGG — Oliver Wyman (@OliverWyman) May 10, 2013

For more on the ongoing work of OWHIC and
its bold vision, see Clinical Innovation + Technology's
July 2013 cover story "All Rise With Innovation."

Patient-Centered, Whole Person Care

A highlight of the event was a visit to CareMore, arguably the best population health management model for frail elders in the U.S. – and a model that has already been brought to scale, replicated, and successfully expanded into many new markets. Leeba Lessin, EVP and President of WellPoint Medicare Programs (CareMore’s parent), graciously hosted us for a “best practice” tour, providing an amazing springboard for our workshop and a starter set of ideas on scaling patient-centered care.

Changing the existing paradigms in healthcare will require a fundamental shift in thinking – away from transactional care for sick patients to preventive care aimed at the whole person. This requires a patient-centered approach that considers the patient’s unique needs and tailors a treatment plan aimed at preventing disease progression. Just like at CareMore, patient care will extend beyond the clinic into patient homes and lifestyles through multidisciplinary care teams utilizing connected networks and wired, intelligent devices that support treatment adherence and generate ever more personalized care regimens.

1After the day-and-a-half session on patient-centered care at scale, what are you most optimistic about?

I was struck by how many leaders in the room clearly sensed the need for change and understood some of the big opportunities. It was also reassuring to hear a growing awareness of successful models in the market and the competitive forces behind them. Both of these elements will be significant motivators of change. Lastly, the enablement players in the room showed that they are ready to be a critical catalyst and educator for patient-centered care.
2What problems were revealed to you?

Though the need for change is clear, the power of fee-for-service economics and the uncertainty of fee-for-value create an environment of caution. Many players are hesitant to make big bets, and the market is littered with pilot programs and strategic hedges. That may be a sign of progress, but it isn’t enough to get U.S healthcare on track in the next five years. We need a CMS push – or a national-scale competitive threat from a WellPoint or Wal-Mart. Next generation models may require a NewCo to overcome inertia and fee-for-service cultures.
3What were the most important insights you gained from this session?

Three takeaways: 1) Most industry leaders believe it makes financial sense to invest in transforming risk-adjusted global payment markets – Medicare Advantage, Dual Eligible, Special Needs Plans – to value. 2) Population health enablement players can change the game, altering cost of entry, de-risking big bets, bringing new competencies, and providing capital for risk reserves. 3) Challenge is less about innovation and more about diffusing existing models.
4What impressed you most about the CareMore site visit?

Beyond the amazing innovation, commitment to their members, and the willingness to leave traditional approaches behind, CareMore brought process, analytics, standardization, and systems to the model, and did what few others have done before in healthcare – brought patient-centered care to scale, replicated the model, and reproduced fantastic results in five states and over 20 communities. Leeba reminded us that despite their established 15 to 20 percent value advantage they are just getting started with what is ultimately possible.