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Population Health Strategies Deliver the Right Care at the Right Place for the Right Cost


Rising costs, combined with alarming health disparities, plummeting consumer confidence and growing complexity call for fundamental change in our health care system. The sad truth is that the industry’s traditional fee-for-service payment system and care models are outmoded.


The system unintentionally incentivizes volume over value and delivers care that is far too reactive and lacks the access, prevention and coordination patients expect and deserve. The result? The U.S. health system serves more as a “sick care” system than a health care system, is one of the most expensive in the world and lags behind other nations when it comes to life expectancy, infant mortality, access and disease prevention.


A New Approach

RIght now, innovative health systems are breaking the mold and leading the way with a new approach that delivers the right care in the right way in the right place to produce the best clinical outcomes at the right cost. And the right care is increasingly focused on early detection, preventive care and better management of chronic conditions which are largely delivered in the outpatient setting. This new approach focuses on population health.


It relies on “big data,” more proactive care models, genetics and precision medicine to improve the health outcomes for individual patients and large patient populations. The goal of population health is to shift the focus from primarily reacting to and treating disease and illness to one that is proactive in helping our patients and community attain and maintain their best health.


At TriHealth, our journey toward population health began nearly a decade ago with a commitment from our board, physician community and leadership team to reimagine and redesign all aspects of care delivery and underlying financing and incentive structures.


Today, we are making significant progress through the advancement of five interdependent transformational bodies of work, whose goals include:


  • Creating an integrated system of care with an unmatched care environment and culture where physicians, nurses and team members work as one team, supported to be their best and do their best for those we serve

  • Building innovative care and financing models that focus on and reward prevention, early detection and better management of chronic disease versus simply volume of care

  • Expanding access to primary and specialty care through a comprehensive network of outpatient centers conveniently located within 10 to 15 minutes of every Cincinnatian

  • Building nationally recognized Centers of Excellence like cancer care, genetics and precision medicine, heart and vascular services, and high-risk maternity and fetal care among others while growing our world-class physician community

  •  Eliminating health disparities to achieve greater health equity through proactive community partnerships like Cradle Cincinnati which has significantly reduced infant and maternal deaths

 

 

Though early in our journey, our transformation is already making a difference in how we deliver and finance care to the approximately 600,000 members of the community we serve. This is resulting in measurably healthier patients, more accessible services and safer and more affordable care.

 

Innovative Care and Financing Models That Focus On and Reward Prevention, Early Detection and Better Management of Chronic Disease

Traditional fee-for-service business models pay providers for delivering episodes of care such as an emergency department or doctor’s visit or a hospital stay. And, with a fee-for-service payment system, hospitals only get paid if patients are sick and need those episodes of care. In contrast, population health unlocks a health system’s potential to improve patient health and provide care cost-effectively. And it does that by changing the incentive structure and shifting focus from reactive episodes of care to prevention, better management of chronic conditions, early detection and delivering care in the most appropriate clinical setting. Economic incentives are realigned to reward health systems for keeping patients healthy and delivering care in the most cost-effective way.

 

We’ve spent the last decade building and perfecting our population health infrastructure. We have implemented massive change and built new core competencies that include: “big data” and advanced analytics; innovative care models; genetics and precision medicine; ambulatory care management teams made up or nurses, social workers, dietitians, and pharmacists; patient engagement and activation; new financial incentive structures and much more. These initiatives enable us to target our services and outreach to the patient populations experiencing rising health risk, unmanaged chronic conditions and gaps in care such as cancer screenings to prevent illness, reduce avoidable hospitalization and emergency department use and ultimately improve health.

 

Changes like these would be financially perilous for any health care organization that relies solely on fee-for-service for needed revenue to sustain itself. So, working with Medicare and Medicaid and commercial insurance companies, we have changed payment models to reward and incentivize our system and doctors for delivering better care, better health, and better value. Today, we do better financially when patients are healthy, and care is more affordable.

 

All of this has enabled us to make huge strides with prevention, early detection and better management of chronic diseases while delivering care in the most cost-effective setting. And this has improved patient health, saved lives, and lowered the cost of health care. Last year alone, the National Committee for Quality Assurance (NQCA) reported that TriHealth led the health care industry by:

 

  • Completing annual breast cancer screenings for nearly 85% of our eligible patient population. The industry average is 72%.

  • Completing colorectal cancer screenings for nearly 80% of our eligible patient population. The industry average is 64%.

  • Better managing chronic diseases, such as diabetes, with nearly 80% of patients having their diabetes under control and about 95% being compliant with diabetes medications and screenings.

  • Reducing the total cost of care by nearly 15% through prevention, early detection and delivering care in the most cost-effective setting.

 

Translated, this means TriHealth screened nearly 20,000 more women for breast cancer and almost 38,000 more adults for colorectal cancer than the average U.S. health system. Early cancer detection allows providers to identify illness early when it is more treatable and curable. We estimate that our rigorous screening efforts saved nearly 1,000 additional lives over the past year alone. In addition to better outcomes for patients, this results in a healthier workforce for employers and a lower cost of care for our community.

 

We’re Just Getting Started

Adopting a transformational population health model requires both courage to step away from what we know to find a better way and a significant financial and human capital investment. We’re excited to join other progressive health systems and thought leaders across the country that have recognized our nation’s health care system is broken and are working to transform health care for the better. Innovative population health strategies not only benefit patients, employers and communities but also contribute to a health care system’s long-term sustainability.



 


About TriHealth

Headquartered in Cincinnati, Ohio, TriHealth is focused on working together with physicians, hospitals and communities to improve the health of those we serve. TriHealth operates 5 hospitals and over 100 other ambulatory, post-acute, and other sites of care throughout the Tri-State region of Ohio, Kentucky and Indiana. The organization also operates the largest corporate health and fitness program in Greater Cincinnati, the largest not-for-profit hospice in the region and major teaching programs, including nine residencies and fellowships. TriHealth believes that everyone deserves proactive, equitable and surprisingly human care that results in better health. Every day, in every interaction, TriHealth is here to help patients feel seen, heard and deeply cared for.


About Mark C. Clement

Mark C. Clement is the President and Chief Executive Officer of TriHealth, a leading Cincinnati-based integrated health system. Mark’s experience in hospital administration spans four decades and numerous health systems across the Midwest and the East Coast prior to joining TriHealth. His forward-thinking approach to healthcare dramatically improved satisfaction scores among patients, physicians and employees throughout his career. His commitment to getting healthcare right for patients, staff and providers – as well as improving the communities he serves – is evidenced by his expansive history as a leader who believes in breaking down barriers to achieve better health and a higher quality of life for everyone.

 

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