This week's blog is by one of our partners in our health consulting business on a two-year secondment to the UK from the US. Dr Robert Williams (Dr Bob to all who know him) is helping us to leverage his knowledge and experience in our work with NHS organisations, particularly in relation to population health management and IT implementation. Over to Dr Bob!
My background includes 20 years as a practicing physician in the United States, medical school faculty member, health services researcher and 20 years as a healthcare consultant, working with numerous health systems. Until last year I was the chief medical officer of Deloitte's US healthcare consulting practice, leading the development of population health initiatives, deploying teams of actuaries, health planning experts and experienced technology and analytics professionals.i We worked with dozens of clients, including health policy makers, providers, physicians, insurers and life sciences companies. We learned many lessons that can be applied globally to countries who are starting to see population health management (PHM) as a potential solution to the many challenges they are currently facing.
The UK is different to the US in that there is a 'place-based' focus in its approach to PHM. This provides unique opportunities to use the scale of such populations to advance the development of the required capabilities. However, it has been my observation since joining Deloitte's UK health care consulting firm last year that only a very small number of health and social care systems in the UK are starting to consider the significant opportunities that can be achieved through investing in a new model of care coordination to proactively manage population health. In these, and I hope other areas, it will be necessary to achieve early significant clinical, social and financial improvements in order to gain the momentum necessary to deliver the expected value.
As place-based, PHM emerges, the opportunity for health and social care improvement is expected to be accompanied by cost reduction or a 'bending of the cost curve.' I know from experience that achieving such outcomes requires multiple capabilities across the geography including but not limited to
- integration of clinical, social and financial data and analytics, to understand population and individual risks
- strategies to identify and prioritise attention on people and groups with the highest health and social care needs
- modified care delivery models, clinician engagement
- 'co-ownership' with social care
- an integrated approach to clinical and business management
- an advanced approach to care coordination of the newly integrated system.
One of the most visible impacts of a successful PHM approach can be reductions in avoidable hospital admissions and A&E visits, with associated clinical and financial gains. To accomplish this require s information on high risk patients in the community so that providers can reach out and intervene with remote support at home, linked to the GP and/or consultant's office. Care coordination and navigation will be a key ingredient in the 'recipe' needed to cater to the needs of the highest risk groups of a population. It is exceedingly difficult to tailor care for individuals and groups without aggregated data from multiple sources to support an effective care management team approach to manage risk in a timely fashion.
My experience also leads me to believe that PHM will require new leadership roles and new types of resource to manage or coordinate care. There are good examples we can learn from around the world and more to be identified as adoption of the model expands. For example, there may be some repurposing of current talent, and the development of a dedicated ambulatory care manager role with clinical experience. In terms of access to advice and support, successful approaches have included face to face interventions as well as the adoption of well-designed telephone based approaches, supplemented by other forms of communication and digital tools. Engagement of the patient, family and other care givers is also essential - the goal is to avoid complications and to enhance functional status, which in turn is driven by patient preferences and desired activities.
Test and learn approaches are essential – I know of one very successful health system which experimented by deploying registered nurses as case managers in every primary care practice. They quickly discovered that this use of expensive highly trained resources was not cost effective and therefore changed the model to share the resources across multiple sites while maintaining some regular on site, face to face contact.
Another very experienced health system that has managed thousands of complex patients over 15 years, has achieved very strong clinical, social and financial outcomes with an almost completely telehealth model of care coordination. This has relied on very effective use of specialised resources to work with patients in a fashion tailored to their most pressing needs, during any given episode of care.
Another example of a place-based system approach, involved highly effective engagement with doctors. Much of the success in delivering high quality, cost effective care, has stemmed from significant efforts to culturally realign generalists in primary with specialist physicians, underpinned by a robust governance model for sharing data and accountability.
What is consistent in all successful PHM models is a new type of care coordination role or care management professional with ambulatory care management capabilities. If PHM is to be successful in the UK, there will need to be an investment in new types of staff and ways of working. The benefits, clinical and financial, are likely to far exceed the cost.
For many health systems, however, while they understand the benefits of PHM, the prospect of adopting a PHM seems very daunting, given the capabilities that are needed to make it work (data analytics, inter-operability, leadership, new skills, etc). We therefor plan to return to this subject in coming weeks to discuss some of practical steps that might help to kick start the transition.
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