PRINCIPLES OF POPULATION HEALTH. Mark C Johnson MD
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1 PRINCIPLES OF POPULATION HEALTH Mark C Johnson MD
2 Pain is inevitable; suffering is optional
3 What is Population Health? 2003 Dave Kindig MD the health outcomes of a group of individuals, including the distribution of such outcomes within the group Tension remains between defining this as a field of study of health vs maintaining health; for todays discussion this is a concept of health and how it is maintained and managed
4 Includes Clinical case reports and managing major public health conditions (excess caloric intake and lack of exercise leading to obesity in children)
5
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7 Health Care Reform. The new paradigm VOLUME QUALITY METRICS
8 Outcomes assessment concurrent event leads to quality improvement by default the discipline of data collection sharp focus on prioritization patient satisfaction drives encounter EMR becomes an asset the ideal situation efficiency follows
9 Care Coordination Across specialties Across professions Across staff Across time and space
10 Care coordination requires another paradigm shift for physician providers: PATIENT AND FAMILY CENTERED CARE WILL MANDATE GIVING UP
11 CONTROL!
12 TEAMWORK
13 There is a central patient center concept that will be a challenge to all of us in the future THE PATIENTS YOU SEE ARE NOT YOUR OWN
14 Collaboration theory: in tightly controlled collaboration : expense and effort rise exponentially with the number of participants. Loose coupling which allows flexibility of thought and imagination without rigid definition of roles leads to better problem solving.
15 The more who have input into the process, the greater the likelihood of success. It makes more sense to work together rather than to compete.
16 Collaboration and consultation will need to be concurrent and in one encounter for the sake of patient safety, convenience, patient satisfaction, and efficiency WHAT DOES THAT MEAN?
17 RESOURCE MANAGEMENT: Currently focused on patient encounter Future will be much more: Family centered Education will be priority for patient, family but also for provider and staff Primary resource is time not money and team building, team rounds, huddle and problem solving will be critical to success
18 Reality of our mobile society even in rural Iowa is patients have multiple options for their health care. Nearly 70% of health care choices are made by word of mouth.
19 Provider incentives will drive the process both financial and non financial
20 Health care quality will be and already is continuously measured against your own internal standardsbut also against external transparent standards that will be in the public domain
21 Return on investment will be much less directly financial and will be driven by patient outcomes measured in quality, safety, and patient and family satisfaction. This will require increase skill in teaching, motivation, and changing behavior which has at its heart more sophisticated education for providers and staff (as well as patients).
22 Every patient encounter should have an element of teaching no matter what the patient s presenting problem or where she is seen or who sees her
23 Changing behavior in patients will require much more intentionality and many more resources in the future (starting with education of providers) Co morbid psychiatric illness needs to be addressed in a new and innovative way for health management to have any chance of success in any specific patient.
24 Skin in the game. There is minimal data or research to determine what level of accountability should be required from the population we serve.
25 Chronic disease management requires anticipation and not reaction to the present situation. An example is euglycemia in the hospital. Another is medicine reconciliation How are we going to deal with access? An example is the ADA suggestion children with type 1 diabetes on pumps need 24 hour immediate access to professional help. Other potential hot spots: CHF, COPD, Cancer patients, DM, post surgical patients.
26 Why Transformation Efforts May Fail No sense of urgency Guiding coalition of leaders not empowered to make change Vision lacking Under communication Not getting rid of known obstacles Not planning for short term wins (win/win)
27 Embracing health care change and improving public health will require best practices that improve patient health and increase productivity. This necessitates options that allow physicians to choose models that fit their mode of practice.
28 Our journey to excellence will require all of this and more and will only be a success with engaged physicians. What will you and your physician group bring to the table? PS As I spent a couple nights doing this my spouse asks are you putting self care in this talk? Yes Rachel I am.
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