The COVID-19 standard describes the principles of population health management and discusses examples from the Accountable Care Organization (ACO) and wellness and prevention programs. The concept is not new; however, it is still relatively new in the United States. Currently, the healthcare system is fee-for-service, which rewards hospitals and doctors for treating sick patients, but does not pay them for preventive care. Fortunately, the Centers for Medicare and Medicaid (CMS) have recently established a value-based payment modifier to reward providers based on the quality of care. Let’s learn more about managing population health.
COVID-19 examples illustrate population health management
Countries like China have adopted community-based public health management and dynamic zero-case policies to combat the outbreak of COVID-19. As a result, the overall epidemic is under control and stable, and national production is thriving. Some Internet speeches claim China is the safest country under the COVID-19 storm. The World Health Organization applauded China’s responses to the outbreak. It is an excellent example of population health management in action.
Community-based public health management in China has four key elements contributing to effective COVID-19 outbreak containment. These components include prevention and awareness, surveillance of new cases, management of contacts, health education, and outdoor environment disinfection. In Wuhan, for example, stay-at-home orders are acceptable when combined with prompt supplies of materials. This approach prevents cluster infections and saves scarce medical resources. As a result, in Wuhan, the number of new confirmed cases each day has decreased.
In addition to the national government, subnational governments are taking on the COVID-19 crisis. COVID-19 has an asymmetric fiscal, social, and health impact. In the US, for example, mortality rates in rural counties are higher than in urban areas. Subnational governments are responsible for critical aspects of health care, including hospital management, and they account for, on average, 25 percent of public health expenditure. Some countries have even expanded the program into rural areas.
Accountable Care Organization (ACO)
ACOs are emerging as a new payment method for healthcare services, primarily focusing on improving population health. They have a standardized payment structure based on incentives, but providers still receive fee-for-service payments during their performance period. In addition, payments are adjusted based on quality measures, and the ACO can earn shared savings payments. ACOs also tie payment amounts to quality performance, holding providers financially responsible for care costs.
The ACOs model fosters patient involvement, education, and self-management support. Moreover, they must meet quality-of-care metrics to earn bonuses. As an example, in the case of diabetes, patients must complete annual prevention measures. Therefore, ACOs can enhance their quality scores by encouraging the timely completion of prevention measures. As a result, the government has made ACOs an example of population health management.
In this model, healthcare providers work together to coordinate care for Medicare beneficiaries. These organizations are responsible for managing their patients’ health costs by preventing medical errors, delivering quality care, and reducing unnecessary expenses. While many stakeholders are experimenting with population health management strategies, Accountable Care Organizations are one such strategy. These organizations are groups of doctors, hospitals, and other providers that contract with CMS for three-year agreements. These networks share risks, and a portion of their savings is shared with the patient. To earn this incentive, ACOs must meet 65 quality measures relating to patient experience, care coordination, and safety.
Wellness and prevention program
Population health management emphasizes prevention and positive health outcomes for members. For example, a population health management initiative may promote healthy eating habits, support for people with pre-diabetes, and other preventive care practices. While hospital and doctor visits are an integral part of any healthcare program, population health management focuses on prevention and improving the community’s overall health. In other words, the goal is to improve health outcomes for everyone.
Developing a population-based approach to healthcare is an excellent way to control costs and improve the quality of care. Health managers use clinical standards and advanced technology to ensure quality care. They use programs to help them create individual action plans and track health statistics. These programs can even provide health trackers to inform them about health events. In addition, a population-based approach can also be used to address comorbid conditions that affect members.
Population health management is important for employers because healthy employees increase productivity and retention. Physically and mentally healthy employees are less likely to miss work and stay with the company. Additionally, a population wellness and prevention program can save employers money, especially when it involves preventing and managing chronic diseases and addressing mental health issues. A chronic disease alone costs an employer 1.5 times more than a healthy employee, and an illness or mental condition can cost up to 12 times more than a healthy employee.
