Influencing Cultural Transformation in Population Health Management

Population Health Management is a phenomenon in healthcare leadership that has increased traction in the last decade and derives from the necessity to measure the achievement of clinical outcomes. A political stance to defend healthcare as a human right, growing U.S. national deficits, incurring billions of dollars of uncompensated care, accountability of care modeling, and significant disparity in healthcare delivery/treatment are root causal factors. Healthcare systems must establish a culturally responsive call-to-action to facilitate a transformation in the environment that addresses the barriers to equitable care models. Cultural competence in healthcare is the ability of systems to provide care to patients with diverse values, beliefs, behaviors, and tailoring the delivery of care to meet patients' social, cultural, and linguistic needs (Bettancourt, Green, Carillo, and Ananeh-Firempong, 2003).

There are three meditations of influence that serve as unambiguous utensils to produce success factors and reduce barriers for healthcare organizations (Distinction, Achievement, and Excellence).

Distinction- Healthcare organizations must be patient-focused to address the barriers of overall care inequities, provide easy access to physician providers (scheduling/appointment availability), demonstrate flexibility in treatment representing multiple specialties, and have innovative therapies that address the medical needs of the patient community. Leading health networks recognize the importance of patient quality and safety metrics to drive best practices. To better calibrate with the requirements of consumers, a transformation from moderate to high will require ethnographic research and application of evidence-based clinical practice that is culturally fluid.

Achievement- The concept of value-based modeling redirects the care delivery focus from volume to value, and financial incentives are established to reduce costs. The overall patient experience now includes monitoring of social factors that influence wellness, measurement of population health, and is a more inclusive process. A research topic might evaluate a hospital's current ability to manage/assess/treat comorbidities of a community at risk or prophylaxis measures using antibiotic treatment to prevent disease/infection. A short read for this model: "The patient is the new payer," authored by Jonathan Wilk explains this climate of transformation in healthcare that is occurring. Another example of value-based modeling in patient care is implementing controls that promote efficiencies in surgical supply chain management. More specifically, to produce the best patient outcomes for patients/providers/employee's, while maintaining organizational objectives to metrics and full optimization of resources. A good analogy might describe the process as an interface between cost and quality, whereby providers are no longer reimbursable on a fee-for-service basis, and rewards are more specific to prevention/wellness/overall delivery of care.

Excellence- Principles of population health focus on the 6 P's: Patients, Providers, Process, Performance, Provision of Care, and Preferences. Population health programs in successful healthcare organizations are goal oriented, results-driven, metric/value based, and include a high degree of integration involving networks of care coordination. Achieving this level of excellence is arduous, a foundation of core mastery in Operations, Finance, and Clinical disciplines is compulsory. Also, a full comprehension of the social and behavioral influencers is necessary to foster relationships that translate to all stakeholders involved in the continuum of care. Developing a broad communication strategy is essential to correct any community misalignment. Failure to identify the needs of the patient can create an inability to execute and prioritize the increasing demands of population health management. The dynamic of clinical excellence is transforming to assign expectations relative to prevention, holistic wellness, employee/patient/provider empowerment, and proactive responsiveness to infuse excellence into practice. 

Message from the author: This article is an extension of research to elaborate on the cultural transformation in healthcare using evidence-based support methodologies and articulating population health/workforce development strategies. This information intends to offer a practitioner perspective, invites frameworks that support ideas and demonstrates the application of expert knowledge while using scholarly reinforcement to influence management decision-making.

References

Bettancourt, J. G.-F. (2003). Defining cultural competence: A practice framework for addressing racial/ethnic disparities in health and healthcare. Public Health Reports, 118, 293-302.