Some thoughts on risk measurement

One reader of my latest blog on segmenting health care consumers asked me if I knew of any tools to calculate a person’s chance of developing a particular disease. That question got me thinking again about the topic of risk in health and disease. I pulled a copy of John Last’s Dictionary of Epidemiology from my office bookshelf for a proper epidemiologist’s definition of risk:

“The probability that an event will occur, e.g., that an individual will become ill or die within a stated period of time or age. Also, a nontechnical term encompassing a variety of measures of the probability of a (generally) unfavorable outcome.”¹

Will the first technology choices in design of population health be the most important?

As the healthcare industry strives to converge all the data sources required to manage population health, the mass of data needed to do it well, and to both clinically and analytically inform, will require something of a science project. Let’s call it gravity.

The seven habits of highly successful care programs—and six examples

Last month, David Blumenthal, MD, director of The Commonwealth Fund, addressed a 3M conference in New York City on value-based care. He mentioned soon-to-be-released recommendations from his organization on effective models for healthcare improvement.

What he didn’t say was that the recommendations would be accompanied by a media crusade. In the past several weeks, The Commonwealth Fund has released a range of multi-media content advocating new models of care.

Good news and bad news: The cost of (partial) Patient-Centered Medical Home implementation

Magill and colleagues published a nice analysis of the staffing costs of a Patient-Centered Medical Home (PCMH). Compared to a regular practice that already has an electronic medical record, they looked at the incremental costs associated with meeting NCQA standards for Patient-Centered Medical Home recognition.

The investigators reported incremental costs in three ways:

Healthcare execs weigh in on population health and value-based care

There is no common definition for population health. But if you ask enough healthcare executives, you’ll get a clear sense of what it means in terms of how it challenges them. That’s what I discovered at the Value-Based Care Conference hosted by 3M in New York City.

In a conference survey, I asked 42 leaders from health plans, government agencies, health systems, quality review organizations and consulting firms what they thought about population health. Their responses are a good gauge for where these organizations will be investing their efforts in the coming months.

Care coordination and the community health worker (CHW) – The time has come

Improving care coordination for the sickest, most vulnerable and highest cost patient segments remains an important component of population health management and achieving the goals of the Triple Aim – better outcomes, lower costs and improved patient satisfaction. Yet, even as we acknowledge the importance of care coordination and devote considerable resources to this effort, the next question is whether these resources are being diverted to the right places to make a meaningful difference in health outcomes, cost and patient satisfaction.

Is the accountable care community the next evolution of the ACO?

The move to accountable care is ultimately about achieving better health outcomes at lower cost while creating a better experience for the patient. This is the Triple Aim. A narrow view of health focuses on health care, which is understandable in the United States, since a wide range of health-related expenditures are funneled through the medical system. The United States has long been the leader among industrialized countries in healthcare spending, while other nations have led in health outcomes, such as lower infant mortality rates, lower mortality amenable to health care and longer life expectancy.

Why I get excited about APCDs (hint: also a memoir and album by Herbie Hancock)

I love hearing about multi-source or all-payer claims databases (APCDs). I’m not a data scientist, but I know enough about analytics to appreciate the possibilities within an APCD. Each announcement of a new state APCD (or private data alliance) feeds the expectation that someone will discover something new and useful and that maybe, sometime soon, the information will change the healthcare system for better.

I get excited about the possibilities. (Jazz musician Herbie Hancock chose “Possibilities” as the title for his memoir. It’s a tribute to those who aren’t afraid to explore in music and in life.)

The Logistics of Population Health Under the IHI Triple Aim

The Triple Aim is a construct developed to move past the trade-offs typical in health care improvement: improved quality at the expense of increased costs, decreased costs at the expense of quality or access, improved guideline adherence at the expense of patient experience of care, etc. The Triple Aim defines success as simultaneous improvement in population health and outcomes, patient experience of care, and cost trends.

Why Primary Care Should Pay Attention to Continuity of Care

Reducing healthcare costs through better care delivery begs the question: “Where do we start?” When the goal includes something to the effect of “the greatest possible improvement for a population,” it is good to reflect on the body of evidence pointing to high performing population health outcomes.

The work of Starfield and others is instructive: High performing health systems have high performing primary care as their foundation. High performing primary care has four cardinal features:¹