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Population Health Model at Methodist Health improves quality of care

Population Health Model at Methodist Health improves quality of care

Over the past year, Methodist Health has been building a Population Health Model. Population Health management is no longer a buzzword; it is a key concept to taking care of the whole patient. Population Health has been defined as “the improvement of health outcomes of a group of individuals.” The goal is to have appropriate care coordination with a network of providers that work together to ensure positive outcomes and to provide the best care at the lowest cost.

The overall goals of Population Health include reducing readmissions, reducing repeat or unnecessary emergency room visits, reducing unnecessary care, managing the care of a population for better outcomes and reducing costs for patients and the health system.

“Population Health requires multiple sources working together to provide the highest quality care to our patients," said Stephanie Jenkins, MHA, Vice President, Methodist Physician Group. “For success, it must have provider champions, administrative support and employee buy-in. This is not just an outpatient endeavor. This involves our inpatient team, emergency room, case management, information systems and many others. Due to the improved coordination of care among other changes over the last six months, we are beginning to see improvements in our data in both the inpatient and outpatient setting.”

Jenkins noted, “On the outpatient side, we have seen an improvement in our quality scores. In 2015, the star rating with some commercial payors was below two (2) and now for 2017 our star rating is as high as 4.88 with the same health plans—the highest we have ever been scored. The highest possible score is five (5).

“We have also been able to avoid a 2% penalty in Medicare reimbursement for the calendar year 2018 due to our improved quality. This will be the first time in more than three years that we have been able to avoid a penalty.

“In regard to the inpatient data, we have seen a marked downward trend in readmissions over the last quarter. This includes readmissions for heart failure, COPD, stroke and others. By looking at the patient as a whole and keeping them at the center of our focus, we are seeing improved outcomes and success in our efforts.”

Methodist Physician Group’s journey with Population Health began in November 2015. A pilot program was started with one Registered Nurse who worked with one family practice office. This began the coordination of care with discharged patients to help reduce their risk of readmission and close any care gaps. Her involvement led to improved patient understanding of their condition, co-morbidities, treatment and health goals.

Registered Nurses have been assigned as Care Coordinators to each of Methodist Health’s family practice providers and residents. Their primary role includes following up with patients discharged from the emergency room or Hospital, following up with high risk patients, scheduling wellness visits and working with specific high risk populations.

They make phone calls to the patients within 48 hours of discharge and ensure patients understand their discharge instructions, have the medications they need, coordinate any outpatient follow up care needed, provide education and alert the primary care provider to any changes along the way. The idea is to have someone at the center of the patient’s care, helping them to navigate their healthcare and ensuring they understand their conditions.

Jenkins continued, “As an industry, healthcare is under constant pressure to continuously improve. Commercial and government payors expect value and quality over volume. This shift to value-based reimbursement requires health systems and medical groups to become creative in how they deliver care. The focus can no longer be on the number of patients through the door, but instead must be on how we care for those patients, the outcomes they achieve through our care and keeping them healthy in the long-term.”

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For questions regarding this press release, please contact Brandi L. Schwartz at 270-831-7836 or bschwartz@methodisthospital.net.