Today, about 80 percent of the $3 trillion spent on healthcare annually is attributed to people who are living with chronic conditions, such as diabetes, obesity and heart failure.
Part of the problem is that hospitals are extremely high cost venues for care, according to Richard Kimball Jr., who started his own company, HExL (which stands for ‘health times longevity). After 26 years as a banker at Morgan Stanley and then Goldman Sachs, Kimball attended Stanford’s Distinguished Careers Institute, a yearlong executive education program. From this experience, Kimball launched HEXL to help independent primary care physicians transition to new outcomes-based healthcare system through population health management.
Kimball says this change will need to come from doctors and patients wanting to align interests to drive better outcomes, lower costs and better accessibility of care.
“This gives physicians the capability to ultimately get paid more and be incentivized for keeping people healthy, rather than per visit and per procedure which is the current model under the fee-for-service reimbursement environment,” notes Kimball. “It requires population health management and proactive care, particularly for people with chronic diseases.”
Creating a better patient care experience
Population health management provides for an overall better patient care experience since a patient’s care will not be compartmentalized as it would be in a typical hospital setting. It also holds the promise of better integrated and more efficient healthcare. In concept it should reduce duplication and by extension the cost of managing an episode of care. Consequently, patients benefit in four ways:
- High quality and cost effective health care
- Early and appropriate management of chronic conditions
- Better, more timely information which leads to better health care
- Providers’ incentives reflect the value of their services
The population health management approach provides continuous and coordinated care throughout a patient’s lifetime to maximize health outcomes while emphasizing proactive outreach by primary care physicians. Providers will be expected to do more to coordinate the entire care of their patients and not just refer them to specialists. The model is a step toward activating the abundance of resources we have in the U.S. healthcare system and a step away from fee-for-service and an activity based financial model.
Under the current fee-for-service reimbursement system in healthcare, Kimball says that physicians and hospitals are paid for more visits and procedures and not for keeping people healthy. As a result, the system doesn’t invest in preventive care and care coordination infrastructure and services.
At HExL, the company is developing new care and financial models to allow physicians to focus on the health of their patients not suffer the burdensome, administrative aspects and misaligned incentives of the fee-for-service reimbursement environment in the current U.S. healthcare model.
While others have tried to pilot a similar venture before with little success, what Kimball brings to the table may be the necessary ingredient to make it work. HExL provides physicians with three components:
- Managed care contracting for taking capitated risk on their Medicare Advantage patients.
- Financial reconciliation tools to help manage those contracts.
- Care coordination technology required to manage populations and keep patients, particularly with chronic diseases, stable at home and out of the hospital.
Using technology to advance population health management
To build a more successful care model similar to the one Kimball describes, primary care physicians must be able to coordinate care and improve the health of all of their patients. Achieving these goals depends on the ability of providers to become clinically integrated and to manage population health at the physician practice level. These capabilities require the use of health information technology.
Over the last 50 years, technology use has dramatically changed the world of healthcare – from the consumer, payer and provider perspectives. Consumers are now more well-informed than ever, using the Internet to research their conditions, possible treatments and providers who specialize in treating their ailments. Providers are adopting electronic health records and collaborating digitally with others to streamline and collectively manage patient care.
Telemedicine is an evolving technology delivery method that has the potential to both lower health care costs while also delivering needed services. In fact, HExL’s telemedicine component offers a much lower cost delivery channel for providing care, particularly for people at home.
By using portable video conferencing devices, physicians are able to attend home visits with patients as well as connect with other physicians via video call. Doctors are able to save travel time and cost by connecting via video, without losing face-to-face interactions with patients.
“It’s just another way for physicians to stay connected with their patients,” says Kimball. “It’s cheaper and more convenient than bringing them into the physician’s office or the hospital. Direct monitoring and communication with patients and their caregivers can not only reduce healthcare costs but lead to better patient outcomes.”