The Forum

Leaving 'pilotitis' behind—what it takes to become a full-scale population health manager

by Paul Trigonoplos

Pilotitis (noun) – the act of continuously pursuing small health care projects but never scaling them, leading to duplication and short-lived benefits.

Case study: How top Pioneer ACO Montefiore approaches care management

I recently spoke with an executive working to transform her system into a full-scale population health management (PHM) network. Over the years, the system had dipped its toe in the population health pool the only way it could—by implementing small pilots with one-off government funding. A COPD bundle here, an integrated care team there. Overall, she said the system had upwards of 50 pilots like this in the past decade.  

These pilots were beneficial of course—this specific system made leaps in not only patient quality but also clinical and non-clinical partnerships through these initiatives. Plus, each success showed a bit of 'the art of the possible,' building buy-in for value-based care in general.

But this executive shared a frustration that we've heard around the world: because the system didn't have the incentives, funding, or internal infrastructure necessary to scale pilots to the enterprise level, each one experienced short-term success that ended after a couple of years once funding dried up.

New policies clearing the path to PHM

Now, thankfully, the era of population health dissonance—governments and systems praising value but continuing to incentivise volume—is beginning to end. Ontario and England are integrating providers (and in some cases, payers) to manage whole populations under a fixed budget. Finland and Quebec began a similar push last year. And Saudi Arabia is pursuing its own version of America's Accountable Care Organisation model—just to name a few recent large-scale moves.

This means that for the first time ever, systems must get accustomed to bringing a population health approach to the enterprise level.

This is great news, but it creates a problem systems have never been forced to solve: What infrastructure do we need to scale our population health approach to an entire population?

Full-scale PHM requires new functions

One of the biggest mindshifts our members in this situation have had to make is understanding that to succeed as a population health manager requires much more than simply extending pilots to larger groups of people.

In fact, when we look at the best PHMs in the world, we find that the institutions each excel at functions that most providers have never had to master.

These institutions—Gesundes Kinzigtal in Germany, Montefiore in the Bronx, Ribera Salud in Spain—have invested in a centralised business unit that serves as the 'population health brain' for their systems. This infrastructure allows systems to decide whether to scale up or down the speed and expansiveness of population health coverage. The system 'brain' generally houses some or all of the following functions:

While an entire, brand new business is not necessary to succeed as a population health manager, the competencies represented above ultimately are.

But the good news is that you can start small. We see systems ramping up their efforts by investing in these functions one at a time, usually starting with hiring care managers and navigators to manage patients across the continuum, and then investing in a data team to track and forecast population health trends. As systems mature and begin to see returns, systems then flesh out arms to handle the other competencies.

How top Pioneer ACO Montefiore approaches care management

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Montefiore serves one of the U.S.'s poorest and most densely populated areas. Learn how the health system overcame the odds to become the most successful Pioneer ACO—saving the government nearly $400 million over two years.

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