When I practiced neurosurgery, I realized that sometimes the most vulnerable group was the population deemed healthy enough to be discharged home from the hospital. Certainly patients who were discharged to long-term care or rehab facilities had their own set of challenges, but patients who were discharged home did not always have the easiest pathway to recovery. Recovery setbacks often add significant costs to our healthcare system.
Socio-economic challenges, co-morbidities from chronic diseases, and mental health issues have significant impact on the outcomes of people recovering at home. Some discharges are eligible for home health services, but regardless of eligibility, there are periods at home when treatment outcomes were solely dependent upon the patient and caregiver. Despite being armed with discharge instructions, and follow up calls and appointments, patients are not always wholly equipped for success.
Now, put the challenges faced by patients at home in the context of current healthcare reform. Providers are facing increasing pressure to improve patient outcomes, including financial consequences. In an effort to mitigate these penalties and manage the movement toward performance-based reimbursement, providers need to somehow influence the population residing outside of healthcare institutions. This influence is the crux of population management and can be done in several ways, including expanding pharmacist roles, using remote monitoring and analytics, and enhancing home-based services.
Pharmacists are a key to population management. They have both the education and access to play important roles in patient lives. Pharmacist roles are expanding in education, medication reconciliation, adherence services, chronic disease management, and wellness services. Accordingly, pharmacists are being recruited to be part of integrated care models, such as medical homes and Accountable Care Organizations. Medication Therapy Management (MTM) has also become more prevalent, particularly since the Affordable Care Act required that Part D beneficiaries enrolled in MTM receive a comprehensive medication review. This service helps patients manage multiple medications, potentially improving adherence and clinical outcomes.
Remote monitoring is also a growing part of population management, given the need to monitor both chronic diseases as well as acute changes in patients' conditions, without the constant presence of a medical professional. Remote monitoring may potentially lead to earlier interventions that help improve overall healthcare costs and outcomes. There are mobile, remote monitoring devices that measure vital signs and other metrics in diabetic, heart failure, hypertensive, and chronic obstructive pulmonary disease populations. Early results have been mixed, but as solutions become more comprehensive, we can expect to see refinements in technology, selected metrics, outcomes and costs.
Population management is more than medication review and the use of mobile technology. It includes the practice of caring for patients in their homes and communities. As reimbursement and other regulatory trends shift care towards the home, enabling this environment will become increasingly important.
Cardinal Health is developing pharmacist patient care programs to help manage different conditions, such as pediatric asthmatics. Cardinal Health is also creating programs that assist providers with the treatment of elderly and chronic disease populations in the home. Population management works best when services are coordinated, to include pharmaceuticals, home health, medical supplies, nutrition, and data and analytics. As population management flourishes, the coupling of appropriate diagnostic measures and timely, multidisciplinary interventions could lead to beneficial clinical and financial impacts upon our healthcare system. More on these opportunities to improve population health in a future post.
American Pharmacists Association. "Medication Therapy Management Digest," March 2013. http://www.pharmacist.com/sites/default/files/files/MTMDigest_2013.pdf
Desai AS. "Home Monitoring Heart Failure Care Does Not Improve Patient Outcomes: Looking Beyond Telephone-Based Disease Management,"Circulation 125: 828-83; 2012
Dolan B. "Report: About 300K patients were remotely monitored in 2012," Jan 22, 2013 http://mobihealthnews.com/19963/report-about-300k-patients-were-remotely-monitored-in-2012
Gleckman H. "Nursing Home Use by Medicaid Seniors is Plunging," ForbesJuly 3, 2013 http://www.forbes.com/sites/howardgleckman/2013/07/03/nursing-home-use-by-medicaid-seniors-is-plunging/