Insiders: GOP reforms make them queasy about population health

The health care industry’s move toward "population health" is a positive development — but Republicans run the risk of dealing it a setback through their health care reforms.

That’s according to most health care IT leaders and thinkers who participated in POLITICO’s health IT advisory forum this week. The forum was convened ahead of POLITICO’s Tuesday briefing on the state of population health reforms.

Respondents generally liked the concept of population health, wherein hospitals, doctors and other providers are rewarded for the quality of care they deliver to a community. But they split over whether the idea had successfully moved from consultant PowerPoint presentations to the boardroom, let alone implementation in practice.

"We are early on the next impact on provider bottom lines, but have successfully ‘crossed the chasm’ in mindshare as far more executives are planning for population health than presuming it will go away," one CEO argued.

"We’re far away," another countered. "Without alignment of incentives between the delivery and payment of health care, payers and providers aren’t motivated to drive rapid or dramatic change."

"There is a real movement toward population health in some pockets of providers," said a third executive at a physician-led organization. "The vast majority are still stuck in the fee-for-service world but for those who have moved to value-based care, like us, we have to put a lot of effort into population health to be successful."

Respondents generally stressed that there are trends that will persist no matter what happens in Washington. For instance, commercial payers are independently pursuing models like Accountable Care Organizations and shifting more risk to providers. And while Obamacare may have fired the starting gun on payment reforms, the industry is off and running.

"The pace of payment reform is accelerating on account of the ACA, and won’t be adversely affected" by Republican reforms, one strategist said.

"Costs are rising, chronic disease continues to affect a larger percentage of the population, and pharmaceutical costs are skyrocketing. It’s unsustainable," one CEO added. "Every administration will need to address this."

One respondent thought population health could improve under Republican leadership. "Reimbursement innovation to support computer-assisted analysis and treatment may actually be slightly easier given the current administration’s attitudes towards free-market innovation," an executive said, with one caveat — "as long as it makes its way to Medicare’s innovation center."

But a deep pessimism pervaded many answers, with most respondents noting that the GOP plan to reduce spending on health coverage programs — the CBO projected the Senate bill would lead to a coverage decline of 22 million over a decade — will be a clear setback. (When asked about the impact on population health, one health care investor just sighed.)

"Taking away coverage from tens of millions of Americans??? Is that a trick question?" a consultant wrote. "Especially, on the Medicaid side, there will be huge consequences from shrinking funding for vulnerable populations."

The dominant ideology in Washington also may be a factor, with the current administration’s conservative principles subtly shaping efforts and metrics of success.

"It depends how you define population health," one researcher added. "Do you consider gun control as a matter of public health? Do you believe abortion is a women’s right? Do you think medical care is a right or privilege? Do you think immigrants — regardless of their status— should receive the same kind of benefits?"

Health IT could play a major role in population health efforts. But it isn’t being properly deployed yet, respondents said.

"Most IT solutions are trying to tackle different specific parts of the problem," one CEO said. "Instead, solutions need to address all the steps: Understand the patient, create a plan and coordinate care."

Another CEO said that many IT products are still being "repurposed from the insurance sector [rather] than natively designed to meet the needs of risk-based providers." There have also been challenges in getting the proper data feeds from payers and providers.

Participants singled out a few top performers. "Some of the physician-led organizations are best positioned right now to succeed," one consultant said, listing Iora, Aledade and Privia as examples. "They have better and more comprehensive capabilities around meeting patients’ needs directly."

"It’s time for the U.S. government to start attacking a beast of its own creation in enabling true strides in payment reform and interoperability," a CEO said.

Meanwhile, a few loud dissenters took issue with the focus on "population health," saying that it’s health care’s latest unnecessary buzzword.

"My view is that population health has largely been a mirage, premised on the unfounded assumption that the ACO experiments would generate savings and that we would see the non-Medicare Advantage part of Medicare transition to capitation," one strategist said. "This is definitely not happening."

"Rather than population health, I rather talk about a specific problem [like] smoking, substance abuse, teen pregnancy, or depression," one researcher said. "It would be much easier to measure the success and think about ways to improve when we talk about a clear subject rather than a broad and general idea."

"I’m not into ‘population health,’" a third strategist said. "It’s the last thing we need right now. The focus should be on the individual, not populations."

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