NWI hospital systems embrace population health management - nwitimes.com

MUNSTER — One of the Region's largest hospital systems has started embracing the trend of population health management, entering into a partnership with a large insurer in the hopes of cutting costs and improving outcomes.

Community Healthcare System and Cigna recently formed a clinically integrated network, meaning the insurer pays the hospital system a monthly, per-patient fee to provide care as efficiently as possible.

To do this, Community Healthcare System has hired registered-nurse care navigators who will check up on patients to make sure they're following through on their treatment plans.

"You spend a little more on preventive services on the front end. But if you're able to keep your patient population healthy by engaging them in their health care and managing their health conditions, downstream illnesses are less likely to occur," said Dr. Alan Kumar, chief medical officer for Community Healthcare System, which operates Munster Community Hospital, St. Catherine Hospital in East Chicago and St. Mary Medical Center in Hobart. "There's long-term savings from upfront investment and management."

Population health management is growing in popularity as the U.S. health care system tries to bend the cost curve. Hospitals and doctor's offices are increasingly being reimbursed on quality and cost-savings measures rather than the traditional fee-for-service model.

The traditional fee-for-service model has been criticized as encouraging health care providers to pile on treatments or services, some of which could be unnecessary.

In collaborative care agreements like the one between Community Healthcare System and Cigna, providers are paid a set fee and thus incentivized to keep patients well.

The Franciscan Health hospitals in Northwest Indiana — Crown Point, Dyer, Hammond, Michigan City and Munster — have had a similar population health management arrangement with Cigna since 2014.

"In Northwest Indiana we probably have something north of 100,000 lives in our population health management programs," said Gene Diamond, senior vice president and chief operating officer of inpatient services for Franciscan Health. "It's just a recognition of the way health care is going. It fits with the mission of the Sisters (of St. Francis): to take care of the most needy, wherever you find them and keep them well and out of the hospital."

In these agreements, providers are also rewarded for meeting certain quality and cost-saving measures.

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"We have whole teams of folks who spend their time working with patients both at home and when they visit physician offices making sure they're as healthy as can be," Diamond said. "It results in lower costs if you can keep patients well and out of the hospital."

Cigna's deal with Community Healthcare System will impact more than 5,000 of the insurer's customers in the Region. They aren't likely to experience a lot of changes besides calls from care navigators reminding them to, for example, take their medication or that they're due for a routine screening. The hospital system will be caring for a particularly challenging patient population; Kumar said it has the highest risk score of any of Cigna's Chicagoland collaborative care partnerships.

"There's no more money in health care," Kumar said of the reason for the trend toward population health. "Health care as a whole is exceptionally expensive to begin with. Now, everyone is demanding more value with less money being spent. Instead of throwing more money at the problem, which was classically the approach, the new paradigm is better preventive care, better coordinated care."

Community Healthcare System has for the past year been using a care-coordination model with its own employees and their families.

"We've seen very good success so far in our own health care system and the early results with Cigna are positive as well," Kumar said.