Long time reader of my site, Lou Galterio with the SunCoast RHIO, sent me a really great email with a fascinating question:
Are only the big hospitals who can afford the very expensive analytics pop health programs going to be allowed to play because only they can afford to and what does that do to the small hospital and clinic market?
I think this is a really challenging question. Let’s assume for a moment that population health programs are indeed a great way to improve the healthcare we provide a patient and also are an effective way to lower the cost of healthcare. Unfortunately, Lou is right that many of these population health programs require a big investment in technology and processes to make them a reality. Does that mean that as these population health programs progress, that by their nature these programs discriminate against the smaller hospitals who don’t have the money to invest in such programs?
I think the simple answer is that it depends. We’re quickly moving to a reimbursement model (ACOs) which I consider to be a form of population health management. Depending on how those programs evolve it could make it almost impossible for the small hospital or small practice to survive. Although, the laws could take this into account and make room for the smaller hospitals. Plus, most smaller hospitals and healthcare organizations can see this coming and realize that they need to align themselves to survive.
The other side of the discrimination coin comes when you start talking about the patient populations that organizations want to include as one of their “covered lives.” When the government talks about population health, they mean the entire population. When you start paying organizations based on the health of their patient population, it changes the dynamic of who you want to include in your patient population. Another possible opportunity for discrimination.
Certainly there are ways to avoid this discrimination. However, if we’re not thoughtful in our approach to how we design these population health and ACO programs, we could run into these problems. The first step is to realize the potential issues. Now, hopefully we can think about them going forward.