Enhancing Population Health Capabilities to Prepare for Downside Risk

Executive Summary

TriHealth needed to expand its population health capabilities in order to successfully manage over 250,000 value-based lives across its commercial, Medicare and Medicaid populations. They partnered with Lumeris to implement a Population Health Services Organization (PHSO) to coordinate all clinical and operational activities tied to its value-based business. As a result, TriHealth achieved notable clinical and financial outcomes across multiple payer contracts.

The Challenge

TriHealth, a health system based in Cincinnati, Ohio, was looking to advance its value-based care strategy and capabilities. Having demonstrated strong leadership commitment, cultural alignment, and investment toward population health, TriHealth was preparing to manage over 250,000 value-based lives across its commercial, Medicare, and Medicaid contracts. To coordinate clinical and operational efforts, the system needed a comprehensive approach to develop value-based care capabilities and prepare for downside risk.

The Solution

With high quality patient care at the center of its strategy, TriHealth partnered with Lumeris to design and implement a Population Health Services Organization (PHSO), allowing the system to expand and optimize existing population health initiatives, and ultimately prepare for managing downside risk contracts.

Delivering Outcomes

TriHealth has started achieving significant clinical and financial outcomes with the support of Lumeris.

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Expanding Value-based Contracts and Capabilities

TriHealth continues to expand its value-based business to better drive population health improvements.

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“The key to change management is developing a leadership group of clinicians who understand the strategy and can lead by example.”

– Bryan Strader, MD, Physician Executive, TriHealth Physician Practices
Key Milestones

TriHealth and Lumeris established the PHSO to integrate the programs, tools and resources necessary to deliver outcomes.

1. Establish PHSO governance

TriHealth and Lumeris co-designed and implemented the organizational governance structure to more effectively lead their population health initiatives, including creating a Primary Care service line.

Key learning: The PHSO brings together clinical and operational leadership for strategic care delivery and business model decisions, with accountable primary care serving as a foundational backbone.

2. Organize high-performing network, engage physicians and drive practice transformation

Lumeris and TriHealth employed multiple tactics to engage the provider network and support practice transformation, such as developing care team playbooks, educating clinical leadership, developing a value-based incentive model and reviewing performance regularly.

Key learning: Primary care redesign, enabled by the PHSO, requires an integrated strategy that supports change management, aligns incentives, and enables accountable primary care.

3. Redesign care delivery model

Lumeris and TriHealth developed provider-led clinical programs enabled by advanced analytics and tailored by population. Current and future programs focus on: access to care, quality management, pharmacy management, complex case management, cost and utilization, specialty care and primary care.

Key learning: Redesigning the care delivery model through the PHSO requires advanced analytics, operational program expertise and effective performance monitoring.

4. Refine payer contracting strategy and manage fee-for-service (FFS) business

While TriHealth had existing value-based contracts, Lumeris worked with the system to identify areas in which to increase their incentive opportunity and establish a pathway toward downside risk. A continued challenge that TriHealth and other health systems will face is balancing their declining FFS business while simultaneously building population health capabilities. An operating partner can support this transition during the low point of this “valley of despair.”

Key learning: Each organization must understand its place on the risk spectrum and how the PHSO will reinforce population health goals and drive behavior change.

5. Optimize informatics infrastructure

TriHealth needed a partner to expand its capabilities for data aggregation and drive insights into the provider workflow. Activities included establishing multiple payer claims feeds, testing and monitoring data, and surfacing predictive analytics insights, cost and utilization reporting, and dashboards within the EHR workflow.

Key learning: Getting actionable information from the PHSO into the provider workflow is essential to drive value-based clinical decision making at the point of care.

Looking Ahead

With a focus on growing population share, TriHealth and Lumeris are pursuing additional value-based strategies such as:

  • Training the market for value by participating in and expanding value-based arrangements
  • Building up strategic service lines to increase presence in market
  • Growing collaborative payer-provider partnerships to create a diversified revenue stream and deliver better health outcomes

With the foundation in place, TriHealth is in a strong position to leverage the synergies and resources of the PHSO to deliver higher quality, cost-effective care across all patient populations.

“Our vision is to be the leader in population health. We need to be the easy choice, whether from an employer perspective or a consumer perspective. When they come into our system, they are getting seamless coordinated care with the best outcomes and experience, and our providers and team members all feel high satisfaction.”

– Terri Hanlon-Bremer, MSN RN, Chief Operating Officer, TriHealth Corporate Health