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The Radiologist’s Guide To Population Health Management

What does PHM look like in radiology and how can it lead to better outcomes for patients?

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What is PHM?

A 2003 American Journal of Public Health study loosely defined population health as, “The health outcomes of a group of individuals, including the distribution of such outcomes within that group.”1 These groups are often geographic ones — a country, a state, a city — but they can also be populations like employees, ethnic groups, prisoners, or any other defined group.

The goal of PHM is to keep a patient population as healthy as possible while reducing costs by minimizing hospitalizations, ER visits, and unnecessary care (including inappropriate imaging). It requires looking at certain patterns among the population and adapting policies and programs based on those trends. PHM now primarily involves using big data analytics to identify patient cohorts and ensure they get the care they need based on risk factors.2

Why is it important to assess the health of a population all together?

Studies show that a zip code is a better indicator of your mortality and health outcomes than factors like genetics, environmental health, social circumstances, and individual behaviors. Researchers note, “In various cities across America, average life expectancies in certain communities are 20–30 years shorter than those mere miles away.”3 Through the lens of PHM, it’s valuable to look at group trends to improve patient care proactively to lessen disparity.

What are the main challenges to implementing PHM?

For starters, the current fee-for-service model isn’t ideal for PHM, which focuses more heavily on value versus volume. In a 2017 Bulletin article on PHM, Richard Duszak Jr., MD, FACR, professor and vice chair for health policy and practice at Emory University School of Medicine and affiliate senior research fellow at the Harvey L. Neiman Health Policy Institute®, stated that PHM contrasts with the approach we currently employ, what he terms “individual patient disease management.”4

Getting physicians to invest time into real change is going to be difficult. It will require being proactive and even, perhaps, making some innovative alterations to the profession without initial compensation.5

What are the biggest opportunities in PHM for radiologists?

In a recent JACR® article, ACR BOC Chair James A. Brink, MD, FACR, specified that variation reporting and control is a major place where radiologists can impact population health.6 By implementing clinical decision support systems like ACR Select® and ACR Assist™, radiologists are already impacting the goal to decrease unnecessary testing and associated costs. The need for automated tools has been touted as a large part of PHM, and radiology is already making great strides in creating and using such tools.

Additionally, screening methods such as mammography for breast cancer, CT colonography for colon cancer, and low-dose CT for lung cancer are existing tools that already have a broad impact on health outcomes for groups. Radiology now has the opportunity to make these screenings more accessible to at-risk populations, as well as to establish follow-up protocols and further understand imaging biomarkers.

What can radiologists do to get more involved with PHM?

This month’s Bulletin features articles, case studies, and tips on PHM and how it affects radiology today. As alternate payment models come to fruition and focus on quality over quantity, radiologists can expect more efforts to improve the care of at-risk populations. By placing the emphasis on high-quality care, radiologists already contribute to increasingly better health outcomes and decreased costs as the healthcare paradigm continues to shift.

On a broader scale, PHM is an industry-wide change happening slowly as healthcare shifts to prioritize value. Success under this new paradigm requires a change in thinking about the healthcare system and a robust infrastructure to collect and analyze a great deal of data.

ENDNOTES

  1. Kindig D, Stoddart G. What is population health? Am J Public Health 2003; 93: 380–383. Available at bit.ly/What_Is_PHM.
  2. Bresnick J. How to Get Started with a Population Health Management Program. Health IT Analytics. Available at bit.ly/PHM_Start.
  3. Graham G. Why Your ZIP Code Matters More Than Your Genetic Code: Promoting Healthy Outcomes from Mother to Child.” Breastfeed Med. 2016; 10:396–397. Available at bit.ly/PHM_ZipCode.
  4. Hudnall, C. What You Mean to Population Health. ACR Bulletin, June 2017;72(6);10. Available at bit.ly/PopHealth_2017.
  5. Willis M. Carpe Diem: Population Health. J Am Coll Radiol 2016; 12:127–128. Available at bit.ly/JACR_PHM.
  6. Brink J. Providing Higher Value Care Through Population Health Management: What Is the Radiologist’s Role? J Am Coll Radiol 2016; 13:759–760. Available at bit.ly/PHM_Value.
    By Alyssa Martino, freelance writer, ACR Press

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