Population Health Management in Practice
What does it look like when a radiology practice participates in PHM?
Population health management (PHM) is a sustainable healthcare delivery model aimed at creating better patient outcomes at lower costs.
PHM will affect all aspects of patient care in the future, including radiology. James V. Rawson, MD, FACR, professor of radiology at the Medical College of Georgia at Augusta University, says, “In addition to the care we provide to individual patients, we have to incorporate PHM into our practices to help improve the health of the communities in which we live.”
A Team Sport
According to 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®, it all begins with teamwork.
“Strong, effective radiology departments with keenly aware, value-minded clinicians are critical to the success of health systems hoping to thrive in PHM.” – Jonathan S. Lewin, MD, FACR
“PHM is teamwork at its very core and radiologists need to be part of those teams,” says Duszak. “The new teams will include primary care physicians, radiologists and other specialists, nurses and other non-physician providers, informaticians, and a whole host of other partners working in a coordinated manner to enhance quality and reduce costs.”
According to Jonathan S. Lewin, MD, FACR, executive vice president for health affairs at Emory University, teamwork in PHM can take on many different forms: the internal teamwork within the health system needed to serve patients and their families, the teamwork between the care providers and the patient, and the teamwork between radiologists and referring clinicians.
Lewin notes that each element of teamwork is essential to providing patient- and family-centered longitudinal care. He points out that a crucial example is how radiologists communicate results and care plans to the referring clinicians: “Early imaging with personal communication of abnormal findings requiring patient intervention is the rule rather than the exception, leading to timely and coordinated care — fundamental requirements for successful PHM.”
Duszak agrees. “The systems that do this well will be the ones that create cultures of communication and collaboration. Radiologists who see this broader picture are in a great position to lead those efforts,” he says.
Patient- and Family-Centered Care
According to Duszak, PHM means assuming responsibility for a large cohort of patients over a long period of time, which only works if the health system and all the people working within it are providing care in a longitudinal and coordinated manner.
Rawson, who also chairs the ACR Commission on Patient- and Family-Centered Care, agrees. He notes that caring for the patient in a longitudinal manner is a key step for the radiology practice, pointing out that radiologists already interact with patients throughout the care continuum.
“Radiologists read screening mammograms and lung cancer screening CT scans,” says Rawson. “They image patients in acute care settings like ERs and hospitals, as well as patients with chronic illnesses in multiple settings, from outpatient clinics and offices to inpatient settings such as long-term acute-care hospitals and nursing homes. Throughout the healthcare system, radiologists perform procedures to make a diagnosis or treat patients. The opportunity is there to organize and coordinate care across the entire spectrum.”
Lewin notes that the patient and family need to be at the center of the radiologist’s care processes and systems in PHM. “Everything we do should be in the best interests of the patient and their family, to provide the highest levels of quality, safety, and service at every touchpoint,” says Lewin.
According to Lewin, to plan for such thoughtful care, radiologists need to think of interactions not as merely individual steps, but as a comprehensive umbrella of activity that ultimately leads to healing and improved health and wellness. “That healing may not be curative, but we should strive for an approach that supports the patient and family through their illness with shared decision-making, empowerment, and transparency around choices that are clinical, emotional, spiritual, and psychological,” Lewin says. “When the longitudinal care team–patient relationship is broken, tremendous acquired understanding and value is lost.”
The Imaging Value Chain
According to Duszak, radiologists should expand the concept of provision of care under a PHM model as outlined by Giles W. Boland, MD, and his colleagues in the JACR® “Imaging Value Chain” series (bit.ly/JACR_IVC).
“Radiologists need to think about the imaging value chain starting when a referring physician and patient even consider imaging in the diagnostic workup — well before we traditionally do, which is typically when the patient calls to schedule a study,” Duszak says. “That means making ourselves available for consultation, helping implement user-friendly decision support tools to guide appropriate decisions, making our scheduling systems patient-friendly, expanding our hours and availability for patient access, and being willing to talk with referring physicians at the time of interpretation.”
Lewin agrees. “The radiologist should have a fundamental responsibility in directing the appropriate utilization of healthcare resources to inform the effective evaluation of patients to allow the early identification and diagnosis of disease,” he says. “Strong, effective radiology departments with keenly aware, value-minded clinicians are critical to the success of health systems hoping to thrive in PHM.”
Duszak refers to it as the opposite of the fragmented transactional approach to care that has led policymakers to aggressively push new care models. “If radiologists want to be successful in PHM, they need to be working together to advance and coordinate patient care,” he adds. “Simply sending a report to a referring physician about them needing to get old outside imaging studies for comparison will no longer be enough. Radiologists who are not willing to do these things themselves and add such value will be far less attractive partners to their health systems than those who are, so the viability of their practices could be on the line.”
According to Duszak, practices need to optimize the appropriateness of imaging studies to do well in a PHM environment. Duszak believes radiology groups willing to manage appropriateness will be highly desired partners for their health systems and regional payers — and for their patients as well, as they increasingly consume patientfriendly appropriateness criteria information (see sidebar) and become more savvy consumers of healthcare services.
How can radiology practices accomplish this? Rawson advocates for the ACR’s numerous appropriateness tools to ensure that the right test is being done for the right reason. “Patients can be partners in the decisionmaking in their care,” he says.
According to Lewin, the prudent use of imaging is critical to ensuring that patients get the most appropriate care at the right time, right place, and right cost, to minimize unnecessary and potentially harmful care. “Effectively balancing care and costs to reach the highest levels of value is crucial in PHM,” he says. “And the radiologist is the most effective advocate for the wise use of imaging technology during the patient’s journey through the healthcare system.”
The PHM Toolkit
The ACR has several tools for radiologists to use in trying to engage and include patients in the decision-making about their imaging:
• The ACR Appropriateness Criteria® (acr.org/AC) are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition.
• ACR Select® (acrselect.org) provides evidence-based decision support for the appropriate utilization of all medical imaging procedures.
• Radiologyinfo.org provides detailed explanations of what patients will experience in various X-ray, CT, MRI, ultrasound, and radiation therapy procedures.
Amidst the ongoing changes in healthcare, radiologists are essential and valued providers of patient care. Learn more about the emphasis on PHM in ACR’s revised strategic plan at acr.org/Strategic-Plan
The JACR ® earlier this year unveiled the first examples of the ACR Appropriateness Criteria® summarized in plain language to help patients better understand which imaging tests may be most appropriate for their particular condition. Find the ACs and patient summaries on jacr.org.
By Lori A. Burkhart, JD, freelance writer, ACR Press