第五回PHM研究部会
Report on the 2019 Population Health Colloquium
in Philadelphia
June 19, 2019Tokyo, Japan
By Gregg L. Mayer, PhD& Shoichiro Meguro

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Agenda• Introductions (10 minutes)• Report on the 2019 Population Health Colloquium inPhiladelphia (50 minutes)– Top 10 Issues Facing US Healthcare– Current State of Population Health Management (PHM)from Stakeholders’ Perspectives– A Look at Current State of Value-Based Care (VBC)• Discussion (60 minutes)

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Introduction• Thomas Jefferson University established the first College ofPopulation Health in 2008
• The university convenes a 3-day academic symposium on
population health management (PHM) annually in March• Concurrently, the Population Health Alliance has their annualsymposium• These meetings attract a wide variety of PHM stakeholders
including payers, providers, hospital and integrated delivery
system (IDS) managers, PHM tool and service vendors vendors, ITvendors, pharmaceutical and medical device companies, and publichealth officials• Today, we will review three topics from the meeting:– The top ten current issues in US healthcare– The status of PHM from a variety of stakeholders’ perspectives– A look at the current state of value-based care (VBC)
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Top Ten Issues Facing US Healthcare
Today• As described by Professor David Nash, Deanof the Thomas Jefferson University School ofPopulation Health

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Top Ten Issues - 1• Rising importance of the influence of theconsumer in healthcare; the system must
accommodate smart phones, wearables, etc.
• Background– Patients demanding care where they are, using
smartphones, data from wearables, etc., not just inside
the hospital• Implications– Health systems that do not meet this demand will losepatients, especially the young generation
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Top Ten Issues - 2• Shift from fee for service (FFS) Medicare
reimbursement to private sector-led Medicare
Advantage plans (i.e. Medicare HMOs); “income basedon outcomes” or “value-based care (VBC)”• Background– Centers for Medicare and Medicaid Services (CMS)
increasing the need to demonstrate value in exchange forpayment through Medicare Advantage• Implications– Providers now have financial incentives to provide qualitycare– Private sector health insurers increasing following CMS’lead and demanding value from hospitals and physicians
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Top Ten Issues - 3• Steep tax cuts imposed by Trump administration
has reduced government tax revenue, which
threatens the future of social welfare programs• Background– Among other cuts, Trump administration cut
corporate tax rate from 35% to 21%• Implications– National debt will increase ~$2 trillion over twentyyears
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Top Ten Issues - 4• The linkage of new Personalized Medicine
with Population Health Management• Background– Many new genetic tests available to determine
genetic health risks• Implications– Genetic tests a new additional tool in PHM
analytics, increasing the accuracy of risk
stratification
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Top Ten Issues - 5• M&A activities in healthcare industry willcontinue• Background– There are many mergers occurring in non-traditional
ways across a variety of healthcare industries• E.g. CVS buys Caremark; wanted to buy Aetna• E.g. Boots/Walgreens owns 25% of Amerisource Bergen• E.g. Amazon buys Pill-Pack mail order pharmacy• Implications– More power to control reimbursement andconcentrate market power
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Top Ten Issues - 6• Healthcare delivery systems (i.e. hospitals and doctor
groups coming together to form Integrated Delivery
Systems (IDS) will continue to consolidate• Background– Hospitals have been merging and acquiring physiciangroups forming IDSs in order to have enough scale toimplement VBC, e.g. as Accountable Care Organizations(ACOs) for Medicare or as IDS for private health insurers• Implications– Larger IDS organizations have more power to makechanges in care delivery and negotiate with health insurers
in local markets

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Top Ten Issues - 7• Government funding of electronic medical records (EMR) is ending; now
there are a new generation of companies that sit on top of EMR data; canthey successfully “pull out” the data needed across platforms to better
manage patients?
• Background– HITECH Act funding to implement electronic medical records (EMRs)
in doctors offices and hospitals is now almost complete• Implications– While EMRs now in place, still difficult for doctors and patients toaccess data across platforms and offices– New software that can find and access a patient’s data in multiple
locations and display it as a single record that can use healthmanagement tools, is needed; i.e. interoperability

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Top Ten Issues - 8• Pharmaceutical companies business models are being
disrupted; they need to rationalize the high prices of new
medicines, or else the government may implement pricecontrols• Background– New drugs are expensive! Zolgensma, a recently FDA-approved
gene therapy drug for Spinal Muscular Atrophy (SMA) has list
price of $2.1 million• Implications– Insurers (including Medicare and Medicaid) may demand
guarantee of efficacy, payment over time, etc.
– Pharmaceutical companies will want to get closer to patient careto help improve quality outcomes in order to get full payment

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Top Ten Issues - 9• The money available for new investment inhealthcare from Venture Capitalists continues
to grow• Background– Lots of money being made in M&A and IPOs fromhealthcare venture businesses, especially inbiotech and pharmaceuticals• Implications– More investors want to enter the healthcare field
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Top Ten Issues - 10
• With the growth in population healthmanagement, there is a need for a larger
healthcare workforce• Background– PHM approaches require a mix of “high tech” and“high touch”, using nurses, nutritionists,pharmacists, health coaches, etc.
– As PHM expands, more healthcare workers areneeded to provide direct patient support
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Agenda• Introductions (10 minutes)• Report on the 2019 Population Health Colloquium inPhiladelphia (50 minutes)– Top 10 Issues Facing US Healthcare– Current State of Population Health Management (PHM)from Stakeholders’ Perspectives– A Look at Current State of Value-Based Care (VBC)• Discussion (60 minutes)

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Population Health Management• What is Population Health Management (PHM)?
• DEFINITION: A population health management
program strives to address health needs at all
points along the continuum of health and wellbeing through participation of, engagement withand targeted interventions for the population.
• GOAL: Maintain or improve the physical andpsychosocial well-being of all individuals
through cost-effective and tailored healthsolutions.
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From the Chairman of the Population
Health Alliance:• The fundamental aspects of PHM are:– Upfront analytics– Actions/Interventions– Outcome focus• Many new health support tools feature a combinations of“high touch” and “high tech” (i.e. even with great technologythe human touch still important)• Care in US shifting from a Hospital-centric model to a Lifecentric model

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From the Better Medicare Alliance Perspective (i.e. Private
Sector Medicare HMO Industry Association):• Medicare reimbursement in US shifting fromfee for service (FFS) to value-based care,increasingly provided by Medicare Advantage
programs (i.e. Medicare HMOs)• Expected to reach 40% of Medicare membersby 2027

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From the Provider Perspective:• Primary Care Physicians are struggling with shift to valuebased care because:– Electronic medical record (EMR) is difficult to use andtime consuming– Value-based care reimbursement replacing FFS, but noadditional payment for additional services required– Virtual visits/patient emails may or may not be reimbursed– Thomas Jefferson University created physician leadership
academy to train doctors how to lead a business

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From the Pharmaceutical Industry Prospective:• Pharma companies are becoming more directly involved inpatient care, as they are increasingly asked to justify the highprice of new drugs– E.g. Merck is working with health insurers and providers,such as Integrated Delivery Systems (IDS) to pilot newprograms such as:• Medication adherence program with NCQA
• Diabetes care program with Aetna• Hospital infection control program with Premier toreduce C. diff. infection rates

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From the Integrated Delivery System(IDS) Perspective:• Increasing interest in the importance of addressing Social
Determinants of Health (SDH) due to its large impact onhealth status and outcomes– Need better analytics to identify SDH needs• E.g. SDH program run by Geisinger Health in Scranton PA,
called “Springboard”– Their #1 SDH gap is lack of healthy food, therefore set up“Food Pharmacy” where patients who receive “foodprescription” from their primary care doctor can visit
weekly to receive free healthy groceries for their family

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From ICT Industry Perspective:• IT vendors are making progress on integrating
regional data from EMRs, hospital billing,
health insurance claims data, immunizationand other information to make integrated
workflows for physicians and the care team inthe network

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From the ICT Vendor Perspective
Evolving Care Outside the Hospital to Meet Consumers Where
They Are
From Philips PHM, Niki Buchanan:• Medicare now reimbursing for remote visits through telehealth• 70% of doctors now offer some kind of virtual on-demand care
• Philips has a patient-facing health support platform that includes
remote patient monitoring for chronic conditions• Now deployed at New York Presbyterian Hospital system, where
they expect virtual patient visits to surpass in person patient visitsby 2024• They have placed kiosks for virtual urgent care visits in Walgreens
pharmacies in the hospital’s neighborhood

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From the Genetic Testing Lab Perspective
From Color Genomics, Alicia Zhou:• Contracts with Employers to offer genetic tests at Color
Genomics at no-cost to employees• Color combines genetic data and the results of an employee’s
health risk assessment to provide “Data-driven Prevention”– This is the intersection of Personalized Medicine andPopulation Health Management• Color also has genetic counselors available by telephone todiscuss results with employees

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From the Third Party Accreditation
Perspective
From the National Committee on Quality Assurance(NCQA), a third party accreditation organization, Margaret
O’Kane:• NCQA accredits PHM programs and also software tools• She believes Medicare Advantage programs are currently
providing the best example of PHM in the US• The Star rating system allows members to see ratings ofcompeting Medicare Advantage programs• NCQA now developing SDH metrics to measure PHM
programs ability to assess and intervene in SDH; it is very
challenging

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From the Employer Perspective:• HealthNEXT has developed new assessment tools tomeasure an employers readiness to effectively
manage employee health, based on a 0-1000 point
rating scale– An increase in 50 points can lead to a 1% decreasein healthcare costs– Intel found that out of its 130,000 employees, 800
people accounted for $100 million in healthcare
costs
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Agenda• Introductions (10 minutes)• Report on the 2019 Population Health Colloquium inPhiladelphia (50 minutes)– Top 10 Issues Facing US Healthcare– Current State of Population Health Management (PHM)from Stakeholders’ Perspectives– A Look at Current State of Value-Based Care (VBC)• Discussion (60 minutes)

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Q: Why are Payers and Providers/IDS’s interested in SDH?
A: They MUST BE, since increasingly they are responsible foroverall health outcomes for a population, not just individuals

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Q: Why is the Employer interested in SDH?
A: Because employee health affects absenteeism, andproductivity, in addition to healthcare costs

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Q: Who is best positioned to apply PHM health support to employees?
A: -Payer, IDS/Providers, Employer can ALL apply PHM outside Clinical Care
-Only IDS/Providers can apply PHM within the clinical care setting.
-Who is at risk determines who pays.

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Discussion
Please email me if you have any questions!
gregglmayer@mac.com

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Appendix• What is PHM?
• What types of PHM are there?
1. Remote Monitoring
2. Disease/Case Management
3. Coaching
4. Consumer-oriented• Who pays?
– Payer– At-risk IDS– Employer– Patient
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