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van Ede AFTM, Minderhout RN, Stein KV, Bruijnzeels MA. How to successfully implement population health management: a scoping review. BMC Health Serv Res 2023; 23:910. [PMID: 37626327 PMCID: PMC10464069 DOI: 10.1186/s12913-023-09915-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Despite international examples, it is unclear for multisector initiatives which want to sustainably improve the health of a population how to implement Population Health Management (PHM) and where to start. Hence, the main purpose of this research is to explore current literature about the implementation of PHM and organising existing knowledge to better understand what needs to happen on which level to achieve which outcome. METHODS A scoping review was performed within scientific literature. The data was structured using Context-Mechanism-Outcome, the Rainbow model of integrated care and six elements of PHM as theoretical concepts. RESULTS The literature search generated 531 articles, of which 11 were included. Structuring the data according to these three concepts provided a framework that shows the skewed distribution of items that influence the implementation of PHM. It highlights that there is a clear focus on normative integration on the organisational level in 'accountable regional organisation'. There is less focus on the normative integration of 'cross domain business model', 'integrated data infrastructure', and 'population health data analytics', and overall the perspective of citizen and professionals, indicating possible gaps of consideration. CONCLUSIONS A first step is taken towards a practical guide to implement PHM by illustrating the depth of the complexity and showing the partial interrelatedness of the items. Comparing the results with existing literature, the analysis showed certain gaps that are not addressed in practice, but should be according to other frameworks. If initiators follow the current path in literature, they may be missing out on some important components to achieve proper implementation of PHM.
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Affiliation(s)
- A F T M van Ede
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands.
| | - R N Minderhout
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - K V Stein
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - M A Bruijnzeels
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
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Wood SJ, Conrad D, Grembowski D, Coe NB, Fishman P, Teutsch E. Medicaid Integrated Purchasing for Physical and Behavioral Health: Early Adopters' Perceptions of Payment Reform Implementation in Washington State. Hosp Top 2023:1-13. [PMID: 36861790 DOI: 10.1080/00185868.2022.2121796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The Centers for Medicare and Medicaid Innovation (CMMI) gave rise to the State Innovation Models (SIMs). Medicaid Integrated Purchasing for Physical and Behavioral Health, referred to as Payment Model 1 (PM1), was a core payment redesign area of the Washington State SIM project under which our research team was contracted to provide an evaluation. In doing so, we leveraged an open systems conceptual model to assess qualitatively Early Adopter stakeholders' perceived effects of implementation. Between 2017 and 2019, we conducted three rounds of interviews, examining themes of care coordination, common facilitators and barriers to integration, and potential concerns for sustaining the initiative into the future. Further, we noted the initiative's complexity may require the establishment of enduring partnerships, secure funding sources, and committed regional leadership to ensure longer-term success.
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Affiliation(s)
- Suzanne J Wood
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Douglas Conrad
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - David Grembowski
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Norma B Coe
- Perelman School of Medicine Department of Medical Ethics and Health Policy Health Policy Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Elin Teutsch
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
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Minderhout RN, van Ede AFTM, Voragen L, Verheijen C, Vos HMM, Numans ME, Stein KV, Bruijnzeels MA. Reforming healthcare in the Netherlands: practical population health management and the Plot model: A questionnaire survey and focus group study to assess the willingness and readiness of six regions in the Netherlands. SAGE Open Med 2023; 11:20503121231160830. [PMID: 36949828 PMCID: PMC10026084 DOI: 10.1177/20503121231160830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/13/2023] [Indexed: 03/19/2023] Open
Abstract
Objective As in many other countries, the Netherlands is facing challenges in the provision of healthcare to its population. To ensure the population remains in good health in coming decades, an integrative approach to the many factors that influence health and health outcomes is needed. Population health management is gaining interest as a strategic framework for systems change in healthcare organisations. Based on population health management, the Dutch HealthKIC has developed the 'Plot model', which takes a regional perspective. The aim of this study was to detail the extent to which six prospective regions in the Netherlands were ready and willing to implement population health management using the Plot model, guided by the Five Lenses Model. Methods Using an exploratory focus group reporting study, we involved stakeholders from six regions in the Netherlands. Thematic analysis followed the five predesigned dimensions of a validated cooperation model. Results The study uncovered the potential for realisation of model aims, as assessed by an expert team, regarding shared ambition, mutual gains, relationship dynamics, organisational dynamics and process management. The exploratory questionnaire suggested that organisational dynamics is the least integrated topic in all areas, followed by process management, a finding confirmed in focus groups. Conclusion The building themes of the Five Lenses Model all represent preconditions for the success of integration in the prospective regions. The present study showed that while some themes were reasonably represented in prospective regions, no region was satisfactory for all themes.
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Affiliation(s)
- Rosa Naomi Minderhout
- Department of Public Health and Primary
Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The
Netherlands
- Rosa Naomi Minderhout, Department of Public
Health and Primary Care/Health Campus The Hague, Leiden University Medical
Centre, Turfmarkt 99, 5th floor, 2511 DP The Hague, Leiden, 2300 RC, The
Netherlands.
| | - Annefrans FTM van Ede
- Department of Public Health and Primary
Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The
Netherlands
| | - Leonie Voragen
- HealthKic Foundation, facilitated by
Noaber foundation, Menzis, Bernard van Leer Foundation, PGGM, All about Health and
Ministry of Health, Wellbeing and Sports, The Netherlands
| | - Carl Verheijen
- HealthKic Foundation, facilitated by
Noaber foundation, Menzis, Bernard van Leer Foundation, PGGM, All about Health and
Ministry of Health, Wellbeing and Sports, The Netherlands
| | - Hedwig MM Vos
- Department of Public Health and Primary
Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The
Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary
Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The
Netherlands
| | - K Viktoria Stein
- Department of Public Health and Primary
Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The
Netherlands
| | - Marc A Bruijnzeels
- Department of Public Health and Primary
Care/Health Campus The Hague, Leiden University Medical Centre, The Hague, The
Netherlands
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Im J, Evans JM, Grudniewicz A, Boeckxstaens P, Upshur R, Steele Gray C. On the same page? A qualitative study of shared mental models in an interprofessional, inter-organizational team implementing goal-oriented care. J Interprof Care 2022; 37:549-557. [DOI: 10.1080/13561820.2022.2113048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Jennifer Im
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, USA
| | - Jenna M. Evans
- DeGroote School of Business, McMaster University, Hamilton, ON, USA
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Pauline Boeckxstaens
- Community Health Centre Botermarkt. Ledeberg, Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Ghent
| | - Ross Upshur
- Dalla Lana School of Public Health, Lunenfeld Tanenbaum Research Institute, Sinai Health System, University of Toronto, Toronto, ON, USA
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, USA
| | - Carolyn Steele Gray
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, USA
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, USA
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Wildin RS, Giummo CA, Reiter AW, Peterson TC, Leonard DGB. Primary Care Implementation of Genomic Population Health Screening Using a Large Gene Sequencing Panel. Front Genet 2022; 13:867334. [PMID: 35547253 PMCID: PMC9081681 DOI: 10.3389/fgene.2022.867334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
To realize the promise of genomic medicine, harness the power of genomic technologies, and capitalize on the extraordinary pace of research linking genomic variation to disease risks, healthcare systems must embrace and integrate genomics into routine healthcare. We have implemented an innovative pilot program for genomic population health screening for any-health-status adults within the largest health system in Vermont, United States. This program draws on key research and technological advances to safely extract clinical value for genomics in routine health care. The program offers no-cost, non-research DNA sequencing to patients by their primary care providers as a preventive health tool. We partnered with a commercial clinical testing company for two next generation sequencing gene panels comprising 431 genes related to both high and low-penetrance common health risks and carrier status for recessive disorders. Only pathogenic or likely pathogenic variants are reported. Routine written clinical consultation is provided with a concise, clinical “action plan” that presents core messages for primary care provider and patient use and supports clinical management and health education beyond the testing laboratory’s reports. Access to genetic counseling is free in most cases. Predefined care pathways and access to genetics experts facilitates the appropriate use of results. This pilot tests the feasibility of routine, ethical, and scalable use of population genomic screening in healthcare despite generally imperfect genomic competency among both the public and health care providers. This article describes the program design, implementation process, guiding philosophies, and insights from 2 years of experience offering testing and returning results in primary care settings. To aid others planning similar programs, we review our barriers, solutions, and perceived gaps in the context of an implementation research framework.
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Affiliation(s)
- Robert S Wildin
- Department of Pathology & Laboratory Medicine, University of Vermont Health Network and Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, United States.,Department of Pediatrics, University of Vermont Health Network and Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, United States
| | - Christine A Giummo
- Department of Pathology & Laboratory Medicine, University of Vermont Health Network and Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, United States.,Department of Pediatrics, University of Vermont Health Network and Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, United States
| | - Aaron W Reiter
- Department of Family Medicine, University of Vermont Health Network and Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, United States
| | - Thomas C Peterson
- Department of Family Medicine, University of Vermont Health Network and Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, United States
| | - Debra G B Leonard
- Department of Pathology & Laboratory Medicine, University of Vermont Health Network and Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT, United States
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Accountable Care Program Implementation and Effects on Participating Health Care Systems in Washington State: A Conceptual Model. J Ambul Care Manage 2020; 42:321-336. [PMID: 31449166 DOI: 10.1097/jac.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study is based on key informant interviews with health care executives representing 5 large health systems that had entered into contracts with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. The purpose of this study was to explain effects of accountable care program (ACP) implementation on participating health care systems. Between January 2017 and May 2018, we conducted 2 rounds of semistructured interviews (n = 20). Results indicate the need to present a modified conceptual model aligned with ACP implementation in the current context.
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Gabel F, Kalmus O, Rosing K, Trescher AL, Listl S. Implementation of altered provider incentives for a more individual-risk-based assignment of dental recall intervals: evidence from a health systems reform in Denmark. HEALTH ECONOMICS 2020; 29:475-488. [PMID: 31984624 DOI: 10.1002/hec.3997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 05/22/2023]
Abstract
Equipping health systems with suitable incentives for efficient resource allocation remains a major health policy challenge. This study examines the impacts of 2015 regulatory changes in Danish dental care which aimed at effectuating a transition from six-to-twelve-monthly dental recall intervals, for every patient, towards a model where patients with higher need receive dental recalls systematically more frequently than patients with lower need. Exploiting administrative data from the years 2012-2016 from the Danish National Health Insurance database containing 72,155,539 treatment claims for 3,759,721 unique patients, we estimated a series of interrupted time-series regression models with patient-level fixed-effects. In comparison to the pre-reform period, the proportion of patients with recall intervals of up to 6 months was by 1.2%-points larger post-implementation; that of patients with 6-12-monthly recalls increased by 0.7%-points; that of patients with more than 12-monthly dental recalls decreased by 1.9%-points. The composition of care shifted more substantially: the proportion of treatment sessions including preventive care increased by 31.5%-points (95%-CI: 31.4;31.6); that of sessions including scaling increased by 24.1%-points (24.0;24.2); that of sessions including diagnostics decreased by 34.5%-points (34.4;34.6). These findings suggest that dental care providers may have responded differently to regulatory changes than intended by the health policy.
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Affiliation(s)
- Frank Gabel
- Department of Conservative Dentistry - Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Olivier Kalmus
- Department of Conservative Dentistry - Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Kasper Rosing
- Department of Odontology, Section 1, Community Dentistry, University of Copenhagen., Denmark
| | - Anna-Lena Trescher
- Department of Conservative Dentistry - Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Listl
- Department of Conservative Dentistry - Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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RE-AIM Evaluation Plan for Washington State Innovation Models Project. Qual Manag Health Care 2020; 29:81-94. [PMID: 32224792 DOI: 10.1097/qmh.0000000000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The State of Washington received a State Innovation Models (SIM) $65 million award from the federal Centers for Medicare & Medicaid Services to improve population health and quality of care and reduce the growth of health care costs in the entire state, which has over 7 million residents. SIM is a "complex intervention" that implements several interacting components in a complex, decentralized health system to achieve goals, which poses challenges for evaluation. Our purpose is to present the state-level evaluation methods for Washington's SIM, a 3-year intervention (2016-2018). We apply the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure our evaluation. We create a conceptual model and a plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.
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Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States. Health Policy 2018; 122:837-853. [PMID: 29961558 DOI: 10.1016/j.healthpol.2018.05.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 11/21/2022]
Abstract
Aotearoa/New Zealand (Aotearoa/NZ) and the United States (U.S.) suffer inequities in health outcomes by race/ethnicity and socioeconomic status. This paper compares both countries' approaches to health equity to inform policy efforts. We developed a conceptual model that highlights how government and private policies influence health equity by impacting the healthcare system (access to care, structure and quality of care, payment of care), and integration of healthcare system with social services. These policies are shaped by each country's culture, history, and values. Aotearoa/NZ and U.S. share strong aspirational goals for health equity in their national health strategy documents. Unfortunately, implemented policies are frequently not explicit in how they address health inequities, and often do not align with evidence-based approaches known to improve equity. To authentically commit to achieving health equity, nations should: 1) Explicitly design quality of care and payment policies to achieve equity, holding the healthcare system accountable through public monitoring and evaluation, and supporting with adequate resources; 2) Address all determinants of health for individuals and communities with coordinated approaches, integrated funding streams, and shared accountability metrics across health and social sectors; 3) Share power authentically with racial/ethnic minorities and promote indigenous peoples' self-determination; 4) Have free, frank, and fearless discussions about impacts of structural racism, colonialism, and white privilege, ensuring that policies and programs explicitly address root causes.
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