Does PHM Stand for Patients?

Drew Nietert, CPHIMS, PCMH CEC, CHPSE, JHD Group

If you know your “ABCs” of healthcare, you’ve undoubtedly heard the term “PHM.”  You may know that it stands for population health management.  But you may also be like many out there, struggling to understand what this term, and this notion, really means.

population healthcareThe confusion is understandable. Terms such as population health management (PHM) and accountable care organization (ACO) are often interchanged.  In practice, PHM is not accountable care, but without PHM, accountable care is unlikely to be successful.  The term is also widely defined: PHM has come to be defined mostly by vendors selling PHM solutions, and has adopted a variety of meanings depending on the various systems’ capabilities.

The definition of “population health,” as noted by Kindig and Stoddart in an article they co-authored in 2003, is “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”  Population health management is how that gets done or, in other words, the methodology and tools for managing the health outcomes of a defined group of people and ensuring the effective distribution of those outcomes across the group.  Key steps in PHM methodologies include, but are not limited to:

  • sharing data
  • aligning and partnering with all aspects of the care continuum
  • changing the mindset and work at the point of care
  • incorporating other modalities of care
  • understanding which patients are costing the system the most
  • proactively reaching out to patients with specific health indicator
  • creating solutions for patient engagement
  • and others

The tools are the data analytics, the EHRs, the engagement DME and patient portals.  PHM must affect the entire continuum of care and be tied into it — otherwise, even small gaps in patient health management will cause great cavernous pit holes of quality and cost.

As you can see, the method is complex and requires a lot of change. In addition excellent and integrated tool sets are needed to drive almost all of the changes.  So how does a healthcare entity create a strategy for success that employs and fully utilizes the best of PHM?

First, a group should define its goals around ACOs and PHM.  For example, does the group want to become an ACO, become part of an ACO, or simply try its hand at managing a portion of its patient population? Second, based on those goals, a group will need to determine what tools it needs to manage its population.  Needless to say, there are dozens available — and choosing the right solution can be time-intensive and mind-boggling.

The JHD Group has developed a comprehensive RFP that helps identify more than 400 software features, as well as how the software and implementation is designed to work with patient engagement, point of care changes, cross continuum workflows, etc.  If you are just starting on this journey or are stuck in the middle of it, call the JHD Group and we will help guide you through a strategy, selection and implementation as needed.  Simply put, we know the ABCs to PHM success, and we’re happy to spell that for you.

Give JHD Group a call today or send me an email to learn more about this new RFP tool.



Accounting for Accountable Care

Note: This is the second in a two-part series on improving profitability from the JHD Group.  Need to know how to implement these ideas?  Get started with a complimentary conversation today.

Accounting for Accountable Care

Who doesn’t love a good come-back story?  For one 243-member physician organization with which the JHD Group has the honor of working, the story seemed more like a sad drama than a celebratory hero story. Going from a mindset of physicians “costing” a Physician and patient smhealthcare system millions each year and instead looking at the long-term value in enabling physicians to be a profitable pieces of a system’s healthcare business has made all the difference.

Now, that group is now a “comeback kid” with success under its belt that has other physician organizations and hospitals asking themselves how they can achieve that kind of profitability.  Is it possible?  Yes!  Here are a few tips to add to your playbook for a Cinderella story of your own:

  1. Choose the right EMR for your organization, and understand fully how to implement it. Ask yourself a few questions, like: Are you able to see lab work across the continuum? Can you use your system for both your billing and your documentation system you use?  If you don’t have the same product for both sides, does it interface with the other system well?  Proper populations management necessitates monitoring throughout your system, and all that visibility matters as you move toward becoming an accountable care organization.
  2. Carefully consider staffing at all levels. Take a good look at your management teams at all levels. Ensure you have a mix of experts in the right specialties, so that you have people who concentrate on specific aspects of the medical group. Someone who understands the operations in physician offices and can work to optimize operations and efficiencies and is committed to reducing costs is a must-have, as well as someone with a good grasp on financials who can be critically important to monitoring the health of the business side.
  3. Optimize clinicians at the top of their licensure. Your office administrators need to have the same quality and dedication as your senior management team — it’s important that your office administrators are talented, smart people who can not only work the financials in the office, but also assist the physicians to make sure they can do their jobs well. Optimize clinicians at the top level of their licensure to allow them to be as effective as possible — consider the full capabilities of your nurses, aids, P.A.s, nurse practitioners, etc.  Take a careful look at how you generate productivity in the office, properly using that mid-level to enhance the ability of the physicians to see more acute patients and those patients who need more time.
  4. Understand your role in the community. Know how your group fits into an ACO within the confines of your region and how you can work even with your competitors to help manage the health of the population. A naive health system is one that thinks it can do it all by itself, and that’s simply not true. All of the tools of the community have to come together to accomplish this, and you need to have good relationships with all of them. Know your part in making sure that the patient gets what they need. Keep your eyes open to opportunities to be creative in how you treat the health of the people in your area and what your role can be in that process.
  5. Learn how social media and online access fit into your marketing and operations strategy. How do you use social media to move your services forward? How do you manage all those social networks and who keeps up with them on a day-to-day, or hour-to-hour basis? Who is going to ensure you respond appropriately to questions, comments and messages? Smart organizations are taking a careful look at how to employ everything from social media to patient portals to connect with their patients and help them to be an active advocate for their own health. Dedicating professionals to the management of these initiatives is imperative.

Is becoming accountable care capable on your organization’s agenda?  Get started today with a call to the JHD Group.

The People Side of EHR Implementation: My Night in the ER


Juanisha “Juan” Johnson, Senior Managing Consultant, JHD Group

As millions of people do each year, I recently found myself in need of some care. Tired, sick, and barely able to breathe with a throat so swollen, I ventured to a nearby emergency room. But this isn’t a story about overcrowding or multiple-hour waits.  I came in feeling sick but left feeling ill for people working a system that needed a remedy.

People are important. You see, they are the component that can exact change for your organization. My daily work is as a Senior Managing Consultant, guiding organizations through the process of EHR implementation and optimization.  At the JHD Group, our methodology for success as it relates to EHR Optimization consists of four pillars:

  • system set-up,
  • processes,
  • governance, and
  • you guessed it – people.

At every level of a healthcare organization are people who will make or break your EHR implementation, your patient care, your business. It also doesn’t take a neurosurgeon to know that the more people understand and feel that they can master their roles and grow into other ones makes for the kind of employees who stick around, who feel that your business is their own.  In many senses, it is.

Late this particular Thursday evening, I was relieved to find the ER waiting room blessedly uncrowded.  I was in so much pain and was having significant issues breathing. I was triaged and then, again, breathed (what little I could) a sigh of relief that I was taken to the back, where I waited. And waited. The nurse came in, did an evaluation, and then told me the doctor would be in. I waited 30 minutes. When the physician arrived, he said he wanted to order a strep test, and told me the nurse would be back in to do that. Another half-hour goes by and the nurse arrives to conduct the test. More than two hours after my visit began, the physician finally confirmed what I told them while being triaged: that I had a case of strep.

Now, I am in no way suggesting that a physician should simply take the advice of his/her patient – thorough evaluations are always necessary — but this experience was a good example of some important take-aways with EHR optimization and implementation:

  1. Staffing. The importance of enlisting the right people to your organization and its mission can not be underscored enough. Putting people in places where their skill-sets are well-used, valued, and sharpened can be key to keeping and growing them. If your healthcare institution is looking for more efficiency and streamlined processes, start with the people.
  2. Training. Was this R.N. trained in a standing order that patients presenting with my symptoms should have a strep test?  Is his office supporting him with top-of-licensure training that not only allows him to grow as a medical professional, but also encourages him to perform tasks that would free up much-needed minutes for the physicians? RNs, LPNs, medical assistants – these are all professionals who can make the daily usage of EHRs something that positively impacts patient care.
  3. Improved face-to-face time. When properly utilizing people and their interface with technology, it can actually free a physician up to get that much-needed face time. More face time improves patient satisfaction and allows the physicians to do what they are best at: treating patients. Physicians often say laptops or pads get in the way of their patient interface. Could an R.N. or medical assistant help with the technology piece so that the patient gets all the benefits of both EHR optimization and old-fashioned person-to-person interaction?
  4. People living the processes. Optimization is something that has to be practiced every day. The care teams should be able to work within a process that is streamlined for everyone’s sake. Good work flows should decrease the time physicians need to document a visit, thereby increasing productivity. Properly investing in the people who are a committed part of that efficient approach is part of what makes the practice a success.

Easy fixes like standing orders (finger pricks for diabetics, throat swabs for those with sore throats, EKGs for cardiac patients) are not only intuitive, but they also enable and empower clinical staff to perform at their best and to do the patient care that they desired to do when they made a commitment to the healthcare industry. Physicians are freed up to focus on other parts of care, and patients have shorter wait times and a more efficient visit. These are the kind of things we of the JHD Group work with clients on, as we do our “boots on the ground,” “at-the-elbow” training and process implementation.

How was my sore throat?  After a round of antibiotics and a visit to an ENT specialist, it was fine. But my visit to the ER that night confirmed what many of us preach all day long: the people component of your processes, whether it’s EHR implementation or ongoing care, is one of the most critical and important – it’s where your focus should be to effect change. Get the human part right, and ensure your machines support that.

Does your healthcare organization put its focus on people to maximize efficiency?  Tell me about it by leaving your own comment.