Population health to survive a Trump administration

While President Donald Trump’s promise to repeal and replace Obamacare has set many healthcare stakeholders thinking about the ways a new law may affect each segment of the healthcare market, one healthcare expert predicts that the march toward a better population health management model of care can’t be turned back.

David Nash, MD, MBA, and dean of Jefferson College of Population Health at Thomas Jefferson University in Philadelphia, Pennsylvania, told Medical Economics that the Affordable Care Act (ACA) has shifted the healthcare cost structure, increased the demand for greater accountability and requires primary care physicians to focus on groups of chronically ill patients that cost more to the healthcare system.

“The horse is so far out of the barn you can’t see its tail,” Nash said. “The most important issue in healthcare is how we reduce costs in the system, and the move to value-based care is inexorable.”

He noted that since the ACA became the law, fundamental changes to care delivery have occurred, especially at the primary care level to support population health. For a start, the push from fee-for-service to value-based care has arrived. Most small practices have outfitted their offices with electronic health records (EHRs) and many received incentive payments under the Obama administration’s Meaningful Use program.

In conjunction with EHRs, the creation of practice-based registries, especially at the small practice level, further deepens a provider’s ability to practice population health because registries give providers a sense of how they are doing and the level of care they are giving to a patient relative to a peer group or a regional or national standard.

“Being able to compare your practice to a regional or national norm is the very beginning of population based care,” Nash said. “The registry also demonstrates how the population of patients with whatever illness they have – diabetes, heart failure, hypertension – are doing as a group, as a population.”

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