Population Health ManagementVol. 23, No. 5 RoundtablesReflections on a Post-COVID World: Lessons from the SurgeModerator: David B. Nash, Participants: Mark D. Smith, Anand K. Parekh, Byron C. Scott, Kavita Patel, Karen Murphy, and Karen B. DeSalvoModerator: David B. NashAddress correspondence to: David B. Nash, MD, MBA, Jefferson College of Population Health, 901 Walnut Street, 10th Floor, Philadelphia, PA 19017, USA E-mail Address: david.nash@jefferson.eduCollege of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.Search for more papers by this author, Participants: Mark D. SmithUniversity of California, San Francisco, California, USA.Search for more papers by this author, Anand K. ParekhBipartisan Policy Center, Washington, District of Columbia, USA.Search for more papers by this author, Byron C. ScottAdjunct Faculty, University of Massachusetts Amherst, Isenberg School of Management, Amherst, Massachusetts, USA.Adjunct Faculty, Jefferson University College of Population Health, Philadelphia, Pennsylvania, USA.Search for more papers by this author, Kavita PatelBrookings Institution, Washington, District of Columbia, USA.Search for more papers by this author, Karen MurphyGeisinger, Danville, Pennsylvania, USA.Search for more papers by this author, and Karen B. DeSalvoGoogle Health, Palo Alto, California, USA.Search for more papers by this authorPublished Online:5 Oct 2020https://doi.org/10.1089/pop.2020.29001.nasAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 23Issue 5Oct 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Moderator: David B. Nash, Participants: Mark D. Smith, Anand K. Parekh, Byron C. Scott, Kavita Patel, Karen Murphy, and Karen B. DeSalvo.Reflections on a Post-COVID World: Lessons from the Surge.Population Health Management.Oct 2020.386-392.http://doi.org/10.1089/pop.2020.29001.nasPublished in Volume: 23 Issue 5: October 5, 2020Online Ahead of Print:August 24, 2020PDF download

Healthcare in the United States has experienced a tremendous amount of reform and innovation, especially in the past 10 years, with an emphasis on improving value. Value in healthcare is driven by increasing quality of care while reducing cost. The evolution of quality measurement has been proactive and voluntary within national organizations, such as the National Quality Forum.1 Reform has been less voluntary through government mandates, such as the Affordable Care Act (ACA). One trend occurring at an accelerated pace right now that will create more changes, and ideally more value for consumers, is convergence. Convergence is not necessarily a new trend in healthcare—an industry in which providers, employers, and health plans have typically operated in their unique areas, serving consumers (ie, patients, employees, or members) in a different way, typically without crossing into each other's domains. The exceptions to this, which is not our focus here, are organizations such as Kaiser Permanente, which has served as a health plan, an employer, and a healthcare provider for more than 60 years. To give convergence some significance, let us look at its definition. According to the Oxford's Learner's Dictionary, convergence is (1) to move toward a place from different directions and meet, (2) to move toward each other and meet at a point, or (3) to become very similar or the same. I propose defining convergence in healthcare as: The collaboration of payers and providers to provide population health management, and Divergent healthcare organizations becoming similar organizations. For the purpose of this article, providers are defined as physicians and hospitals, unless otherwise noted. The United States currently has approximately 5600 registered hospitals,2 hundreds of health plans, and thousands of large employers. Convergence can be broken up into many categories, but this article focuses on the 3 areas of: Health systems having their own plans Health plans having their own providers Employers directly contracting with providers. I have excluded employers that employ their own providers, because many large employers have employed physicians and/or other advanced practice providers in their own clinics to service their employees for many years, so this is not necessarily a new trend. However, methods that bring providers to the workplace, such as primary care onsite healthcare clinics, are expanding as employers look at new ways to keep productivity in the workplace high, with less absenteeism.3

493 www.AHDBonline.com l American Health & Drug Benefits l Vol 9, No 9 l December 2016 The implementation of the Affordable Care Act (ACA) introduced significant changes to the healthcare landscape that have affected patients, providers, and payers. Among other things, the ACA has accelerated the shift from fee-for-service care to valuebased care across the country. Although there is debate regarding the ACA’s success and the need for modifications, the majority of people would agree that the ACA has helped jumpstart conversations about innovation, quality, and demonstrating value in healthcare. In 2015, the Centers for Medicare & Medicaid Services (CMS) announced its intent to transform 50% of Medicare payments to alternative payment models (APMs) by the end of 2018.1 APMs are reimbursement models based on value; they were introduced to help reduce Medicare spending, reduce readmissions, and increase care quality while simultaneously creating more coordination across the acute and postacute care continuum.2 The new focus on value-based care and APMs has spurred activity in bundled payments models. The concept of bundled payments is not new. Bundled payment models were first proposed in the early 1980s, with the inception of diagnosis-related groups (DRGs) for acute inpatient events.3 Recently, bundled payment programs have received attention as an alternative to traditional reimbursement models, and these models have extended their purview to manage an entire episode of care. A bundled payment is a single payment for the care associated with a specific condition or procedure for a predefined period of time.2 These bundled payment programs focus on a patient’s entire episode of care. Episode-based bundled payments programs take aim at siloed fee-for-service arrangements by encouraging coordination of services across the entire continuum of care. By design, bundled payment programs extend beyond inpatient acute care to include postacute care services. Bundled payment programs affect postacute care providers, including skilled nursing facilities, home healthcare, rehabilitation hospitals, and long-term acute care.2 Hospitals began to be held accountable for managing episode-based Medicare spending across the continuum of care several years ago, with the implementation of the Medicare spending per beneficiary measure in the CMS value-based purchasing program.4 Medicare spending per beneficiary measures the spending on an episode of care across all providers from 3 days before hospital admission through 30 days after admission.4 Although drugs are not a large part of the cost, and Medicare Part D is not included in the current CMS bundled care programs, future bundles may focus on drug cost in some bundles of care, such as oncology.

Health care leaders read their daily news alerts and monthly journals of choice with the mention of population health during this era of the Affordable Care Act and Accountable Care Organizations (ACOs) in the United States and the drive for quality improvement internationally. Population health strategies vary among health care organizations; however, alignment of physicians with an organization’s strategy is crucial to achieve success. Hospitals and physician groups may want an overall population health approach to improve the overall health of the populations they serve, or want new payment models such as the Medicare Shared Savings Program (MSSP) and bundled payments. Underlying all of this, every organization is inherently concerned about improving health care quality and patient safety. The challenges to improving quality in health care involve not only changing organizational culture but improving our leadership, something that occurs wherever health care occurs in the world. We must be mindful that even with the most technologically advanced information technology, electronic health records, and other health analytics tools to help us with population health or quality improvement, organizations will have limited success unless we have physician leaders to manage and drive results.