Dr. Mark Leenay discusses population health approaches for addressing rising healthcare costs and improving outcomes. Population health is a proactive, patient-centric model that engages patients, clinicians and providers in wellness, prevention, care coordination and management. There is no single right model, but options include partial or full risk arrangements, bundled payments, and pay-for-performance programs. Fully integrated systems such as Accountable Care Organizations can achieve the best outcomes at lowest costs by coordinating across the full continuum of care. Core capabilities for population health include data analytics, care management platforms, quality measurement, telehealth, and network management.

1. #ntsummit
ACOs and vanguards: Reflections from the USA
Dr Mark Leenay, Chief Medical Officer and Senior Vice
President, Optum International @Optum

2. Enabling New Models of Care
Dr Mark Leenay - Chief Medical Officer, SVP; Optum International
04/03/16

3. Why population health?
• Increasing costs – reactive, fragmented,
activity-based systems no longer fit for
purpose in light of growing LTCs
• Lower than desired quality outcomes due
to lack of coordination and difficulties for
patients and clinicians to navigate health
systems
• Variable access
• Changes in provider landscapes (e.g.
increasing pressure on primary care
systems globally)
Internationally, drivers of population health are similar
Population health is a
proactive, patient-centric
approach that engages
patients, clinicians and
providers in wellness,
prevention, care coordination
and management, improving
outcomes and reducing costs.

4. No single ‘right’ modelReimbursementoptions
Partial/global risk model Optimised
population
health
Bundled services payment
Episode of illness payment
Pay-for-performance
Activity-based
Worst outcomes, highest cost
Best outcomes, lowest cost
Sole provider
delivery
Loose, collaborative
arrangements, e.g.
federatedworking
Alliance contract Prime contractor Fully-integrated
system (e.g. ACO)
Delivery Models
Source: Modified version based on original chart published by Stephen M
Shortell, Dean, School of Public Health, University of California – Berkeley

5. Core population health capabilities
• Data aggregation and
normalisation
• Health Information Exchange
• Claims/payment systems
• Care management platform
• Actuarial consulting
• Predictive modelling
• Quality measurement
• PROM tools
• Wellness tools and portals
• Patient activation and self-care
tools
• Shared decision making
support
• Tele-health
• Value-basedcontracting
• Contract management/provider management
• EBM clinical protocol development
• Variation management
• Financial reconciliation and reporting
• Specialty network development
• Financial protection
• Pathway re-design
• Risk stratification
• Single Point of Access/Carenavigation
• ReferralFacilitation
• Wellness and care management, including
high-risk, complex care management
• Clinical workforce development
• Utilisation management
Infrastructure Analytics Engagement
Network Management Population and Care Management