June 2019 —The concept of population health — using numerous sources of ”big data” to identify patients’ health position and risks — gives our providers actionable information to keep patients healthy
and out of the hospital, thereby preventing unnecessary acute care events and hospitalizations, and reducing overall health care costs.
With the data-driven guidance they receive from Sharp Health Plan, providers are able to recommend more personalized health interventions to patients who could benefit from covered programs and services, like health coaching. Sharp Health Plan takes population
health a step further by working closely with its provider partners to meet the Sharp system’s rigorous quality and service standards.
“Population health tells us what’s happening in our population, engages providers to deliver the right care, and improves our patients’ quality of life,” explains Cary B. Shames, DO, chief medical officer at Sharp Health Plan.
A key principle of population health is to focus on the whole person. This means that in addition to health behaviors and health history, Sharp Health Plan looks at how social determinants — such as where you live or how you access transportation
— impact someone’s ability to become or stay healthy. The organization works directly with local nonprofit 211 San Diego to support its members facing health care barriers, helping them gain access to trusted community resources and get
the care they need.
“Sharp Health Plan has been using this comprehensive population health management model for over 25 years,” says Dr. Shames. “We’re now seeing a seismic shift in how health plans are managing their memberships closer to how we
provide this holistic, data-driven, integrated care approach. This is all provided within the framework of Sharp’s value-based provider reimbursement model.”
The shift toward population health received an official push in 2018, when the National Committee for Quality Assurance (NCQA) established ‘population health management’ as a new category for its health plan accreditation standards. “The
future is integration,” says Patricia M. Barrett, vice president for product design and support at the NCQA. Barrett adds, “These standards take the first step toward that integration […] in pursuit of better population health outcomes.”
Dr. Shames is hopeful that these industry moves will encourage more health plans and health systems to follow Sharp Health Plan’s lead and take more steps toward a population health management model.
“At its core, our model is about providing patients with 360-degree care,” says Dr. Shames. “We’ve been a proponent of population health for a long time, and without a doubt, it plays a major role in how Sharp Health Plan receives
national and statewide recognition for our clinical quality and patient experience, year after year.”