The Center for Innovation works to reduce preventable morbidity, mortality and costs of care that result from the most common and costly chronic conditions. Patients with these conditions should receive the bundles of evidence-based services that are recommended for routine care of that condition—for example, checks of hemoglobin level, blood pressure management, and eye and foot exams for diabetic patients.
Specifically, we are collaborating with Johns Hopkins HealthCare—the managed care arm of Johns Hopkins Medicine—who works with the “gold standard” in health management and medical research to develop comprehensive clinical data profiles of patient populations. This data is used to identify the patients who need targeted interventions and improve their health in the long run, while benefitting communities, employers and payers.
Increasing the value of healthcare—improving population health while reducing the high costs of care delivery—will be far more challenging. The longer the time window, the larger the number of health care settings and clinicians involved in the patients’ care. Achieving significantly higher performance will require a high degree of collaboration between providers in a community. But improvements in longitudinal care delivery and efficiency offer the greatest promise of reducing morbidity, eliminating variation and health disparities, and eliminating large amounts of waste.
Because of the fragmented health care market and information systems, no one group alone can improve population health. Leadership is needed to bring together various stakeholders and get them to collaborate.