By Sean Williams | Health Care Column

In its simplest terms, improving population health means an opportunity for health care systems, agencies and organizations to work together to improve the health of individuals in the communities they serve.

We know that narrowing a population to a specific health concern to improve, such as lung cancer (reduce smoking rates), low birth weight (increase access to prenatal care) or Type 2 Diabetes (improve diet and exercise), is the best way to yield positive results.

At Mercy Iowa City we are closely following strategies to improve outcomes for patients who are covered by Medicare. Our Mercy Population Health Service Organization (PHSO) is a partner in the MercyOne Accountable Care Organization (ACO), with more than 315,000 members in Iowa. Together, we are focused on improving health outcomes, reducing readmissions to the hospital, improving quality of life and lowering the cost of health care for our patients.

The goals of the Mercy PHSO include rewarding providers for keeping people healthy rather than just treating them when they are sick, while delivering better care at a lower cost. There is a financial risk but the national trend is moving away from fee for service and toward what is called a value-based reimbursement system. The PHSO is designed to do this. Hospitals and providers must demonstrate they are providing quality care and if successful, are reimbursed for doing so.

Under the leadership of Dr. Steve Scheckel, chief medical officer and vice president medical affairs, and Jody Gunn, director of the Mercy Iowa City ACO, the PHSO is using specific, targeted strategies to achieve measurable results. Examples include calling patients the day after being discharged from the hospital to review discharge instructions, scheduling follow-up appointments, and referring those who are high risk or have multiple chronic health issues to health coaches for additional follow up and coordination with providers. Sometimes this involves transitioning a patient to a skilled nursing facility where coordinated care with both their provider and the facility is essential.

Other quality initiatives include annual visits with providers and appropriate preventive screenings such as colonoscopies and mammograms. Health coaches help patients understand why these actions and following discharge instructions after hospitalization are important. They can also discover what are called social determinants of health, the barriers that prevent patients from following their instructions and care plans. Social determinants of health may include lack of transportation to get to an appointment or a pharmacy to fill a prescription, or a broken wheelchair so they can’t leave their house. Health coaches can help find resources and services to help meet these types of needs and address other barriers that prevent patients from adequately following their instructions.

Utilizing strategies such as these, Mercy Iowa City’s PHSO is working to provide the best possible care to our patients to keep them healthy and out of the hospital while improving quality of life and better health at a lower cost.

Sean Williams is president and CEO of Mercy Iowa City.