Main Line Health's Lankenau Medical Center sits on the border of two Pennsylvania counties with wildly different average health outcomes. The realization of that stark divide galvanized the hospital's focus on population health.
Lankenau is in Montgomery County, which is consistently among the top 10 Pennsylvania counties in the Robert Wood Johnson Foundation's annual rankings evaluating quality and longevity of life, access to clinical care and health-related behaviors. But the medical center also serves nearby Philadelphia County, which consistently ranks toward the bottom of the state's 67 counties. In 2015, it was dead last.
Main Line launched its focus on population health in 2009, but its hospitals began conducting community health needs assessments after the first RWJF rating in 2013. They surveyed patients and community leaders, and used state, local and federal quality data to uncover the challenges that affected patient outcomes.
Lankenau found that patients sometimes skipped routine breast and colon cancer screenings because they did not have transportation or access to child care. Obese and diabetic patients did not improve their diets because they were unfamiliar with healthy nutrition, or could not afford healthier food choices.
“We learned about patients' competing priorities,” said Chinwe Onyekere, the hospital's associate administrator. “Then we developed a robust implementation plan based on the data we collected.”
Main Line started an annual colloquium, an event in which staff and leadership share updates on community needs. By late 2013, Lankenau had started a partnership that allows medical students to act as advocates. The students connect patients with unmet needs to resources, follow up with them, and document their progress in an electronic health record.
As Medicare and other payers increasingly reward or penalize providers on their quality metrics performance, those incentives have come under scrutiny because it's unclear how much healthcare providers can counter socio-economic factors and how to properly adjust for them in quality metrics.