Population health management (PHM) can be confusing at times — with many different definitions put forth in the literature. Upon closer inspection, the differences in the various descriptions really reflect differences in emphasis in the components of population health. The American Hospital Association definition might serve as a useful starting point: Population health is “the process of improving clinical health outcomes of a defined group of individuals through improved care coordination and patient engagement supported by appropriate financial and care models.”1 Radiologists are central to care coordination, which opens opportunities to participate and lead in alternative reimbursement models.
An important element of population health bears being called out explicitly. Patients in a population — whether defined as within a healthcare network, insurance plan, or geographic
area — may have varying degrees of access to healthcare. A central aim of population health is to identify the social determinants of health that contribute to these access issues and to formulate action plans. Improving access to care contributes to the goal of promoting proactive care to all patients in a given population. The following Imaging 3.0® case studies demonstrate leadership
opportunities for radiologists committed to improving access to care through PHM.
Addressing a Care Gap
Breast cancer is the most common cancer affecting women in the U.S. While mammography screenings are proven to reduce breast cancer mortality rates, many women forgo the annual exams.2
Recognizing this, one South Carolina health system took action. Working with radiologists, referring physicians, and scheduling staff, the population health team
at Bon Secours St. Francis Health System, a market of Bon Secours Mercy Health, launched Save a Life, a campaign to increase access to mammography screening for women in the Greenville, S.C., area. Radiology schedulers reached out to patients directly to schedule screening exams, the radiologists added additional hours to accommodate more screening appointments, and the health system deployed a mobile mammography unit to increase access to screening.
Since the team permanently adopted the program in March of 2018, following a successful pilot, the number of mammograms Bon Secours St. Francis Health System has performed has risen significantly. The campaign led to a 39% increase of monthly mammogram orders year over year, contributing to the health system’s 256 positive breast cancer diagnoses in 2018.
This approach is like a spider web,” Tami Johnson, director of business development at Bon Secours St. Francis, says. “It starts in the center with one focus and then stretches outward to cover other areas. If you know your part and your area of influence, consider how you can use it to make a positive impact on patient care.”
While you can assign responsibility for improving the patient experience to administration staff, you won't be as successful if you don't have a physician champion who can ensure that the patient remains at the center of the entire care process. The culture starts at the top and works its way down.
Connecting With Patients
During imaging exams, RTs often provide directions about how patients should position themselves to ensure the best image acquisition and quality. But when language is a barrier, providing optimal patient care can be difficult. While in-person translators and telephone-based translation services can help, connecting with those services can sometimes slow down care.
That’s why radiologists at Massachusetts General Hospital (MGH) have leveraged AI to develop a translation tool to enhance care and improve health equity among non-English-speaking patients. MGH radiologists created RadTranslate™, a web app that currently delivers imaging instructions in Spanish, Mandarin, and Portuguese — the three most-common languages after English among MGH patients. The web-based tool delivers common imaging exam instructions, such as “hold your breath,” at the push of a button. Since MGH deployed the tool, preliminary data shows that exam times are more predictable for standard chest X-rays while enhancing the patient experience.
“As large academic medical centers with the means and resources, if we can use technology to help reduce health disparities, then it’s our obligation to do it,” Marc
D. Succi, MD, emergency radiologist at MGH who led development of RadTranslate, says. “Everyone deserves a high level of care, and this tool can help us deliver that level of care to all of our patients.”
After engaging patients who are living with physical limitations, a New York radiology practice adapted processes to improve the patient experience and expand health equity. Lisa Panzica, MHA, has lived with the neurodegenerative disorder spinal muscular atrophy since she was a child. Unable to walk and reliant on a wheelchair, Panzica has come to expect daily obstacles and persists to overcome them.
It was when she was denied a screening mammogram due to her disability that Panzica was truly stunned. Still, she managed to turn her disappointment into action — partnering with the radiology team to improve care for patients living with physical limitations. Based on Panzica’s feedback about gauging patients’ challenges and concerns ahead of time, the radiology team at Northwell Health added a question to their digital intake form that asks patients about their limitations and needs. The team then proactively responds to patients’ concerns and provides enough support for every patient to have the same access to care.
“Leadership in this arena really has to start with the radiologists,” Nina S. Vincoff, MD, chief of breast imaging and radiology vice chair for patient experience at Northwell, says. “While you can assign responsibility for improving the patient experience to administration staff, you won’t be as successful if you don’t have a physician champion who can ensure that the patient remains at the center of the entire care process. The culture starts at the top and works its way down.”
“Always put yourself in the shoes of the patient and be proactive — not only addressing expressed needs, but unexpressed needs, too,” Panzica says. “That’s how to raise the bar in healthcare.”