From volume to value: Population Health Management

Typography

Never before have so many factors come together to accelerate change in health systems as today


Health systems are facing similar situations from different perspectives:

  • Accessibility to health coverage. The incorporation of excluded populations within health systems or private or subsidised insurance.
  • Accessibility to health services is critical in health systems. Due to the scarcity of resources as much as to dispersion or excessive, unjustified demands for services.
  • The growth of health spending is related to health models focused on direct care attendance as per the demand of services; rather than those that are oriented toward prevention.
  • The difficulty of integrating new technology solutions in health systems. As well as the alignment of these solutions with coverage and provider reimbursement models.
  • The political and economic environment is shaping budget cuts. As a result directly affecting coverage and health services.

Quality, coordination and patient-centred care are bases for the development of a population approach. Interoperability and information exchange become critical for success.

The WHO’s Commission on Social Determinants of Health (SDOH), reported in 2010, that SDOH factors were responsible for the bulk of diseases and injuries. In the US these were estimated to account for 70% of avoidable mortality.

The natural evollution of moving from Health Medicine to Population Health Management (PHM), requires a collaborative strategy by healthcare, community, political, charity, educational and business leaders.

An important priority in achieving this aim is to reduce health inequalities or disparities between different population groups due to the social determinants of health (SDOH).

Clinical Care accounts for only 20% of success factors for true PHM (access to care and quality of care). Social and Economic factors accounts for 40% of success (education, employment, income, family and social support, community safety).

Health Behaviours accounts for 30% (tobacco use, diet-exercise, alcohol-drug use, sexual activity)

 

Population 

When we talk about Population we can distinguish two different levels in health systems:

‘Defined Populations’, a group of individuals that receive care within a health system, or whose care is financed through a specific health plan (employees or members). These can be known with some certainty.

‘Community or Regional Populations’ are geographically defined inclusive population segments. These segments are unified by a common set of needs or issues. They may receive care from diverse kinds of systems or may be unconnected to care. It is often difficult to enumerate the population with certainty.

 

Population Health 

Is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographically defined populations, such as nations or communities, but may also be other kinds of groups, such as employees, ethnic groups, disabled persons, or any other defined group. As a result Population Health Management is placing a specific focus on reducing or eliminating disparities and inequalities.

 

Population Health Management (PHM) 

The purpose of Population Health Management (PHM) is to keep patient populations as healthy as possible, minimising the need for expensive interventions, such as emergency ward visits, hospitalisations, imaging tests and procedures. This not only lowers costs, but also redefines healthcare as an activity that encompasses far more than just sick care. 

While PHM focuses partly on the high-risk patients who generate the majority of health costs, it systematically addresses the preventive and chronic care needs of every patient. Because the distribution of health risks changes over time, the objective is to modify the factors that make people sick or exacerbate their illnesses.

 

Communication with patients 

Engaging patients and establishing a system of communication about their care. 

Current solutions are fragmented and immature but will improve dramatically over the next few years. 

Today’s typical patient engagement solution is through a personal health record, tightly associated with a healthcare delivery organisation. The future patient engagement solution will be completely patient owned, decoupled from an EMR or single healthcare organization.

The Personal Health Record will evolve into a Personal Project Management System with a combination of Project management, knowledge management and social support.

 

Patient education

Materials and distribution system will be tailored to the patient’s status and protocol. 

Current materials are not tailored to blend comorbid conditions together.

Population health management is the key to accountable care and healthcare reform.  

By applying technology to population health strategies in order to continually identify, assess, and stratify provider panels, physician groups can use technology and automation to augment the role of care teams, manage the patient population more effectively and efficiently, deliver better outcomes, and decrease overall cost, as demanded by new payment incentives focused on value.

 

Conclusions 

Never before have so many factors come together to accelerate change in health systems as today. The development of information technology has provided alternatives to transform the financing and delivery of services to decision makers. 

Population Health Management is an opportunity to respond to all of those situations. 

Entrepreneurs represent a substantial change in health innovation. Innovation offshoring has never been closer to a social environment distanced from the big industry players, as now. This paradigm also supports a new vision of collaborative intelligence in society. 

From prevention to rehabilitation through habits and lifestyles, the whole healthcare value chain is receiving new forms of improvement.

Efficiency and effectiveness are closely linked to innovation and Health Population Management. Information technologies are facilitating the integration of all areas of activity in organizations and companies. 

Today it is technically feasible to functionally integrate knowledge and experience. 

Business and clinical management has software tools to manage knowledge and activity, helping decision-makers to improve outcomes and allow for predictive analysis of future scenarios. 

Thus, Health outcomes can be measured and displayed, representing individuals and populations and shaping a virtual representation of Health Population including the stratification of risks in several subgroups.

This integrated experience (PHM) is being built up in different countries. It comes from realities that, conceptually speaking, appear to be disparate or antagonistic. 

Public-private collaboration must gain traction to improve the design of health systems and the health of populations. PHM adds value to the Public Health Authorities emphasizing their perspective as health insurers. 

Population Health Measurement contributes to the development of financial risk management. This allows for a step up from budget-based payment services to a risk-adjusted capitation model. (Health-Based Capitation Risk Adjustment). Providers will adapt their strategies prioritising prevention, not only health medicine. 

Effective PHM will require new partnerships between providers and payers, integrated data support, redesigned IT structures a focus on the non traditional healthcare workforce and new care management models. 

 

 By Javier Esteras