An idea in search of reality

Simply and succinctly, population health can be described as an approach that aims to improve the health of an entire group of people. With population health, the world could, indeed, be a better place.

How so? Those with chronic diseases could manage their conditions, thereby maintaining higher levels of health and enjoying more productive lives. Healthy people could stay well, taking all of the preventive measures to keep their bodies and minds in tip-top shape. Care providers could rest easy, knowing that they are doing what’s best for entire groups. Lastly, the healthcare industry could realize cost reductions by emphasizing wellness over sickness, prevention over acute care.

Indeed, the concept of population health is a good one. But, thus far it remains an idea in search of a reality.

The challenge is to find a way to bring the concept to fruition. To accomplish this task, we – the healthcare industry and all of the other interested entities that could become involved in this massive endeavor – must collectively reach an understanding of exactly what population health is and how it will be implemented in America.

First, we must have consensus on the end goal – a slippery slope if there ever was one, as the “picture of health” is continually evolving. Consider the following: In the early 1900s, a healthy population was defined as one having low levels of serious infectious diseases, such as polio and cholera. The development of immunizations shifted science’s attention to preventive efforts, which were ultimately supported by government campaigns and programs that encouraged widespread adoption of immunizations. By the middle of the 20th century, when common infectious diseases were less prevalent, research turned to preventing trauma through improved automobile safety and injury prevention (e.g., seatbelts, car seats, bike helmets). Society promoted their use through political action and laws. By the end of the century and into this century, the focus has shifted to obesity, stress and drug use – all in the name of wellness and longevity. We are at the dawn of this new phase of population health. Research on obesity, gerontology and nutrition will drive the sociopolitical agenda. Because the concept of health continually evolves, we must constantly recalibrate and gain consensus on our goals before we can strive to achieve them.

Second, we need to define the scope of population health programs. Are we taking care of an entire community or a subset of the community? Furthermore, how do we define who is a member of the group? Is inclusion based on geographic boundaries? Is it specific to those who are insured by the same payer? Is it limited to patients defined by a common disease?

Although population health could, in theory, include any one of these groups, the challenge is to identify and define groups that will be most amenable to population health efforts. While it’s likely that many initial population health programs will focus on a disease state, the population health model must expand well beyond disease management to reach its potential.

Third, we need to define which organizations will carry the population health torch. As population health tackles wellness, it’s likely that the majority of programs will be administered outside the hospital setting. Senior living communities could provide population health to residents. School districts could administer population health programs to students. The challenge is to identify organizations that have the governance in place to administer impactful programs.

Although it will take time to reach consensus on the “vision of health,” as well as ideal populations and governance structures, one certainty remains: Population health initiatives, regardless of how they eventually end, must be heavily steeped in science.

Most importantly, evidence-based medicine must support these initiatives. As such, everyone involved will take action based on proven evidence, not intuition.

We will also need tools to disseminate the information to participants. Currently, much of our evidence, or clinical decision support (CDS), is delivered to caregivers at provider organizations; however, much wider and more varied distribution will be needed in population health programs.

Lastly, the CDS will have to be fully leveraged in a manner that is effective. For these programs to succeed, we must continually measure just how much impact the CDS has on actual outcomes – as measured against an agreed-upon vision of health.