By Gregg Masters, MPH and Fred Goldstein, MS
The concept of ‘managed healthcare’ has been part of the health policy lexicon in one way or another for decades, and has been variably embraced and scorned by different stakeholders. Now that costs have reached unsustainable highs and life expectancy for Americans is on the decline, we’ve finally begun exploring ways to move from a ‘sick care model’ to one that values the health of the individual and the community.
Individuals point to the legacy U.S. fee-for-service payment model as either the inflationary culprit of a cost prohibitive, often inaccessible healthcare delivery system with wide variations in both quality and outcomes, or conversely, as the ‘strong medicine’ our challenged ‘health system’ requires. U.S. healthcare per capita spending is at a 2-5x that of its international peers (developed nations in the OECD) since it’s fueled by a set of incentives that encourage healthcare providers to ‘do more, to earn more’.
Our industry remains challenged to transform its care delivery model to enable the system to consistently deliver high quality care at reasonable price points both the end user (patient or consumer) or third party payer deem to be ‘fair value’ or reasonable.
Robust conversations in board rooms of major healthcare organizations have focused on the impact of the social determinants of health – non-clinical concerns (food and housing insecurity, poverty, education and employment) – on health status, have leaders beginning to direct their focus outward in an effort to understand how health care delivery must change to meet these critical needs.
It’s generally acknowledged that when payment is ‘episodic’ in nature (fee-for-services) we incentivize a sick care model that merely treats symptoms without impacting overall health. When we examine health from a population-level perspective, we are able to address health maintenance or promotion at the individual or community level, by putting a spotlight on the causes of the underlying presenting ‘dis-ease’.
Both Government and the private sector are actively looking to transfer risk via a range of payment models from capitation to bundles, to all-inclusive population-based payments. However, their uptake has been slow, spotty and has met with variable degrees of success. Yet, all are organically converging under a ‘population health’ perspective or frame of mind.
Conceptually, a ‘population health’ approach makes enormous sense. Because it typically involves connecting with stakeholders and organizations outside the healthcare delivery system, successful implementation often presents with significant challenges. The ‘how to’ is often disguised in myriad choices not easy to discern, differentially evaluate, and fund.
By all appearances, the move away from fee-for-service medicine to value based healthcare is accelerating. Underlying this change is the not insignificant question of how one successfully completes the transition to the new paradigm while maintaining care quality and financial margins.
Some have downplayed the impact of population health…or positioned it in opposition to another high priority theme for healthcare leaders, i.e., precision medicine. Yet, it is, in fact, the framework for success. Understanding the specific characteristics of the target population is the open window into the risk, outcomes and costs associated with the group, and the best way to truly measure one’s impact over time. Did the health of the group of persons we served improve overall?
There is good news for those who view precision medicine and targeting individuals as the ideal approach; in fact, the two actually can co-exist. Assessment and stratification, resulting in an intervention(s) to the individual are key characteristics of both precision medicine and population health frameworks. The introduction of genomics, proteomics and other more “individualized” assessment measures allows for a more precise determination of risk, stratification and selection of the appropriate intervention(s).
None of this is easy, but it is necessary if we are to improve the health of our nation’s citizens in a financially responsible way. Social determinants of health play an oversized role in health status, and in order to address them effectively, we must undertake new approaches and thinking, working in broader coalitions and collaborative community partnerships.
Enter the Population Health Colloquium
Jefferson College of Population Health opened a decade ago, under the direction and guidance of its Founding Dean, David B. Nash, MD, MBA, as the first institution dedicated to the study of population health. Since 2008, it has been adding value via research, empirically demonstrated best practices and stewarding the training of the practitioners equipped to connect health with healthcare delivery.
In its 19th iteration, the Colloquium is an immersive experience that brings together thought leaders, innovators and entrepreneurs across the care continuum, including health policy wonks and regulators, to network and learn from one another.
Dr. Nash extends his invitation to the community in the video below:
This Wednesday, February 6th at on PopHealth Week, Dr. Nash chats with Niki Buchanan, Population Health Management Lead at Philips Wellcentive.
For more information on the 19th Population Health Colloquium including keynote faculty and the program agenda, including the Hearst Health Prize, click here.
See you in Philly!by