Five Reasons Why Population Health Management Matters


The term Population Health has replaced patient engagement as the latest buzzwords in healthcare. There are a few reasons for this. It is a necessary evolutionary strategy born out of the worsening epidemic of chronic diseases (obesity, diabetes, hypertension, and others). It is also the foundation of a new payment model.  Population health is best defined in an article in the American Journal of Public Health by Kindig and Stoddart as “…the health outcomes of a group of individuals, including the distribution of such outcomes within the group…The field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two.”  Of related importance is addressing disparities in healthcare as contributors to outcomes. As patient outcomes become a metric for value based healthcare payment models, the focus of providers is shifting to preventive medicine, less testing and procedures, and helping people manage their own lifestyles as much as their chronic condition care. Addressing epidemic levels of chronic diseases as a matter of public health (as was done in past centuries in efforts to address infectious diseases) may seem appropriate on the surface, but presents problems concerning civil rights and other regulatory bodies.

  1. It is about people. An interesting overview of the potential roles of the Center for Medicaid and Medicare Services (CMS) in population health management (PHM) is given in an article in the New England Journal of Medicine. It describes the importance of healthcare between visits to providers, issues around provider scope of practice, necessary partnerships with private industry, and other issues. The article conveys a realistic assessment of the magnitude of the challenges involved in such an undertaking. It will not be something addressed with a single program, entity, or technology. A population is composed of individuals. Many will share common chronic diseases for which treatment guidelines are in place. Others will be at high risk of developing these chronic diseases. Within these groups lie factors which cannot be approached in a cookie cutter fashion.
  2. It creates a new and questionable way of paying for healthcare services. While population health outcomes are a laudable goal of payment models, there are limitations to what an individual healthcare provider can accomplish. One cannot force a patient’s change lifestyles or medical regimen adherence. Tools which improve adherence and lifestyle can be ‘prescribed’ but many need to be proven and adoption will take years before a (potentially) positive financial impact is felt, for which payment models should take a huge back seat to patient outcomes as a focus of PHM. What does not need to be proven are benefits of changes in lifestyle (which can be facilitated with motivational messages, coaching, and financial incentives). As with all policy changes, the devil is always in the details. Will a physician in a solo or small private practice who is exempt from having electronic health records be held to the same metric standards of PHM as a large physician ACO? Will physicians in geographical areas of high and low rates of obesity or significantly diverse ethnicities be held to the same outcomes metrics? Questions remain as to whether PHM will actually change the delivery of care itself by physicians. According to a report by The Rand Corporation the implementation of other newer health care payment models have resulted in huge increases in non-clinical administrative burdens without a significant change in face to face care changes. I would submit that better access to relevant data (via excellent analytical tools) reviewed and managed by informaticists (recently approved as an internal medicine subspecialty) with technology providing accurate and filtered actionable data is a better way to effect change in care. The implementation of deep and customizable (according to clinical profiles, geography, genetics) patient population registries with analytics and EHR interoperability seems to be an appropriate first step.
  3. It is a potential equalizer for providers and patients. EHRs were touted to decrease divides among populations by providing data which can result in the delivery of more equitable care. This hasn’t happened because of the inability of EHRs to collect data from multiple disparate sources, facilitate data searches, provide good analytics and to proscribe strategies for PHM. EHRs have the potential to improve patient care if improvements in the user experience of providers via easy to use interfaces and customizable data collection and analysis take place. Patients on the other hand desire, deserve and are not offered portals with good visuals, are mobile, and provide information which they feel will be useful to their clinicians. Patient use of portals presently has been sadly predominantly limited to encounters of minimal quality meeting Meaningful Use criteria which enable providers to receive incentive payments.
  4. It provides a new focus for innovation and investment. As with all new initiatives in healthcare, PMH presents opportunities for innovation and thus investment in products and services designed to provide the necessary infrastructure and tools to support it. Adoption of tools which provide a perspective (via good registry and analytics) on what is ‘going on out there’ (outside of the enterprise) as well as others connecting the public as consumers and patients to providers is the minimum goal we need to first achieve. According to the 2015 HIMSS Leadership Survey, 38% of respondents said they had PHM tools in place and 51% said their organization improved population health based on IT tools. Two-thirds stated that their organization was increasing its IT budget this year. However, according to a KPMG poll, 38% of respondents described their PHM capabilities as in their “infancy.” Investment by enterprises in analytics is critical in these efforts. The technology is here. Putting the pieces together (see below) and adopting them involve shifting cultural, economic, and internal political forces.
  5. It requires a multidiscipline team and portfolio of technologies. There is no single organizational department, process or technology which can address PHM. The varied needs of the spectrum of individuals in a population and requirements of different enterprises necessitate diverse strategies, goals, and utilization of human and material resources. As stated previously on this site, technology is not a solution but only becomes such when incorporated into processes and human workflows which accommodate it.  Predictive analytics,  proscriptive analytics,  excellent remote patient monitoring tools,  customized and EHR-integrated connected clinical business intelligence,* and intuitive user interfaces* all provide elements necessary for successful PHM. Partnerships among technology vendors, public and private healthcare stakeholder sectors, and between patient advocacy and provider groups need to occur for success. It will take investment and creative strategies to design the most economical,efficient and effective PHM initiatives.

The culture of healthcare on the part of patients and providers must change. Transformation needs to occur more quickly than regulators expect from changing payment models. There is a stellar quality of leaders already in this field. They must be given the political clout and technology tools to achieve those goals because clinicians and patients will not tolerate the status quo of the 15 minute encounter for much longer. The goals of population health management, if focused on the people and not regulations, commercial successes of vendors, or payer subscriber levels, can be met in some significant degree.

*As disclosure, the author serves as an advisor to  Medivu.

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About davidleescher

David Lee Scher, MD is Founder and Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in advising digital health technology companies, their partners, investors, and clients. As a cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he understood early on the challenges that the culture and landscape of healthcare present to the development and adoption of digital technologies. He is a well-respected thought leader in mobile and other digital health technologies. Scher lectures worldwide on relevant industry topics including the role of tech in Pharma, patient advocacy, standards for development and adoption, and impact on patients and healthcare systems from clinical, risk management, operational and marketing standpoints. He is a Clinical Associate Professor of Medicine at Penn State College of Medicine.
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3 Responses to Five Reasons Why Population Health Management Matters

  1. waynecaswell76 says:

    As Benjamin Franklin said and public health officials acknowledge, “An ounce of prevention is worth a pound of cure.” So I’m glad to see any discussion of Population Health, because a wellness priority can help shape public policy in many ways, facilitating the development of a healthy & productive workforce that drives economic growth, jobs, wages, GDP, and global competitiveness. Corporations have wellness programs to (1) help lower healthcare costs, (2) lower absenteeism rates, and (3) improve productivity all around.

    In my area of sleep wellness, we’re launching public- and private-sector initiatives aimed at Population sleep wellness. That’s because is directly tied to all sorts of health connections and impacts performance, career advancement, and profits. I’ve calculated nearly $1 trillion in potential health benefits from prioritizing sleep, but the benefits to businesses may be greater. After all, research has confirmed that good quality sleep improves many attributes associated with improved performance at work, in school, and in sports. These include: alertness, attention, balance, behavior, concentration, creativity, decision-making, emotions, energy, endurance, focus, goal-setting, health, IQ, judgment, karma, learning ability, mood, motivation, optimism, performance, problem-solving, reaction & recovery times, reasoning, risk-taking, self-control, talents, utility, value, working memory, and more.

    Sleep is a pillar of good health, along with nutrition and exercise, and it joins with things like social connections, purpose, and happiness to form wellness. Thanks for the article. (more thoughts at http://www.mhealthtalk.com/transforming-our-flawed-healthcare-system/)

  2. Sid Brumbach says:

    Spot on. There simply is no single answer or strategy for population health, an issue as complex as the individuals comprising any cohort. This is probably the best population health summation available today. Thanks David.

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