By Accountable Care Journal-
Population health management requires systematic change. Achieving this requires rethinking the entire narrative.
Population health management is defined by Dr Mark Davies, Chief Medical Officer at IBM and Watson Health, as “an approach aimed at improving the health of an entire population; it is about improving the physical and mental health outcomes and wellbeing of people, while reducing health inequalities within and across a defined population. ”
Building on this definition, the Accountable Care Journal panel debate at the Public Policy Projects Annual Conference sought to discuss how this can be achieved, while exploring the role of data in predictive risk modelling.
The challenge that healthcare leaders face is moving from organisational health management to population health management. In practical terms, this means shifting the focus from organisations, finances and services that provide the majority of healthcare for a given population, towards a focus on understanding the profound health needs of that population. To do this, data is required, not only to analyse and evaluate those population needs, but also to derive interventions to address them and improve outcomes.
As a GP, Professor James Kingsland has carried out over 250,000 consultations, which can primarily be classified as “reactive care”, or treating people when they become ill. Professor Kingsland, however, believes that through primary care networks (PCNs) GPs can come together, pool resources and achieve a sufficient scale of operation to implement proactive and preventative healthcare strategies going forward. The key question around population health management is why some people are healthy and others not.
Changing the narrative
Public health and healthcare services have traditionally been separated into streams of responsibility. However, the adoption of a whole system view of health is required for transformative change to become a reality. To ensure institutional reforms are sustainable, changes must encompass care reform that is backed up by payment reform.
A shrinking of public health budgets, in favour of population health management from healthcare providers, constitutes significant payment reform. Going forward, it is debatable whether public health should be considered a sub-set of population health.
“In order to establish the fundamental drivers for population health, we need to understand how to create value,” said Daniel Casson, Digital Development Executive at Care England. “To do this, we need to blur the lines of where value is. ” This must come from recalibrating the language; to talk about the well-being of people, as opposed to thinking strictly in terms of health and social care.
“In order to establish the fundamental drivers for population health, we need to understand how to create value”
Julia Ross, a member of the Digital Health Council for the Royal Society of Medicine, reflected on the extent to which the language of patients, as opposed to people, has an incarcerating impact on system mindset change. For effective population health management to translate into improvements in citizen health, interventions must go beyond the NHS and involve wider public services and social care. This starts with a change in the narrative.
Lessons from overseas
“One of the things that has fascinated me is how much more analytical we are as a healthcare provider in the US than I have experienced in thirty-odd years in the UK,” said Professor Simon Jones.
Professor Jones works as a professor of population health at NYU Langone, a provider covering around 400,000 people in New York. The system at NYU is currently moving from a fee-for-service model to a value-based contract, whereby healthcare insurers pay a fixed amount for comprehensive care for an individual or group of individuals, regardless of their requirements. It is then for the provider to ensure healthcare services meet the needs of citizens. This creates a key incentive for providers to invest in prevention and avoid costly treatments through acute services.
The panel were challenged on the barriers created by inconsistent criteria for data and research across the UK. Professor Richard Barker, Chair of the Population Health sub-group of the All-Party Parliamentary Group (APPG) on Healthy Longevity, asked what learnings can be taken from best practice overseas.
The response, from Professor Jones, was to focus less on the risk model and more on the interventions that can be implemented as a result of the findings. In the case of falls, this may be new technology, but could also be proactive awareness campaigns. In the case of malnutrition, the best intervention may be working in partnership with local shops to ensure fresh food is available to local residents, as has been the case in parts of New York.
Rethinking the data culture
Thinking pragmatically about population health management, we have to consider the legalities of access, control and application of citizens’ data. The GDPR Act is a framework that sets parameters for what happens within data processes. Everything within is open to interpretation, argues Gerard Hanratty, Partner at Browne Jacobson.
There is a culture of fear around the sharing and use of data which is limiting the benefits of its application. “We have done a wonderful job of making people scared about the concept of confidentiality,” said Mr Hanratty, arguing that organisations in the UK are guilty of overestimating the consequences of using data at all.
“We’re data rich in the NHS but still information-hungry,” added Professor Kingsland. Despite the NHS having a wealth of data at its disposal, providers are often not able to use it effectively to facilitate better outcomes. The NHS needs to understand how it can best use the data it already has to achieve improved patient outcomes.
“We’re data rich in the NHS but still information-hungry”
As Dr Davies summarised, when data is shared professionals are put at risk, but when data is not shared, it is patients who are put at risk. The downside of this is a culture around data that is closed and protected. While Mr Hanratty and Browne Jacobson conduct workshops with trusts to demystify GDPR, he called for leadership from the top to help encourage a more open culture within NHS England.
A more holistic approach
For population health interventions to have a significant impact, they must take a more holistic approach. Mr Hanratty raised the example of Browne Jacobson’s work in Greater Manchester, where schooling and housing is considered as part of a way to address homelessness. This takes into account the cost of hospital admissions as opposed to housing and whether the most cost-effective solution is to invest in affordable housing.
One thing is certain, the culture of healthcare systems is changing in England.
£4.5 billion of investment for PCNs is shifting the focus from public health to population health at the local level. Integrated Care Systems are bringing together more service providers to consider the health of populations over simply that of patients. However, to enable these structural reforms to deliver tangible benefits for patients, we must first start by changing the language.
Watch the full session
This session was kindly sponsored by Browne Jacobson LLP
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