If anyone should know what “population health” is, I should. After all, for the last twenty years, I’ve designed and implemented population health programs for managed care organizations and health management companies. More than a decade ago, at a major health plan, I renamed my department of dedicated staff “Population Health and Wellness” to reflect this important work. All of these programs had the objective of improving some aspect of health and wellness for various populations. Strategies and tactics varied depending on the objectives of the “purchaser” and the needs of the particular population. Whether the individuals being supported were Medicare Advantage members, employees at large or small employers, Medicaid members, pregnant women, union members, retirees, or others—each program had “population-based” goals to improve health outcomes.
But I admit I am struggling for a “population health” definition that works for hospitals, provider organizations, health plans, and others seeking to improve health for a population for which they have clinical responsibility and financial risk.
There are reasons why we have many different definitions, explanations, and concepts behind the term “population health.”
For most of the last 50 years, health plans have been the primary integrators of the financing and delivery of health care, and thus responsible for quality and cost for defined health care populations. My example above notwithstanding, managed care organizations usually did not refer to their many population-based interventions as “population health.” Until recently, providers might speak about their “patient population,” but by and large, they cared for individual patients one at a time. The clinical interventions they ordered or performed were one-to-one actions.
Not surprisingly, academics in public health and health policy tend to use definitions that emphasize research, causation, and outcomes. However, these definitions of population health do not always work in the real world of managing health care populations today.
Many industry coalitions and trade groups, such as the Population Health Alliance, prefer a definition that emphasizes products and services that enable “population health management.” It’s a reasonable try, but as provider organizations struggle to explain the shift to value-based care to their clinicians, it may fall short.
And finally, with accountable care as a key driver, health management and data analytics vendors of all types are now packaging their services as “population health.”
So, does the health care world need another attempt at defining population health? Or should our energies be directed to doing population health—using health information in new ways and innovating in care delivery?
Yes and yes.
Health care is moving quickly to value-based models. Provider organizations responsible for the full spectrum of health needs for a population (as opposed to those delivering episodic procedures or illness-focused care) very quickly realize they need to know about their population’s risks and needs even before they get sick—and the equal need to measure and improve care processes for their overall population.
From a practical standpoint, it is not enough to say, “Population health—you know it when you do it!” We risk thinking that the complex work of clinical data integration or that the equally challenging evolution of clinical practice patterns and provider incentives are, by themselves, population health. And words matter—if we are on common ground with our understanding, we can move the conversation forward to wise investments in population health.
So here is my attempt at a description that providers and consumers can understand: “Population health refers to health care efforts that aim to use health care resources effectively and efficiently to improve the lifetime health and wellbeing of a specific population.”
It’s not the most elegant language, but it’s concise, inclusive, durable, and hopefully it advances our common understanding of the population health challenge.