Essentials in Population Health, a four-part webinar series for children's hospital leaders and teams, kicked off with "Population Health—Why it Matters." Here's a glimpse into that session and the move toward this emerging health care approach.
What makes us healthy? It's a simple math equation, according to the Robert Wood Johnson Foundation (RWJF): 20 percent genetics + 20 percent environment + 10 percent access to medical care. The other 50 percent is individual behavior: Healthy habits like diet and exercise.
Yet, the country's spending habits around health don't add up: 88 percent of resources go toward delivery of medical services, while 4 percent is put toward healthy living. Even though the major determinants of health are behaviors, genetics and environment, most health spending is on medical care. This disconnect is one of the driving forces behind the move toward population health.
Population health: A term often used in health care, yet not universally understood. In this first leg of the Population Health Virtual Learning Series, we explore why population health matters. Here, David Nash, M.D., MBA, dean of the Jefferson College of Population Health at Thomas Jefferson University in Philadelphia, shares four things you and your teams should know about population health.
How we got here
For generations, the health care system has operated in reactive mode rather than working proactively with people in the community to create a culture of wellness. Care teams have been lulled into the habit of making autonomous decisions for patients, instead of partnering with other health care providers to enhance care and outcomes. This approach has led to disparities in access to and quality of care.
The result, Nash says: The U.S. ranks 17th in the world in self-reported, research-validated measures of (health-related) quality of life, even though we spend more on health care per capita than any other country. "Unless we can change, pivot and move toward population-based care, upstream medicine, prevention and wellness, we are going to be in a real jam," he says. "Our millennial-aged children might have a shorter life span than the baby boomers."
Defining population health
Population health seeks to create conditions that promote health, prevent disease and adverse events, and improve outcomes. In broad terms, it aims to address the large-scale social, economic and environmental issues that impact health outcomes of large groups of people. From the perspective of health care delivery, population health is a purposeful shift from the volume of care to the value of the care delivered.
Recognizing that individual behavior and socio-economics have the biggest impact on health, population health zeroes in on these factors and works to connect proactively with communities—to engage patients and families to become more active partners in the promotion of their own health.
"Population health is not just about doctors, nurses, pharmacists and the hospital," Nash says. "It's about everything else. It's about the fact that poverty is a major predictor of health—ZIP code as a proxy for education level, income level…that in our great country, social determinants are key drivers."
Connecting population health and health reform
Let's start with the focus of health care reform today: The Triple Aim, a framework developed by the Institute for Healthcare Improvement (IHI) to optimize health system performance. The three dimensions of the Triple Aim are:
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of healthcare
Nash says the goals of the Triple Aim align with those of population health, but the challenge is implementing population health within the constructs of the Affordable Care Act. "Health reform is all about adopting the tenets of population health due to realigning the economic incentives," Nash says.
This ties back to the shift from volume-driven care to value-driven care, where payments are made based on outcomes rather than the amount of service provided. It also means bundled payments, where primary care physicians and specialists work together toward a positive outcome. Nash considers this concept critical. "Bundled payment—which, by definition, will engage with the pediatric specialist—is our hope for the future," he says.
What the future holds
It's all about creating a culture of wellness. As population health increasingly catches on, Nash predicts a continued rise in consumerism—in retail care outlets and expanding markets for health information and products. He says to also expect a continued push for medical staffs to adapt to the value-based payment model, resulting in more team-based care.
While the health care community is beginning to make strides, Nash says more work is needed because the current approach to population health "is not sufficient to tackle the amazing challenges we are facing."
To learn more, listen to the replay of the "Population Health – Why It Matters" webinar or view the whitepaper. This webinar is part of the Essentials in Population Health, an educational series through CHA that explores changes under health care reform and how to operationalize a population health strategy. This member benefit also offers insights on social determinants of health, the role of data analytics and staff competencies to support your child health priorities.
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