Understanding Population Health

Are You Working to Keep People Healthy? Here's How to Find Your Place in the Crowd.

July 9, 2014

Healthcare Strategist, NBBJ

@dbellef

“Population health” is one of the most widely used and least understood buzz-phrases in healthcare today. You can just imagine some CEO calling the Chief Strategy Officer to the corner office and asking him or her to explain the organization’s population health strategy. I’m betting ten such conversations result in ten different explanations.

For some, population health encompasses the broad determinants of acquiring and sustaining a healthy lifestyle; for others it’s the treatment and prevention of the very chronic diseases that were acquired because the basic building blocks of a healthy life were not available. Then there is the notion that population health is managing a very specific population — diabetics, for example —within a larger panel of patients or, for a manager of an Accountable Care Organization that has taken on the financial risk of treating patients, the top 1–3% of the “super-utilizers” of services they are trying to bring up to some level of health.

It’s a quandary many of my colleagues in the strategy and planning business face every day: many well-meaning and passionate practitioners have very good and solid reasons to invest in the wellbeing of their populations, yet resources are scarce. The strategist has to take all this in and bring purpose and cohesion to it all so good decisions can be made.

To help, I created an initial attempt at a broad classification of the different aspects of population health. Once an organization classifies what kind of entity it is, it can determine the types of patients in which it should invest its efforts, based on an objective classification rather than trying to serve a variety of competing interests. It can also guide efforts in developing partnerships to either co-care for particular populations or align different populations in one continuum.

Toward a Taxonomy of Population Health

Responsible Entity

All Jurisdictions:
Public Health

Health Insurance Plan:
Member Health

Health Provider:
Patient Health

Role

Primary and secondary prevention of major diseases — obesity, diabetes, cancer, heart disease, etc. — addressed though public initiatives.

Federal direct research and funding of research and NGO participation included.

Addresses the specifics of maintaining a healthy lifestyle and offers incentives to do so.

Manages the care of the member in all settings (can be outsourced to health providers take on risk).

Direct care of specific patient groupings that require a licensed provider to treat.

Geographic Reach

National, regional, local depending on population health profile

Insurance plan market area

Local market

Patient Risk Profile

(Percentages reflect low, rising, and high risk only. Source: The Advisory Board)

  • At risk but no active disease
  • Low risk (60%-80%) minor conditions are easily managed
  • At risk but no active disease
  • Low risk (60%-80%) minor conditions are easily managed
  • Rising Risk (15%-35%) may have condition not under control
  • High Risk Patients (5%) with complex disease and comorbidities
  • Rising Risk (15%-35%) may have condition not under control

 

The chart begins to lay out who does what, to whom it is done, and where it is done. With further development from some budding Linnaeus, it can be really specific about sub-populations within the broader classes. Of course, as strategists and planners we are not creating the health protocols a specific population will need, but we certainly are designing the overall operational and physical structure required for the population’s care, whether in a community setting or a facility. Because such a broad range of settings are possible, we need to broaden our scope and incorporate elements of facility and urban planning.

Find your organization’s place in population health by asking some basic questions: Who are we serving? Where are they located? Why are we serving them? What are their primary and secondary diagnoses? What services do they use? Do we have services close to them or do we make them come to us for care? Are we good at serving them? Can we be the best in our market at serving them? Who else do we want to serve? Why? Can we be the best in our market at serving them? Who don’t we want to serve? Why?

The answers will guide you to your place in the taxonomy and set you on the path to your strategic design. And guess what? It’s not really a population health strategy anymore. It’s The Strategy: the one goal that aligns all elements in your organization because of its far-reaching consequences.

Image courtesy of Flickr.

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