In the U.S. expenditures on healthcare grow proportionally to the growth in the number of older people. Although according to a study from the Commonwealth Fund, U.S. spending on healthcare is the highest among developed nations (constituting more than 17% of the GDP and five times higher than in Canada, the second-highest spending country), it has the lowest life expectancies, only 78.8 years. Encounter-based medicine has proved to be ineffective when it comes to chronic diseases and population health.
Healthcare Population Management
Though new technologies, such as telehealth or remote monitoring, may result in better outcomes, the system needs a more proactive approach. According to the 2015 Commonwealth Fund Study, eighty percent of the factors that affect health outcomes are outside traditional healthcare delivery. Daily behavior such as alcohol use, exercise and diet, social and economic considerations including employment, education, social support, and community safety, as well as the physical environment (air and water quality) significantly affect outcomes. Clinical care covers the remaining twenty percent. Undoubtedly, access to quality care is important for improving population health, but is it enough?
Population Care Management
“Population health” is a widely used term, but it is not yet universally understood. Its concept first came about in the early 2000s to emphasize the health outcomes of a group instead of an entire population. Population health aims to examine a wide variety of groups such as analysis of disease incidence between groups of different ages, professions, and living in different locations. Unlike public care management addressing all members of the public equally, population health care management is more about finding patterns within a defined group and eliminating risk factors at the earliest possible stage. For example, disease prevalence in a certain group, such as low-income families, can reveal problems far beyond healthcare delivery: low salaries (adequate care is not affordable), increased exposure (taxi drivers, grocery clerks, etc.), environmental problems (air and water quality in the community),
absence of primary or secondary education encouraging healthy lifestyle, etc. Effective population care management leverages data across populations to find actionable insights, care gaps, and at-risk patients for early intervention.
The most common definition relates to the “Triple Aim” stating that population health can be reached by providing the best quality care at the lowest possible cost, ensuring the patient has a positive experience and is satisfied with the care received.
At the heart of population healthcare management is the fact that it is people-centered. The better health of a given group leads to a healthier nation, resulting from improved preventative care and people’s engagement in their own health. It ensures that patients receive care when needed, instead of later, at the onset of acute conditions caused by neglect; and that patients feel empowered to manage their conditions resulting in better health related behavior and proper lifestyle changes.
The core goal is the system’s shift from service-based to the value-based model resulting in better health outcomes and higher care quality for lower cost; identifying care gaps and best treatment protocols for the group with similar characteristics (especially when it comes to chronıc disease management) is another chief concern. To ensure this, all physicians and providers should have access to relevant safe patient data stored electronically, meaning that technological advances will drive the new system. But what is even more important, healthcare population management requires changes in patients themselves, ensuring their encouragement and engagement in the treatment. Automatization of most processes, care coordination, and data availability, as well as the more engaged patients, will potentially reduce the burden on physicians.
Solve.Care cooperation with Arizona Care Network has evidenced how significantly technology advances may change health outcomes and administration processes. Results were so conspicuous that in 2019, at the National Association of Accountable Care Organizations (NAACOS) Spring Conference, Arizona Care Network won a NAACOS Innovation Award for their implementation of the Solve.Care application, Care.Wallet for Physicians.
“The relationship with Solve.Care completely aligns with ACN’s Quadruple Aim to improve the health of our population, reduce the cost of care, improve the patient experience and drive provider satisfaction,” said Dr. David Hanekom, former CEO at Arizona Care Network and now the Chief Medical Officer and Regional President, North America of Solve.Care. “The Care.Wallet brings focus to our most important care metrics and gives our providers a solution that is easier and better than the outdated and expensive legacy technologies used in their practices. It removes their pain points and lets them get back to doing more of what they are trained to do – deliver great healthcare.”
Several components that increase the success rate of any population healthcare program are: 1) digital data coordination and availability across all specialists engaged; 2) analytics to identify health trends and care gaps, and develop preventative programs 3) risk stratification to predict risks in different groups, identify group-specific risk factors, and develop individualized care plans; 4) patient management, including enhanced communication, automate scheduling and availability of reliable information for patients; 5) effective coordinated care, especially for patients with multiple chronic conditions; 6) patient engagement.
Similarly, the culture should drive systemic changes. Not only patient engagement and awareness of their responsibility for their own health, but also the correct goal setting and appropriate approach for physicians are crucial for population health care. While the whole system is changing, it is important to keep up with the times and develop a new vision on the individual, population, and public healthcare.