Wednesday, September 17, 2014

Population Health Management Era Arrives

The Affordable Care Act, as well as changes in how employers and insurance companies address health care, will try to change these disincentives (individual fee-for-service overuse) and encourage health-care providers to manage populations. A population may include a company’s employees and their families, a union’s members, a group of individuals who purchase a like product on the insurance exchange, or a group of Medicare or Medicaid beneficiaries.

Kenneth Davis, MD, CEO and president of Mount Sinai Health System in New York City, “Hospital Mergers Can Lower Costs and Improve Medical Care," Wall Street Journal, September 16, 2014

We are now in the Population Health Management Era.

The big data revolution made it inevitable. You can now connect instantly connect everything with everybody. You can calculate outcomes for different conditions for different populations. You can measure the overall health of different populations in different states and regions under different health systems. You can compare results. You can evaluate the impact of health reform. Above all, you can “manage” care for large groups of people rather than deal with individual problems. Managing populations and their health is said to be easier, less costly, and more efficient than directing and controlling health of individuals.

What’s not to like? Population health management is rational. It is objective. It is controllable. It lends itself to large organizations, like hospitals, who can now coordinate care, get hospital departments and specialists to work together with caregivers, measure health care improvements.

Besides, as Doctor Davis says, “Physicians participating in larger networks will be able to learn more about the best treatments because they will have larger populations from which to draw conclusions.. one can apply supercomputer resources to mine the data and create predictive models of disease….help individuals better understand their risk of illness, and customize preventive or treatment strategy.”


It is a very persuasive and seductive argument, but it has downsides – loss of personal privacy, narrowing of personal choices, erosion of physician autonomies, and an over reliance on data and actions of policy makers and health executives rather than clinical judgments of patients and their physicians.

Carrying out population health management programs is expensive. It requires major technology investments, faith that electronic medical record system will bring efficiency rather than impediments, a belief that various computer system will flawlessly communicate with one another, and “an army of care coordinators to serve as a backbone of an integrated care team.”

Patients and physicians are not yet convinced that population health management, as envisioned by the Obama administratio and large health sysems is the way to go. Four and one-half years after ObamaCare’s enactment, the public consistently opposes the health law by 10 % to 15% margins. And a just released survey of 20,000 U.S. physicians indicates only 24% say electronic medical records have improved efficiency while 46% say they distract from patient care, and only 25% give the Affordable Care Act an A or B grade while 46% give it a D or an F.

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