NEJM Catalyst recently surveyed health care professionals across the U.S. on their views on care redesign, and found mixed support for the concept of population health management. While executives and clinical leaders believe it is the future path to better care delivery, frontline physicians feel that population health implies a focus on broad interventions aimed at public health, at the expense of the highly personalized care that Americans expect — care centered on their individual needs, values, and preferences.
This fundamental disconnect in views seems rooted in the ways different constituents define population health. Executives and clinical leaders view the concept as a financial construct — the way that the health care system will actually move from volume to value. They focus on paying primary care for the efficacy of preventive care, as measured by reliable primary and secondary prevention metrics, or on creating a medical home with accountability and risk for a defined population. For health care executives, population health is all about the money flow and the metrics that evidence-based guidelines say the system should be providing reliably.
Clinicians, on the other hand, view population health as a clinical construct. They want to know whether their patients are behind on their cancer screenings or cholesterol control, and how well they are doing caring for their assigned population. Clinicians understand the goal of adhering to guidelines for prevention and reliability but also the need to customize care for real human beings, in all their complexity. The reason a physician doesn’t do cancer screenings on Mrs. Smith is that she’s refused them on numerous occasions. And whenever Mr. Jones’ depression reactivates, he stops his statins, so a physician knows to address the former before getting to the latter.
As a clinical leader who is also a clinician, I view population health management as both a financial and clinical necessity. It is a “both-and” concept rather than “either-or.” A seminal article by Beth McGlynn and others in 2003 showed that U.S. health care delivers evidence-based care reliably to our communities roughly half the time. Clearly, we need to do better than that for the population. At the same time, we don’t want to lose the sense of personalization in care. Patients should not feel like a number, a nameless cog in a health care machine. Using financial tools to help promote reliability, while also creating flexible, clinically relevant support systems to make the right thing easier to do for both patients and caregivers, would help end the dichotomy revealed by the NEJM Catalyst survey.
Understanding the different lens used by different audiences can help everyone in health care leverage population health as both a financial tool to optimize health outcomes and a clinical construct to make personalized care more reliable. That will get us all closer to the ideal of linking health care payments to the product the system should deliver: better health.