Health care in America is in a period of transformation. While some view the transformation as a response to the emergency we are facing, we must recognize that there is no silver bullet that will fix the problems. Reforms are focused on balancing cost and quality—getting more for less, though that is interpreted differently among key stakeholders. Policymakers are saying that keeping people healthy and out of the hospital will lower costs, but providers understand that doing so requires providing more services for less payment.
Instead of traditional payment models that focus more on quantity than quality, pay-for-performance strategies slowly are changing the landscape, but we still have a long way to go. We could discuss all the systems issues that are to blame, but that would indicate that we are, in fact, waiting for change to happen—the silver bullet mentality—rather than making it happen. There must be something that we can do, strategies that we can employ now that will create change. Population health is the answer.
What Is Population Health?
Population health is an approach that aims to improve the health of an entire population. While it seems to be another health care buzzword, it has the potential to effect real change. Population health focuses on: 1) the distribution of health outcomes within a population; 2) the health determinants that influence distribution; and 3) the policies and interventions that impact the determinants. As a strategy, it concerns groups on a macro level. (For definitions of population health, see "What Is Population Health" by David Kindig and Greg Stoddart in American Journal of Public Health, March 2003, and "Understanding Population Health Terminology" by David A. Kindig in The Milbank Quarterly, January 2007.)
Population health reveals patterns and connections within and among multiple systems (health care, neighborhoods, communities, etc.). These patterns and connections inform strategies by accounting for the characteristics of the population—including common health issues and the environment in which they live—while addressing needs. A population health strategy requires the collective support of key stakeholders, namely health care providers, policymakers, public health professionals and, most importantly, you and me—the patients who value optimal health.
If this sounds like utopia, it's because we aren't there yet. Awareness is the first step. We need to recognize how we can improve the system and devise a strategy to promote health and prevent disease before we can achieve it.
Health care is one small contributor to a population's overall health, yet it receives the greatest volume of resources and attention, because providers are the primary resources for patients when it comes to their health. But, second to the patient, providers also have the most to gain from these strategies. Population health will lead to better quality care, improved safety and better prevention strategies, all of which look favorably on the provider because the result is a greater number of healthy people.
How It Will Change Practice
Many thought leaders have developed reports, models and frameworks, all of which are helpful to gain an understanding of the health problems within a population. Tools such as the Dartmouth Atlas and County Health Rankings also are available to provide a snapshot of a population's health by geography. But these reports and tools often lack strategies to overcome problems. While it is clear there is no single approach to improving population health, we lack evidence on how to implement strategies that can bring about improvement. So, in the spirit of "making it happen," rather than waiting for the necessary systems changes to take place, we can learn from our colleagues who have developed and tested improvement strategies.
The National Priorities Partnership is one group that is making strides toward transformational change. In 2008, the group of 48 stakeholders joined together to devise a set of prioritized goals to improve delivery of care. The partners organized work groups for each of the priority areas, among them population health. Partner organizations are taking the strategies devised by the work groups and implementing tests of change to produce evidence of what works.
A much different population health strategy is the one developed by Jeffrey Brenner, M.D., in Camden, N.J. In many ways, Brenner's approach is as close to utopia as we can hope. As a family physician practicing in one of the nation's poorest communities, Brenner devised a strategy to target neighborhoods where the highest utilizers of health care services live. In "The Hot Spotters," a Jan. 24 article in The New Yorker, Atul Gawande, M.D., portrays Brenner as a true population health provider. Through home visits, he helps patients manage their medications and provides behavioral therapy and counseling, while using their home environment to understand their health needs and taking tips from his colleagues engaged in medical-home demonstrations.
What It Means for Us
This period of transformation produces opportunity. Acting on an opportunity begins with a choice. We can wait for change and continue to approach health care reactively, or we can be proactive by engaging in the transformation.
As health care providers, administrators, policymakers, researchers and public health professionals, we are challenged to broaden our perspective. Population health strategies require treating the whole person, focusing on health promotion and disease prevention, and restoring and maintaining health. It is both morally and fiscally responsible. It is a call to action. The National Priorities Partnership is answering the call in communities across the country and Dr. Brenner is answering it in Camden. Are you ready to answer the call in your community?
Valerie P. Pracilio, M.P.H., is the project manager for quality improvement at the Jefferson School of Population Health, Thomas Jefferson University, and a 2008-2009 AHA-NPSF Patient Safety Leadership fellow. She is a co-author of Population Health: Creating a Culture of Wellness (Jones and Bartlett, 2011).