Now Is the Perfect Time to Advance Population Health

will caldwell
Will Caldwell, MD, MBA

There is an opportunity facing us, an opportunity to embrace more equitable and efficient healthcare.  In a world that is driven by market forces, we cannot be constrained by the status quo and instead, must lean into a true, sustainable shift to population health.

Population health – the identification and management of the drivers of clinical and financial risk impacting a patient’s health outcome is where healthcare is heading and three key opportunities: market-driven innovation, horizontal care management, and behavioral health transformation, will enable this shift.

Funding and regulation are leading indicators of where healthcare is headed.  Private equity is pointing in the direction of innovative services that drive population health outcomes. This can be seen as private equity funding flows into out-patient behavioral health, specialty pharmacy, telehealth platforms, home health services, remote monitoring services, and data integration technology. Not only do all these technologies and services drive population health outcomes, but many of them have been traditionally ignored by health systems because organizations couldn’t figure out how these opportunities could be monetized. The enthusiasm private equity firms have shown in taking on the initial financial risk of supporting new technology enables health systems to take advantage of healthcare innovation that was previously stifled by a lack of funding.

As the market moves to support a population health future, we must also consider how we can utilize these new innovations to bolster care management programs.

When you think about care management at a health system today it is really care management around several diseases. While these care programs are essential, on average they only provide support for a limited number of patients.

For example, if we look at patients who receive care management in a typical U.S. health system—those with diabetes, congestive heart failure, low backpain, lung disease, or chronic kidney disease—and add them, those disease management verticals only benefit 55 percent of a given population.

Care management programs are too often more like disease management programs because the healthcare system has long been focused on encounter-based billing linked to specific diseases. We need to rotate the care management paradigm and turn it on its end.

Let’s shift population health care management from more vertically oriented disease management programs to more horizontally integrated series of pathways, such as nutrition and weight management, exercise and physical therapy, financial health, preventative and palliative care, and behavioral health. Providing care management services tailored to these pathways would ensure we reach 100 percent of the population instead of 55 percent.

Along each of these pathways sit proven, private equity-backed companies and tools ready to provide value for patients and those bearing financial risk for the necessary care.

Finally, the largest untapped clinical and financial opportunity in population health is the intersection of behavioral health and chronic disease. Behavioral health redefined is the largest opportunity to bend the cost curve and improve outcomes to chronic disease management. It is the missing piece for many of us in population health management.

The failure to recognize and treat behavioral health, not as a mental illness but a physical one, is a huge mistake.For example, the total cost of care for a Medicare patient in Florida who has diabetes is $12,000. However, if they have diabetes and unmanaged mild-to-moderate mood disorder, their cost of care balloons to somewhere around $28,000.  

There is no more common thread in managing the health of a population regardless of diagnosis than better behavioral health management. Private health companies are figuring out how to scale behavioral health management through digital engagements, identification of rising risk, and provision of alternative sites of care.

Population health is ultimately about the individual. The individuals in the population are either happy or sad, feel joy or pain, experience suffering and despair, and ultimately live or die. The individual. Not the population.

For individual patients, there exists a fierce urgency of now for providers to tirelessly push for comprehensive population health programs in healthcare systems. For patients, population health isn’t a theoretical construct. For patients, population health is a hopeful reality. And now is the perfect time to advance it.

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