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Population Health

Our population and our use of the finite resources of planet Earth are growing exponentially, along with our technical ability to change the environment for good or ill - Stephen Hawking

Population Health

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"What makes us think that population health can be achieved? The natural act of self-interest may answer that question. We are far more apt to do something if it is shown to be in our self-interest or the interest of those we care about -- and when it is built into the routines of medical care and our lives.

We now have inescapable evidence that illness is bad for business. We know that illness produces absenteeism, presenteeism (showing up but being unproductive), and greater rates of disability. We also know that wellness ("... a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." -- The World Health Organization) increases worker (from the factory floor to the corner office) productivity and is associated with higher corporate earnings (so says IBM).

We know that 1 percent of patients in a large group of people account for about 20 percent of medical costs; that 5 percent of patients account for 50 percent of costs; and that 10 percent of patients account for 75 percent of costs. But if only 10 percent of their health is determined by the provision of health care we are talking about a tiny fraction of what can reduce costs.

Enter population health: Unless we change behaviors and the environments people live and work in there will be limited impact on the economic burden a society and a community face. In other words, we can't afford to still primarily focus on medical care.

We also have a sea change underway in the financing of health care. Buyers of health care (federal and state governments and large employers in the private sector -- the vast predominance of the purchasers of medical services) are now putting in place payments that will reduce reimbursing medical providers for doing more and instead incentivize them to economically contain the health costs of their subscribers. When health plans and medical practices are put at financial risk for not managing to a fixed budget or, even better, create arrangements where savings are shared by purchasers and providers together, the marketplace can add its muscle to achieving health.

Penalties like not paying for inpatient readmissions within 30 days also drive better health. They force hospitals to be partners with communities and with patients (and families) since what happens after a hospital stay usually has little to do with what happened in the hospital and everything to do with follow-up care and the attention patients give to their health.

Privacy concerns notwithstanding, we also are seeing an explosion in information technology -- the nervous system of health care. We are positioned to place a cortex, an IT cortex, to inform and help improve the health of patients and populations. Information need not stop at the grounds of a hospital. Patients, primary care clinicians and medical practices can (and are doing so in demonstrations underway) be linked to information about what consumers buy in the supermarket, the fitness they pursue with pedometers and in clubs, and their smoking and drinking habits.

If Netflix and Amazon can know so much about you and influence what you buy and do, so can health IT. What's more, insurance premiums paid by subscribers may come to reward, or not, those whose habits are less costly to society. Using information to shape public behaviors may be called the "nanny state" but it is also a way by which individuals can take control of their health while businesses as well as state and municipal governments save money and lives...

Population health will not be achieved by a few missionaries. But it can be led by a confederation of public health advocates, organized medicine, government, independent businesses, and patients and families. What seems out of reach is possible when so many players are on the same team.

As individuals, we can benefit from new medicines and more frequent MRIs, surgery or other procedures. In fact, we have an amazing health care system in this country that does just that for those who have good medical insurance. We don't want to lose that capability; we want to add to health care the needed attention to the 90 percent of determinants that impact our health, our longevity and our pocketbooks. To paraphrase President John F. Kennedy, changing the public's health will not be easy -- it will be hard..."

Source :Lloyd I. Sederer, MD, Excerpt from Population Health: Transforming Health Care to Improve Our Health, The Blog, Huff Post, February 15, 2014.