A Look At the Shared Values of Population Health

A shared population health value system may be what the doctor orders next. The current healthcare system is a patchwork of siloed organizations, sectors, and special interest groups that define a healthy state as simply not needing to seek health care^[1]. This approach has been met with minimal successes as the US has continued to outspend its counterparts in the developed world while seeing minimal gains. The controversial WHO 2000 World Health Report ranked the performance of the US healthcare system as 37th in the world^[2]. The report found that The U.S. health system spent a higher portion of its gross domestic product (GDP) than any other country but ranked 37th out of 191 countries, while the UK ranked 18th, only having spent six percent of its GDP. A recent 2014 Commonwealth Fund report ranked the U.S. 11th out of a list of 11 wealthy countries, in terms of overall health ranking^[3]. Although the U.S. health system is the most expensive in the world, these reports consistently show the U.S. underperforming across most dimensions of performance. A new approach is needed to secure the health and well-being of Americans. The solution can be seen in local, regional, and international efforts at developing multi-sectoral partnerships that intervene across the social determinants of health (SDOH).

Population health requires multi-sectoral intervention across the SDOH, and not just the healthcare domain. The challenge begins with the definition of population health. Traditional clinical care service providers have defined population health, in practice, by expanding their clinical focus to the subpopulations of their client base. In actuality, a true total population health approach views the health care status of the public through the lens of geopolitical boundaries^[4]. This definitional challenge subsequently impacts decisions around program interventions, as well as the identification and selection of appropriate outcome measures. This can be seen in the definitions and use of the Triple Aim and the federal Healthy People initiative, two important tools guiding population health programming, policy development, and measurement identification strategies in the United States.

The Triple Aim was first described in 2008 as improving population health, improving the patient experience of care, and reducing the per capita cost^[5]. This has proven to be an important perch from which the health care system has seen the need for a multi-sectoral response to these complex issues. Although the Triple Aim has expanded the scope to include population health, experts have identified limitations in the lack of clarity regarding the definition of population health indicators. The Institute for Healthcare Improvement’s (IHI) guide to measuring the Triple Aim identifies health, disease burden, and behavioral and physiological factors as the population health outcome measures which, although a broader scope than traditional clinical outcome measures, still fall under the health and healthcare SDOH category. Other determinants of health, including social & community context, education, economic stability, and neighborhood & built environment are not included. A coordinated, multi-sectoral population response should include the broader determinants impacting the population, and their respective private, public, and community stakeholders^[6]. The county health rankings model indicates that the greatest impact to health is through socio-economic intervention^[7].

The federal Healthy People initiative sets ten-year population health improvement goals and objectives for the nation and provides a national report on the success or failure of the system to achieve them. This initiative has been enhanced most recently in the Healthy People 2020 plan to better reflect the importance of health promotion, prevention, and the SDOH. The initiative has also incorporated an interactive online data resource to improve utilization and dissemination^[8]. Unfortunately, mid and end of decade assessments have often shown little improvement in the national outcome measures, and, in fact, have highlighted increased disparities across several health indicators.

At first look, some may see this as a failure of the Healthy People initiative to serve as a call to action for the States. I submit that there is no inherent fatal flaw in the Healthy People initiative and that in fact we need the most effective use of it and other existing resources all grounded in a shared population health value system.

The task of building a systemic culture of health, collectively seeking to improve the health and wellness needs of the total population is not a small task. The Robert Wood Johnson Foundation’s (RWJF) Culture of Health Action Plan, is a broad framework designed to rethink health and wellness in the US. Dr. Risa Lavizzo-Mourey, President, and CEO of RWJF describes it as,

“…taking in the bigger picture of what defines health in America—how health will always be linked to health care, but also extends to work, family, and community life; how health equity is connected to opportunity; and how we, as a nation, must balance the costs, benefits, and effectiveness of treatment and prevention to provide our people with care of the highest possible value. It means focusing on the grander whole of what being healthy and staying healthy means. And it requires an understanding of a dynamic new world of Big Data, social networking, and creative innovation that is both cross-disciplinary and interprofessional.” ^[9]

At Trident House International LLC, we focus on three core components of what we believe amount to a shared population health value system. Recent RWJF and IOM-sponsored population health forums also highlighted these same elements as important concepts for consideration:

1. “Digit to Digest” pipeline: Develop a robust data collection, analysis, translation, dissemination, and end user literacy pipeline
2. Multi-sector strategic partnerships: Develop strategic partnerships across the various SDOH sectors
3. Health in All Policies (HiAP): Incorporate a shared value approach to program and policy development

That being said, it is also clear that improving population health is a very complex matter, and that more strategic research is needed to validate the methods and interventions used, including the components described above.

The firm believes that through thoughtful partnerships across the appropriate public, private, and community partners, that we can ask the right questions, and implement meaningful and timely interventions.

 

 

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