The term “population health” seems to mean many different things to different people. For providers, a population may mean their panel of patients. For health plans and insurers, it is often their enrollees. For hospitals, it may be patients and the surrounding community. For advocates, it might be a particular disease group or demographic group. From the public health perspective, it can mean everything from a community to a county to a state to the whole country.
Too often, trying to reach a shared definition has gotten in the way of us realizing that we all have a shared goal: Across the spectrum of health fields, everyone wants to improve the health of the people they touch.
In October, the Robert Wood Johnson Foundation sponsored a groundbreaking event—the National Forum on Hospitals, Health Systems and Population Health: Partnerships to Build a Culture of Health—to bring all these perspectives together to find ways to work together. The forum focused less on what interventions are being implemented and more on why executives are adopting population health strategies and how their organizations partner to go about it.
What is novel about this approach to population health is that it combines thinking about how to ensure that more Americans receive top-notch clinical care with the need to support health outside the clinic walls in people’s daily lives, where they live, learn, work, and play. This forum brought together experts who often work on parallel tracks to find places for collaboration and improved health.
Participants learned about emerging models and examples where these types of collaborations have led to better health and, in some cases, lower costs. It was chock full of information about what types of best practices, partnerships, resources, and skills were contributing to improving the mission and business goals of hospitals, health systems, public health departments, and health plans.
Participants left with increased knowledge of a variety of population health models, best practices, resources, and skills and started the conversation about how to bring these ideas to scale to benefit more of the country.
For example, from Boston Children’s Hospital, Shari Nethersole, MD, highlighted how the Community Asthma Initiative, a nurse and community health worker model, has been improving both the health of children with moderate to severe asthma in targeted neighborhoods and the bottom line of the hospital. The initiative provides a home environmental assessment and asthma management and medication education. A nurse also works with community organizations, daycare centers, and schools to provide asthma education in the community for parents and caregivers. In fiscal year 2011, the program returned $1.46 to insurers and society for every $1 invested. As of October 2012, the program was credited with an 80% reduction in the percentage of patients with asthma-related hospital admissions.
Nick Macchione from Live Well San Diego talked about how San Diego County built a 10-year roadmap to improve health, safety, and the economy. The portion of the plan focused specifically on health had four key goals: building a better service delivery system, making the healthy choice the easy choice, supporting sustainable policy and environmental improvements, and promoting employee wellness. Among the program’s initial successes was the reduction of childhood obesity and overweight by 3.7%.
Recently, at CareOregon, a nonprofit health plan serving low-income Oregonians, Laurie Lockert explained how CareOregon piloted a program that created a new type of worker, called a health resilience specialist, to go out into the community and work with high-risk patients who had experienced a lot of trauma in their lives. The specialists were based in the clinic but quickly became a liaison between the patient, clinic staff, and CareOregon. After the specialists delivered their model of trauma-informed care, they saw decreased utilization of hospital and emergency departments. Anecdotally, they also saw that high-risk patients were now interacting differently during clinic visits—more engaged and receptive. CareOregon, if it expands the program to similar clinics with high-risk patients, expects to save up to a few million dollars a year.
To reach underserved populations, Irene Krokos, MD, of Molina Healthcare, which serves Medicaid, Medicare, Children’s Health Insurance Program, Marketplace, and dual eligible plans, shared how they invented a new position called Community Connectors. These are individuals who “serve as liaisons between patients and clinicians and take a personal approach to assessing needs and assisting the treatment team with coordinating members care.” They intentionally leave the clinic walls to connect patients with vital social services, such as safe, affordable, and healthy housing. In New Mexico, the program demonstrated savings of $4,564 per enrollee and reduced utilization of healthcare services.
These are all wonderful examples of what population health is and can do to improve health and reduce costs. In the end, the forum clearly demonstrated a critical mass of hospitals, public health departments, health plans, and others working to improve population health by addressing the social determinants.
However, while these innovative models were wonderful, they have happened too sporadically across the country. The forum demonstrated clearly that there was a major disconnect: The health care payment system was not supporting this work and the country needs a value-based system that accurately rewards models and initiatives like those mentioned.
At the same time, the forum raised the potential and promise that population health, by all its definitions, holds. The next steps toward realizing the possibilities rests in continuing this conversation and making the connections so that different parts of the health and social systems, from hospitals to providers to insurers to community health workers to public health departments and social services agencies, work better together by focusing on populations and improving health both inside and beyond the doctor’s office, in neighborhoods, workplaces, and schools around the country.