One of the most discussed topics in the delivery of healthcare over the last ten years has been population health management. The idea is that we can manage everyone’s health in a way that keeps them healthier and in less need of medical care. This is as opposed to the traditional way of providing care to people when they don’t feel well and seek medical attention. The thinking behind this approach is that if we find and address health risks in individuals, we can prevent more costly downstream medical care. People will live healthier lives and we’ll lower the cost of care. Everyone wins!
Even with the upstream investment of screening the population and carrying out risk assessments and management, this would be a massive cost saver overall. Why? Because most healthcare dollars are spent dealing with the complications of chronic diseases. If we can prevent those, the savings will be massive and the upfront investment will be minuscule in comparison. For example, elevated blood pressure causes kidney disease and cerebrovascular issues in the long term. Those are costly because chronic kidney disease care (such as dialysis) costs the system a lot of money every year. However, with a generic $10 per month blood pressure pill, all of that could be avoided. A person with high blood pressure who takes blood pressure medication won’t develop any of those complications. But for that to happen, we need to find those individuals, convince them to be screened and ensure that they take their prescribed medication. We’ll also need them to follow the recommended behavioral changes such as lowering their salt intake, losing weight and exercising, following up with their doctor on a regular basis and continuing to be checked for complications.
There are a number of barriers that can stop this approach from being successful. People often prioritize things other than their health unless they’re not feeling well. They find it hard to change their diet and exercise habits, might not have the time, money or transportation to show up for appointments, don’t always understand instructions from their providers and can have pre-existing beliefs about medication that keep them from taking it on a long-term basis. They also often forget to take their meds.
Many historical attempts by payers to control the cost of care through “case management” didn’t show any appreciable benefits. Around ten years ago, when the Affordable Care Act (ACA) passed, the thinking shifted towards providers being expected to do this instead of payers. This was due to a couple of reasons. First, much of the data needed to manage patients is clinical data and not the claims data that the payers have access to. As such, providers should theoretically be more effective at identifying people at risk and understanding what those risks are for each individual. Second, providers have relationships with their patients and are trusted by them to provide advice and care. As such, they should be able to succeed where payers can’t.
Although progress is being made here, it’s also difficult and has led to mixed results so far. I built one of the first companies in this space. Acupera built software to allow for the intelligent automation of the ongoing care management process for health systems. Given the number of activities that need to be performed beyond what’s traditionally been done, providers simply can’t do all of this. Technology has to be used to scale these programs to touch enough patients. What we found is that medical institutions and healthcare providers are already busy managing the patients who are presenting for care, and so it’s not easy for them to take on the additional job of managing population health. It requires a rethinking of their entire business model and a redesign of processes, staffing and the technological infrastructure. That takes time, planning and execution, along with realigned incentives. That’s why progress towards true population health management has been slow and why we haven’t seen the expected pay-offs just yet.
