Readers Write: What Is Population Health Management, Exactly?

What Is Population Health Management, Exactly?
By Steven Merahn, MD

While at HIMSS, I stopped by the KLAS booth and ended up revisiting the October 2013 KLAS report on population health management. I was both impressed and concerned about its findings. Impressed because of the level of market commitment to population health-related solutions, but concerned because I still don’t think the market gets it when it comes to population health management.

The real power of population health is the opportunity it offers those delivering care to disintermediate those we now call payers — removing or disrupting a layer insulating patients from their providers – or at least put physicians and provider networks in a position of strength in negotiations with those contracting for care (unfortunately, it also puts hospitals at risk for similar disruption, like what happened to the railroads when airline travel began to get traction).

HIMSS was full of vendors hawking analytics and care management platforms, but population health is really not at its heart a technology play. In the executive summary of the KLAS report, author Mark Wagner tried to address this issue when he said,  “…automation is a misnomer for vendor solutions and PHM remains largely a manual process.”

However, the use of the phrase manual process is itself a misnomer. It presumes that automation is even possible for population health management. Elements of a technology stack can enable (and may be necessary for) population management, but these elements – individually and collectively – are wholly insufficient for successful implementation of a population management infrastructure.

Wagner again alludes to this in his reference to the value of “collaborating with physicians early,” but there’s more to this than simply physician engagement. It’s far more fundamental, as physician leaders, provider networks, and healthcare delivery systems are discovering. In successful population management, the databases, software analytics. and care planning platforms — whether EHR-based or independent but interoperable — are largely subordinate to a more dominant factor:  the human factor.

If there’s one thing that has been consistently affirmed to me in the 30+ years since medical school graduation, it is that health and healing is impossible without the human connection. I submit that the value in value-based care – improving quality of care and quality of health based on more efficient use of effective healthcare resources across a cohort or defined population – is more powerfully achieved through reconsideration of the organizational principles and operating relationships among the people, programs, platforms, and partners that comprise healthcare delivery and care management.

Population health management transcends the technological elements that may fulfill some of its specific functional requirements. Product, services, and channels may be necessary, but are insufficient to truly influence the trajectory and quality of a person’s health. That influence occurs at more tactile and emotive levels in people lives, “tactile” referring to the responsiveness, reliability, consistency, and convenience of care; “emotive” referring to the sincerity, authenticity, integrity, and dignity associated with the experience.

I am reminded here of Dr. Lipton, our family physician in the 1950s and 1960s, For him, what we now call population health was just the way he practiced medicine. If my grandfather – who had his first heart attack in his mid-30s – missed his quarterly blood pressure check, we would get a call. After my grandmother’s sigmoidoscopy — then done in an operating room as an inpatient — he stopped by the house.

His technology for this: the work of worry — and a weekly index card tickler file. But despite what would seem to us some technological limitations, time and time again he demonstrated to us that we were very present for him even when we were absent from his waiting room.

He did get paid in cash for services rendered, on a fee schedule and sliding scale, but he also worked to earn our trust. There was no doubt that this was an important form of compensation for him. His value proposition was threefold:  mastery of his craft, demonstrable commitment, and genuine consideration. As such, his responsibilities for our health extended beyond the doors of his office.

For our family, he provided comfort and a safe harbor – despite some looming health threats — because there was a person, and not just a person, an expert, who worried along with us and that was in many ways a more powerful influencer of our healthcare quality then the medicines he prescribed. His recommendations were followed, even when there was intellectual resistance, because we could not imagine letting him down.

Our current approach to technology is focused on “managing measureable variables,” but the real challenge is that quality of health is based on a different set of variables than quality of care. Our technology may allow us to identify and attempt to control dozens of evidence-based clinical factors, but is still not powered by factors representing the capacity to influence a patient in ways that truly matter.

Which means that if we truly want transform care delivery with technology, we need to shift our focus from the meaning of the data to what we mean to each other.

Healthcare technologies should be instruments of human expression in service of health and healing, with a fundamental mission to provide the patient and their family the same sense of comfort, safety, and reliability provided by the Dr. Liptons of the world – where professionals are valued for their commitment to mastery and human service and patients are helped to find the meaning of health in the context of their relationship with themselves and others.

This will require us to reconsider what we mean by population health by designing systems of care that amplify the humanness in our care delivery, where technology supports goal-directed collaboration between humans and machines and where we are allowing people to find meaning and value within themselves and from each other.

Steven Merahn, MD is senior vice president and director of the Center for Population Health Management at Clinovations of Washington, DC.