Population Health Redefined

When “population health” crops up in the national conversation the definition is broad, ambiguous or highly variable based on setting and speaker. As the founder of population health for my organization, I have had to ask myself what population health means to the members I serve. The definition in and of itself though, isn’t as important as the structured development of a vision and mission for population health that brings better health to our members.

To me, population health is a way to conceptualize delivering the right care at the earliest point that adds value and contributes to improved health. This a tall order, but there is no needs to wait for precision medicine, AI and CRISPR Cas-9 to catch up to the needs of everyday Americans. In fact, population health innovation can be implemented in many “micro-health systems” today.

When I hear about population health in other forums, the meaning spans from colonoscopy screening, to reducing hospital admissions and emergency department visits. These are on the opposite ends of the pro-activity/reactivity spectrum. Neither is wrong, but neither is comprehensively right either.

In my opinion, population health is and should continue to be a dynamic process of using EXISTING resources to create a culture of health (including provision of necessary services) ACROSS the care continuum from healthy to sick in a way that integrates all existing and potential health determinants.

Micro-health systems provide a foundation for this to occur. Micro-health systems are units or packages of people, processes, and systems which deliver a health service. These micro-health systems are innovating and evolving at a clipping pace, and as smaller units of innovation they do so more efficiently than any major healthcare organization. It is here where the opportunity lies to advance the vision of population health.

This belief runs counter to the belief of those who are convinced we need the big disrupters; the robot doctors and the nanomedicine innovations to advance care. Although these big disrupters would be nice—and we will get there someday – disruption is within our grasp right now. Simpler, cheaper, readily available disruption. Micro-health systems provide us a breeding ground for iterative learning and delivery of care models that adapt to real-world needs from on-the-ground experience. These micro-systems are often pliable, portable, resilient and come with a lot less of the political, bureaucratic, and special interest barriers which can too often impede progress. We can wait for the pie-in-the-sky solution to “fixing healthcare,” or we can start now.

For example, In India, they have a practice called de-skilling which refers to lay workers learning to do defined jobs so that doctors no longer have to waste their time doing them. Doctors are able to help more patients at lower total costs, thereby bending cost curves. Such innovations, although not sexy, were created at the micro-health system level in response to real-time needs.

Another example is a program I developed for low-income populations with complex health needs (60% of whom have behavioral health needs). The program utilizes lay community health workers to address the needs of the population beyond those that can be solved in a physicians’ office. I consider this a mini micro-health system as these community health workers have had to develop a set of efficient processes to interface with almost every level of the health system, from doctors to hospitals to hospice to skilled nursing facilities. By using micro-health systems in this way, and by innovating in real-time in order to meet population-level needs, we have been able to reduce readmissions by 67% and have increased the efficacy of our performance (as measured by readmission rates) by 300% from the first year of the program to the second year of the program.

It is my belief that the key to advancing care is the scaling and dissemination of best-practices at the ground-level, within micro health systems. These systems can create precisely the fast-paced, tuned-in response that will generate the change we need from the healthcare system. 

I plan to write a part II, which lists recommendations for leveraging micro-health system units to incite this type of innovation.

Thank you for reading, please reach out to me with comments and/or suggestions.