This is, I hope, the last in a series of blogs on population health. This one will try to bring it all together to answer the question of “what’s the point”.
Previous blogs in this series are here:
1.Population health / public health, what’s in a name – effort to try to distinguish. We couldn’t find much distinguishing ground, but Dave Buck sent us a table that helped.
2.Population Health, essential components – 20 competencies, 5 accelerators, methods for QI in a population health context, exam questions for system leaders around how well they know and can define a strategy for their population, link to Muir’s instruction manual.
3.Population health, population health care, population management. Trying to define some terms – population heath, population health management, population health care. It’s all a bit tricky and it’s important to be clear on terms and the meaning of words.
4.Five capabilities for population health management – trying to define core system capabilities
5.Revisiting segmentation – we all know segmentation is important, but it’s not ALL or ONLY about segmenting and analytics. Some thoughts on segmentation.
What’s the point of it all -Ten points
1. We know that until we solve the population health problem we might make little progress in addressing the challenges in the Health and care system. This is particularly so with regard to not addressing inequalities in outcomes.
2. We know the causes of ill health and what leads to wellness
3. You can look at this from a pathogenesis or a salutogenesis perspective
4. We know that solving these problems individual by individual is necessary, but not sufficient. A population perspective is needed, particularly looking further upstream and especially at structural policies as opposed to reliance on service based solutions. Some take this further and argue we spend £114 billion on the NHS to correct suboptimal health policies made elsewhere
5. But whole populations are too big but we need to segment
6. Once we have segments we need to design models of service to manage risk,prevent or delay complications and improve outcomes in each of those segments.
7. Focusing only on high risk, top of triangle populations is a bit silly. In a health care context see Roland & Abel for the reason why. I will bet a months pay that the same concept applies in every policy / outcome area context. Changing whole populations is needed.
8. Those models need to be population focused not service or organisation focused
9. One decision point is weather the population health system is about managing risk and improving outcomes in those that are receiving health & care services (ie those who are poorly) or about the above and preventing illness in the first place (i e a whole population including care service users and citizens). Obviously both are important and necessary and the question is therefore about balance and focus
10. Obviously remember that a only a proportion of health outcomes are attributable to healthcare this varies depending on the outcome search the population group in concerned and the time frame