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DIY Healthcare System: What is Population Health, Anyway?

Posted on Wed, Dec 17, 2014
DIY Healthcare System: What is Population Health, Anyway?


“You all are in the cat bird’s seat. Because you are in the hospital most of the time and in the ED particularly, the common pathway for entry into the hospital, you know what’s going on better than anyone else. You are in the best position to implement change. You are in the right spot at the right time. Our country needs your help.” With those words, David Nash, MD, MBA, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, opened EmCare’s 2014 annual conference with his presentation entitled, “Population Health & Quality in the New World of Health Reform.”

Dr. Nash, an accomplished educator and author, was instrumental in founding the country’s first school of population health. A board certified internist, Dr. Nash is passionate about the need to reform America’s healthcare system.

He divided his presentation into five parts:

  • How did we get into this jam?
  • What is quality in healthcare?
  • What’s population health, anyway?
  • What is health reform and what’s its special connection to quality, safety and accountability?
  • What’s in the future?

Over the next few weeks, we’ll post key takeaways from Dr. Nash’s presentation.

What is Population Health, Anyway?

In an effort to address the challenges outlined in the IOM report, one approach has emerged as promising – population health management. What is population health and is it the answer? Dr. Nash said the concept is attributed to David Kindig, who espoused it 35 years ago. The concept looks at health outcomes (morbidity, mortality and quality of life) and their distribution within a population, health determinants (medical care, socioeconomic status, genetics) that influence the distribution and policies and intervention (social, environmental and individual) that impact these determinants.

"The take home message," said Dr. Nash, "is that medical care is 15 percent of the story the other 85 percent are the messy social determinants of health. Four determinants– smoking, unhealthy diet, physical inactivity and alcohol use -- account for 40 percent of all deaths in the US."

A study by the Bipartisan Policy Center examined what makes us healthy. The results showed that individual behaviors such as diet, exercise and education determine 50 percent of an individual’s overall health status while genetics comprise 20 percent and access to care makes up the remaining 10 percent. The ironic fact is that as a country, the US spends 88 percent on medical services, eight percent on other activities and only four percent on healthy behaviors.

While population health seems to be the magic pill to cure the healthcare system of its ills the facts are that most healthcare organizations don’t have the resources or scope to build a comprehensive population health management program. Doing more of what we are already doing won’t address the many factors that affect the health of a population that extend beyond the realm of traditional medicine. Successful population health management initiatives will cover between 250,000 and 500,000 lives so healthcare organizations will be required to add new components to their care delivery infrastructure, recruit new talent and develop a culture of innovation.

Dr. Nash’s organization, Thomas Jefferson School of Population Health, published the first textbook on the subject, Population Health, Creating A Culture of Wellness. The school also publishes a population health management journal. Dr. Nash also cited the Trust for America’s Health Report, A Healthier America 2013: Strategies to Move from Sick Car to Health Care in the Next Four Years, as an important addition to the library of knowledge on the subject.

Consider this fact: the US spends under two percent of its health dollars on population health and there is no dedicated federal funding stream to address chronic diseases that comprise 80 percent of the total disease burden in America. It’s sad but true that only three percent of the US population exercises for at least 20 minutes three times a week, doesn’t smoke, eats fruit and vegetables regularly, wears seat belts regularly and is at its appropriate body mass index.