As providers move rapidly into what they call population health, it is becoming clear that there are many definitions of population health and many people who state they provide population health management. David Kindig, MD has pointed out, it’s time to provide more specificity to delineate what population health is, and what providers and others are doing within population health.
Dr. Kindig proposes that we use the term “Total Population Health” to define programs that seek to improve the health of all individuals while we re-name the services offered by providers which tend to be clinical in nature and focus more on the care of individuals as “Population Medicine.” I think this delineation is a good way to define the difference. In fact I have used a slide for years to illustrate this point, When looking at the social determinants of health: community, transportation, safety, environment, access to foods, etc and considering the obesity epidemic and its precursor to Type 2 diabetes, heart disease and other chronic illnesses. Here it is,
Is this the classic lazy American?
Can the Healthcare System Fix This?
Or is this a lack of sidewalks, an unsafe neighborhood? And what role should/can providers play in this?
I believe the providers should focus on Population Medicine, better caring for chronic diseases and providing acute medical care and leave the social determinants, which are well outside the walls of the care system, to others with more expertise. An area of low hanging fruit is the inefficiencies, abuse and fraud in the healthcare system identified by IOM (see slide 3). Now there’s a good place to start as one moves to Value Based Payments and capitation.
The thinking of Dr. Kindig is also similar to the Accountable Health Organization approach that David Nash and I wrote about last year.
What do you think?
Accountable Health 
I very much appreciate your wise perspective. I believe population health requires a social revisioning outside of physicians offices. Once a construct exists identifying the physician’s role and making sure they have the tools and information they need to play it effectively should come next. Believing the physician has a primary influence over the patients’ daily decisions being made outside their office is wishful thinking. If patients followed physician orders pharma would rejoice!
Recent study shows 1 in 3 scripts go unfilled:
One in Three Patients Not Filling Prescriptions, Study …
http://www.aafp.org › health-of-the-public
Taking a pill is much easier than changing your diet or increasing exercise. Sugar and salt loaded processed food is more convenient than shopping, prepping, and cooking–if they even know how to cook. Unless we face these facts and are realistic about our expectations, we are kidding ourselves. (Again.)
Cathy,
Thanks for your comments. You are correct that it requires work outside the physicians office. The providers are but a piece of the puzzle, there to handle the clinical care issues associated within the persons broader domain of health. We do need the providers to reinforce health decisions, but must create an environment where the healthy choices are the easy choices, readily available directly in front of the person and create some form of incentive for doing the right things.
Why must we struggle to place a label on patient care. Good patient centered care covers wellness and prevention as well as treatment of chronic illness . New labels just allow for more silo type practice instead of treating the patient as a whole. We have to stop bucketing or labeling care and start giving it
Cheryl, I understand your concern, as I too lament that healthcare is very fragmented. The issue is that often times terms are misused or not understood and in the case of population health, this is clearly occurring. Patient centered care may well focus on prevention and some wellness, but the majority of Lifestyle based issues occur outside the walls of the provider community and are the result of issues that providers have little to no impact on. These Social determinants of health, such as where you live etc. are a large component of population health and to solve them requires the efforts, services and programs of non-providers. While the providers focus on chronic care management and other low hanging fruit as a portion of population health (or Population Medicine), others (government, community based non-profits, schools, etc,) need to focus on safe parks, transportation, access to healthy foods, education and other factors. These are for the most part not patient care issues.