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Navigating health reform
Translating Population Health to Senior Services
In health care, we use a lot of abbreviations, acronyms, and terms that do not always translate across providers or from providers to residents to family members. I remember when I first started hearing the term “culture change” in senior living circles, I really didn’t know what people meant. When someone explained, I said, “Oh, you mean patient-centered care.” I needed a translation.
The term “population health” is often heard in reference to acute care services or accountable care organizations, but I wonder if everyone is using it the same way. And how does “population health” translate to senior living?
Defining population health
According to a recent study conducted by Weill Cornell Researchers and supported by the Commonwealth Fund, “population health” is one of these terms that does not yet have a shared definition in accountable care organizations (ACO) and public health. ACOs view population health as those individuals for whom they have a budget to manage their care. Public health professionals, not surprisingly, view it as the health of individuals within a given geography. So, what is population health?
According to the Institute for Healthcare Improvement, one of its population health researchers, David Kindig, first coined the phrase in 2003, defining population health as, “The health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Public health professionals interviewed in the Weill Cornell study view population health as addressing all of the social determinants of health for a population.
According to the World Health Organization’s Commission on Social Determinants of Health (SDOH) in 2008, SDOH are responsible for most diseases and injuries, and are the major cause of health inequities in all countries. SDOH include poverty, clean air, water, access to healthy food, and exercise.
In high-level terms, population health means addressing all the aspects of an individual’s life that influence his or her health — and not just treating a person’s symptoms. At a care delivery level, population health is more closely related to some of the wellness initiatives that senior living settings have been adopting in recent years.
Wellness programs focus on the Six Dimensions of Wellness (emotional, physical, spiritual, intellectual (cognitive), social, and vocational) developed by Dr. Bill Hettler, co-founder of the National Wellness Institute. Wellness initiatives introduce interventions that seek to improve quality of life, engage seniors in self-care, and reduce avoidable hospitalizations.
At a practical level, the term population health is being used in the context of new payment delivery models, such as Accountable Care Organizations, that providers and the Center for Medicare and Medicaid Innovation are currently testing. So, while the concept of population health resembles senior living wellness initiatives, it differs from wellness initiatives in the sense that it is used as a guide to help determine where the dollars should be focused.
Health rather than symptoms
A population health approach means breaking away from the focus on symptoms and embracing a proactive, whole-person view of care as well as the other non-medical interventions needed to maintain or improve an individual’s health. Providers use four basic tools when they implement this model:
1. Define the population
A population can be defined by geography, age group, disease, diagnoses, or in any number of ways. In the Oregon Coordinated Care Organization model for Medicaid patients, the providers are responsible for the total cost of care and health of patients in a state-defined geography for all ages and conditions. Alternatively, Baylor Health Care System chose to define its population as diabetics in South Dallas.
2. Take a health inventory
Once you have defined your population, you need to understand that population’s full health picture. This means conducting individual health risk assessments or using other tools that provide a full understanding of the population’s physical, mental, social, and environmental needs.
3. Use electronic health records (EHR) to segment your patient population
The population health approach shows greater potential now that more providers are utilizing electronic health records to compile and record patient diagnoses, medications, care, and tests. EHRs create the opportunity to look at an entire defined population and identify high-cost and/or high-risk patients in order to deploy targeted interventions and care. EHR allows providers to test certain interventions and monitor their effectiveness in varying populations.
4. Deploy targeted interventions and care by segment or risk tier
Most experts on the topic agree that the level of care management and coordination should vary by risk tier or population segment. Cost-effective strategies seek to deploy the most intensive care management on high-cost, high-risk patients to improve chronic disease management and eliminate unnecessary high-cost interventions. Relatively healthy individuals can be given tools to assist them in self-managing their needs.
The Advisory Board, a global research, technology, and consulting firm, suggests in its population health guide that medical homes are most cost effective for individuals who are not yet high-risk but could become high-risk without proper monitoring and intervention.
Alternatively, Dr. Jeffrey Brenner, Executive Director of Camden Coalition of Healthcare Providers, has suggested that it is not enough to stratify the risk — we need to view patients the same way that marketers view a population by segmenting them. Segmentation looks at multiple dimensions of an individual to identify what they need to achieve better health. For example, we must go further than defining someone as high-risk because they’ve been hospitalized four times in the past year.
Similarly, we must carefully examine our classifications: all diabetics are not alike. Some are young, and some are old with multiple health issues. Some have controlled diabetes and others do not. Some are high users of the emergency room and of clinic services, while others just receive treatment in the ER. Therefore, the approaches to their care must target their specific needs while also being cost effective.
New terminology for familiar concepts in senior care
I think of the term population health resembles the work long-term care and senior living providers have been accomplishing using the six dimensions of wellness to deliver care to older adults. Similar to population health, wellness programs do the following:
- Examine the needs of the overall person versus just treating the symptoms they are experiencing
- Promote healthy lifestyles and behaviors for those with chronic conditions to help them better manage their condition
- Improve physical function
- Engage the resident in self-directed care to manage their conditions
- Reduce unnecessary hospitalizations and therefore reduce the total cost of care
Regardless of the terminology you use — population health or wellness — the approach to care will be similar: treat the whole person with a focus on cost effectively achieving or maintaining wellness, and both your population as a whole and the individuals within it will benefit.