Is population health the future of healthcare? Physicians are told population health strategies will solve many of our current problems, providing better care to all segments of society at a lower cost. First, what is population health? It’s defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. Despite the press surrounding Apple’s Research Kit, collection of data is great, but nothing is going to change right away. We have a long way to go before we will have reliable techniques to utilize data efficiently. This is the beginning of the future. It’s another step towards the improvement of health for everyone.
One disadvantage of being older is that you have heard this all before. The inconvenient truths are that we are facing rising demand for healthcare services, rising costs and limited resources. When similar situations have occurred in the past some leaders have been tempted to make convenient lies or at least to provide misdirection.
The key feature of population health is that the population matters more than the individual. What you want when it comes to your healthcare is not as important as the needs of society as a whole.
In many cases reimbursement is being tied to the care for large groups of people. Here there are incentives for providers to provide as little care as possible. The less we spend on you the more we get to keep. Expensive medical services like orthopedic surgery and oncology will be rationed (i.e., unavailable unless you live long enough). And if you are in a program that splits any savings with the government, then the government has an incentive not to ask too many questions.
But aren’t there supposed to be measures taken to protect the patient? If you have a one-to-one relationship with a physician, then you know who to go if you have a problem. With large health networks with shifting providers, just who do you go to with a problem? And if you decide that you need legal recourse, you’ll be going up against hugely powerful corporations, backed up by an army of lawyers.
Of course quality measures will be monitored. But these will consist of statistical models developed from population health data. Since there are many more healthy people in a population than sick ones, any problems experienced by the latter can be easily smoothed away when describing the population as a whole. While you might be frustrated with the care that you are getting when you’re ill, healthy people will be told that things are just fine. There will be statistics to prove it and we all know that statistics don’t lie.
If you believe in population health, then the only chance that it has to deliver on its promises will be for healthcare to become highly automated and costs must be controlled. One way to achieve this is through the use of automated medical algorithms that are extensively integrated into the electronic health record (EHR). This combination has the potential for significant cost savings while maintaining quality care.
Current practice is dogged by inefficiencies. A patient may see multiple specialists, some of whom may be unable to easily share information. Procedures may be done with little regard for guidelines or indications. Duplication in testing and prescribing is common. If these inefficiencies can be brought under control then we can better allocate scarce resources. A single provider with access to the right tools and all the information about a patient should be able to manage a patient more efficiently.
If you are less optimistic about the prospects for population health then you should be prepared to be responsible for your own health and that of your family. You will need to have access to healthcare information that you can trust and presented to you in ways that you can use. If you are unable to get in to see a qualified provider when you want, then a digital health companion powered by medical algorithms may be the next best thing. Maybe better. And with fewer forms to fill out.
