At the recent EHI Live 2017 conference and exhibition in Birmingham an entire conference stream was dedicated to a discussion on Population Health Management (PHM). Strolling among the vendors in the exhibition hall it seemed everyone had a story to tell.
It would appear that PHM is a ‘movement’ whose day may have come. PHM strategies are of course closely allied to the concept and practice of Accountable Care Systems. There is a lot hanging currently on Accountable Care Systems. For many policy ‘wonks’ there is no Plan B.
Shifting the model from our current fragmented and provider focused system requires all concerned to reassess how we deliver healthcare in this country. What is required is nothing less than a critical reassessment of a) how we assess and monitor quality, b) how we reimburse for healthcare, c) how we monitor health and health needs, and d) how we define optimal health and prioritise health needs.
This is no small task, but if there truly is no Plan B then best that we all get on with the task in hand.
For Accountable Care Systems pursuing a PHM strategy a useful starting point is to segment a population into groups that are sufficiently homogeneous and which are amenable to support. This could mean more focused or better managed direct care (for example, through improved pathway monitoring and management), a shift of delivery vehicle (for example, from the acute sector to the community), palliative intervention, preventive care, or a combination of these. Whatever the purpose of the change, due attention must be paid to the ‘impactibility’ of the segment, in relation to the planned intervention.
Traditional stratification approaches have tended to focus on population groups who have a high risk of experiencing an event, while segmentation has often been overly clinically-focused, sometimes to the detriment of considerations of social and environmental factors.
Increasingly the narrative is shifting to the need to focus on highly impactible groups.
Dr Geraint Lewis – Chief Data Officer at NHS England – has written most eloquently about impactibilty models. As he says, impactibility is not one metric, but covers a diverse range of effects.
If we can get this right then there is an opportunity to design new care models around a set of common needs. The approach here should be person centred – holistic – rather than simply diseased focused.
Segmenting patient populations holds out the possibility for the creation of more effective strategies for safe, efficient, effective, patient centred and more equitable health care. This of course puts us at the very heart of the New Model Care Programme.
The other big hope is that with Accountable Care Systems we create a paradigm shift in the way we deliver healthcare and in doing so, eventually, we fundamentally shift the cost curve. It is an inescapable fact that given the financial climate within which the NHS must currently operate, there will be forensic analysis on how a reformed health and care system can reduce the per capita cost of healthcare to the taxpayer – the third component of the Triple Aim.
There are a number of different ways of segmenting populations but whatever the strategy all are dependent on linked health and social care data sets and their successful implementation requires data mining skills and intuitive analytical tools.
Accountable Care Systems will need to operate within information rich environments and data scientists will be to the fore as they – in partnership with expert clinicians – turn that information into actionable insight.
Population segmentation is therefore part of the story for radically transforming health services. The good news is that many of the tools, skills and competencies to deliver on population segmentation strategies are available today.
For more insights into population health management strategies, download our white paper, Understanding Population Health.