Improving the nation’s health: No place for anecdote and fairy tales

On Monday last week, the Department of Health & Social Care published, Prevention is better than cure – Our vision to help you live well for longer‘.

Few would argue that prevention is a bad thing and the themes discussed in the paper are entirely consistent with current health policy which stresses the importance of integrated care, built around the implementation of Population Health Management (PHM) strategies.

Yet despite the paper being published on 5th November, for me at least the sky above refused to colour and sparkle. There was little to celebrate here that was genuinely new and grand claims are made for the game changing capability of new technology and personal responsibility.

New technology alone will not slay the dragon of health inequity and as for personal responsibility, well it’s not that this approach hasn’t been tried before. It has and in large part it has failed.  On this matter I tend to agree with the view expressed by Jeremy Taylor – Chief Executive, National Voices – when he states, “No-one ever took more responsibility after a government minister told them to.”

And yet now is not the time for despair. So where to start?

One good place might be the data.

Professor Paul Corrigan has blogged eloquently on the power of data and his contention that “Data is changing everything” is a compelling one.

We operate of course in a world of scarce resources and as such, tough decisions need to be made in terms of where we best spend our ‘prevention pound’.  These potentially life changing decisions should not be made on the basis of anecdote and fairy tale. We need evidence and that evidence should be based on data, or more to the point the insights mined from data.

I would therefore contend that a good starting point for any prevention strategy should be the identification of population cohorts who might best respond to intervention programmes that have prevention at their centre.

This is where population segmentation can help. I offer up the following as a useful definition of population segmentation:

…the purpose of segmentation is to enable specific groups, or cohorts of patients to be identified and explored in more detail, and ideally to define groups of similar patients who may be suitable for a particular intervention or new care programme.
— Understanding Population Health, Sollis and Johns Hopkins University, 2017.

These interventions and new care programmes will often have prevention built into their DNA. The first task is the identification of specific groups or cohorts for which you can have greatest impact.

There exist many methodologies for segmenting populations. Based on our experience one of the most powerful of these is that developed by clinicians and population health experts working with the National Association of Primary Care (NAPC) on its Primary Care Home (PCH) model.

Innovative thinkers and clinicians such as Dr Steve Laitner and Dr Mark Davies have constructed the following 3×3 population segmentation matrix which is as elegant as it is easy to understand. Our role as data and analytics experts working with Primary Care Home sites has been to make the matrix come alive, this based on business logic and algorithms we have run against linked data sets.

The image below is the matrix as configured to support prevention strategies.

PCH 3x3 Segmentation Critera

By segmenting populations in this way it suddenly becomes possible to craft population health management strategies – to include prevention – that are patient centred (based around the holistic needs of patients) and which address issue of health inequity.

With prevention in mind there could of course be many things we don’t want to happen – premature acquisition of chronic conditions or comorbidities, loneliness and social isolation, homelessness, lack of community cohesion, substance abuse and alcoholism, excessive healthcare costs.  All of which might be the target of prevention strategies.

How effective this will/can be is closely linked to deprivation and stressed lives – people who struggle with life stressor events on a regular basis will find it hard to solve their own problems, and for the sake of equity will require additional support.  Social and environmental factors are key. I claim no original thinking here and for anyone out there not familiar  with the work of Michael Marmot I urge them to read The Health Gap.

Population segmentation is a direct response to some of the key themes addressed in the ‘Prevention is better than cure’ paper.

For this reason alone I am happy to march behind the flag of prevention. Not because the idea is in any way new, and certainly not because I think that a slew of shiny new technology allied to a refreshed set of pleadings based around personal responsibility are on their own going to move the needle. I do it because it is the right thing to do and because I am convinced that progress is possible, if only we fully exploit that most precious of resources – data.

. . .

Workshop promo

Join us at our forthcoming Population Health Workshop: On Thursday 29th November, Sollis will be hosting a FREE one-day workshop at the balcony room at the Swan, part of the Shakespeare’s Globe Theatre complex in London. Register here.