The Opportunity for Providers to Adopt the Concept of Population Health Care

J Clin Pathways. 2021;7(10):18-19. doi: 10.25270/jcp.2021.12.2

Words matter when trying to improve health. For many leaders, this issue is particularly relevant when implementing pathways and other strategies to support population health—a popular concept for improving health outcomes.

There is clearly value in considering and working to address the health of entire groups. But enthusiasm about population health has not translated into systematic improvements in outcomes. One reason is variation in how providers and other groups define and approach population health.

This is not an issue of semantics. Conceptual differences can affect how groups invest in and design population health-related initiatives—for instance, how policymakers commit public dollars, how payers incentivize activities within networks and contracts, or how provider organizations implement initiatives such as pathways. When definitions and approaches differ, even successful initiatives can conflict with or duplicate others. Ultimately, these dynamics risk wasted energy and investment for organizations. For patients, it can mean misalignment of need and services, with some individuals offered services they do not need, while others lack access to services they do need.

To address this issue and support provider organizations seeking to improve the health of populations, this article briefly describes the population health definitions and articulates an opportunity for providers to align their work under the concept of population health care.

Future articles will describe operational frameworks for doing so.

One Term, Different Perspectives

For health care providers, the concept of population health has clear clinical connotations. This can be traced back in part to the Triple Aim, a widely recognized framework that was first introduced nearly 15 years ago to reflect a tri-partite goal of “improving the health of populations” alongside reducing health care costs and improving how people experience care.¹ Internalizing the Triple Aim as a mission, many health systems, hospitals, physician groups, and other provider organizations have implemented “population health management” programs that seek to address care processes among populations defined based on clinical conditions or utilization patterns. Smaller provider groups sometimes enlist help from outside organizations to perform these activities.

But there is also a view of population health rooted in public health. Using a framework that considers relative marginal returns from multiple health determinants, some have defined population health as the health-adjusted life expectancy and other aggregate “health outcomes of a group of individuals, including the distribution of such outcomes within the group.”^1-4 These definitions not only emphasize the relationship between determinants and health, and their economic trade-offs. Compared to those adopted by health care providers, these perspectives are also often rooted in broader views of populations (eg, groups living in a geographic area, rather than those served by a provider in that area) and outcomes (eg, overall life expectancy rather than process and clinical outcomes for groups defined by diagnoses or therapies).

There’s a need for different perspectives on population health. Health care delivery plays a key role in many health outcomes, and given the room for improvement (eg, not just in clinical outcomes, but incorporating others, such as patient-centered outcomes), providers and payers should continue to develop care delivery-related initiatives such as clinical pathways. On the other hand, social and other non-health care factors contribute to health, and we need to address them by going beyond a traditional disease- or treatment-focused perspectives.

While different definitions are needed, they should not be conflated. The major danger of doing so is fragmentation (failing to coordinate initiatives across providers and other groups), misalignment (assuming that groups are working toward similar goals when they are not), and poor return on investment (overinvesting in work with limited health gains and underinvesting in work with substantial gains). The consequences will likely only increase amid the ongoing shift toward value-based payment and care delivery models.

The Need for a Population Health Care Concept

How should provider organizations and their leaders proceed? One solution is to use change in how they refer to, design, and implement provider-driven population initiatives. While population health management is increasingly used within the provider community, it has drawbacks. For one, “management” is not something that pertains only to work in the clinical or payer domains; it is also required in public health, community-based, and other initiatives. For another, the term does not distinguish between traditional disease-driven population care vs novel work partnering with non-health care groups to address both clinical and social determinants. Terms like population medicine and total population health add to the lexicon without necessarily being clearer.³

Another approach would be for provider organizations to organize pathways and other programs targeting populations under the aegis of population health care. Not only does the term accurately reflect what is happening (delivering health care to populations); it also anchors the work in the health care system and leverages long-standing, existing recognition about differences between health care and health. Population health care also preserves space to acknowledge distinct types of community-based and public health work addressing health, and collaborations between these groups and health care providers.

Conclusion

There is continued enthusiasm for using clinical pathways and other initiatives to improve outcomes across populations. While this work has been conceived under the heading of population health, variation in program design and goals arise in part from different definitions and approaches. For providers, there are potential problems with failing to recognize and maintain these distinctions. One solution is to organize population-focused work under the aegis of population health care, and use the concept as a unifying method for either implementing or partnering with other groups to support the health of populations.

References

1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. doi:10.1377/hlthaff.27.3.759

2. Kindig D, Stoddart G. What is population health? Am J Public Health. 2003;93(3):380-383. doi:10.2105/ajph.93.3.380

3. Kindig D. What are we talking about when we talk about population health? Health Affairs Blog. 2015. Published April 6, 2015. Accessed December 6, 2021. https://www.healthaffairs.org/do/10.1377/hblog20150406.046151/full/.

4. Evans RG, Stoddart GL. Producing health, consuming health care. Soc Sci Med. 1009;31(12):1347-1363.

Author Information

Author: Joshua M. Liao, MD, MSc^1,2

Affiliation: ¹Value & Systems Science Lab, Seattle, WA
²Health Systems Collective, Department of Medicine, University of Washington School of Medicine, Seattle, WA

Disclosures: Dr Liao has no disclosure to report.