Successful population health management will require a lot more from the nation's healthcare leaders than merely revamping their systems' delivery models—as difficult as that will be.
The vagueness of the term population health management is part of the problem. It conjures different images for different players in the system, each of whom is jockeying for an expanded role in the healthcare system of the future.
Social workers, nurses and the home health industry see new jobs for their specialties. Electronic health-record vendors are busy developing software programs to help providers identify and manage their most costly patients. Consulting firms are touting their expertise in big-data analytics to identify patients at risk.
Within healthcare systems, the discussion about population health management usually centers on better care coordination. Systems are enlisting every provider in their networks—from the primary-care physicians to the post-acute nursing facilities—in the battle to limit unnecessary treatments and prevent costly readmissions.
But this relentless focus on improving the internal operations of the healthcare delivery system, while necessary, is insufficient to hold healthcare costs in check over the long term.
The economy that emerged from the Great Recession of 2009-2011 has produced millions of jobs. But it has also produced growing income inequality and endemic job insecurity.
Young families raising children today labor under greater economic stress than previous generations. Half of older workers have inadequate retirement savings and live in constant fear of losing their jobs.
The U.S. has the highest incarceration rate in the world—over 2.2 million people, disproportionately black and Hispanic men. Keeping men in prison for minor offenses rather than in the workforce undermines the economic prospects of their communities. More than a third of the nation's kids are growing up poor in women-headed households.
The level of economic stress we're seeing today has major health consequences. If we are serious about population health management, healthcare leaders have to give more than lip service to what social scientists call the social determinants of health.
Presidential candidates are already talking about income inequality and the poor performance of the economy. It's long overdue.
But there is also a specific public health agenda related to economic insecurity that needs to be addressed. No one is better positioned to speak to those issues than the nation's healthcare leaders.
Food insecurity isn't about hunger in the traditional sense. The food deserts that plague our inner cities rob people of access to basics like fresh fruits and vegetables.
Nearly a third of the population is obese—a form of malnutrition. Diabetes prevalence is worse here than anywhere else in the world, according to the Organisation for Economic Cooperation and Development.
About 20% of the population still smokes. Obesity and smoking are closely correlated with many forms of cancer. The U.S. has the sixth-highest cancer rate in the world—and second- highest if you look only at women.
Asthma rates are rising—growing by 25% over the past decade to 26 million people. Children, especially minority children, are disproportionately affected because of bad housing conditions and greater exposure to small-particle vehicle pollution in urban areas.
Hypertension, which affects over 30% of U.S. adults, is a leading risk factor for heart disease. While a person's genes can trigger high blood pressure, so does air pollution and stress. More than half of individuals with hypertension don't have it under control, even though a majority of those people have regular access to healthcare.
Healthcare leaders can start addressing these issues by focusing on their own workplaces. Hospitals are often leading employers in the community. Yet wages for many workers at hospitals, nursing homes and home healthcare agencies are barely above minimum wage.
Look at the financial margins of your institutions and the salaries of senior executives. Can they be adjusted to begin offering a living wage?
That will provide a moral platform for healthcare leaders to speak out on the broader public health agenda. They must engage with community leaders and organizations—even providing financial support if necessary—to tackle the social determinants of health. Successful population health management will depend on it.
