The complex world of modern health care cannot have a single definition of population health.

As the term population health grows in strength and as providers grapple with how to build networks and deploy services to implement it, one can’t help but ask, what exactly is population health?

Early on, it was simply defined as trying to understand the determinants of health of populations. Now, let’s fast forward to today’s world of the Triple Aim, rapid system collaboration models, ACOs and new payment delivery incentives. 

The idea of population health originates in 2003, defined by David Kindig, M.D., Ph.D., and Greg Stoddart, Ph.D. as “the health outcome of a group of individuals, including the distribution of such outcomes within the group.”  

Many argue that the term should be reserved for referring to geographical populations and many assumptions contend that improvements in population health will reduce gaps of socioeconomic status and race. Widely used and not universally understood – outcomes, measurement and accountability are terms commonly inserted in the population health discussion. 

It is important to note that no one in the public or private sectors currently has responsibility for overall health improvement. 

We need to carefully understand our role in this discussion from a clinical perspective and allow non-clinical factors such as education and economic development to play out in the broader forums. Engaging with the business community and other key stakeholders will help to make solutions more realistic. Integrating investments and policies across all determinants will be the path to success. 

David Kindig and Greg Stoddart began their research with the question – is population health a concept of health or a field of study of health determinants? They concluded that, because improvement in population health requires the attention and actions of multiple players (legislators, managers, providers and individuals), the field needs to pay careful attention to the knowledge transfer and academic-practice partnerships that are required for positive change to occur. 

In 2016, The Institute for Healthcare Improvement defines population health through the eyes of the Triple Aim: Population Health, Experience of Care, and Per Capita Cost including measures such as life expectancy; mortality rates; health and functional status; disease burden; and behavioral and physiological factors such as smoking, exercise, diet, etc.

The rapid shift in focus from care provided and paid for at an individual level, to managing and paying for health care services for a defined population – is termed, population management. 

Population management should be clearly distinguished from population health (which focuses on the broader social determinants of health). Population management as presently practiced is best conceptualized as population medicine.

Population medicine is the design, delivery, coordination, and payment of high-quality health care services to manage the Triple Aim for a population using the best resources we have available to us within the health system-ACOs, patient-centered medical homes, team-based care, etc.

Understanding populations, the lines between a population management/medicine focus on health care services and a population health focus on the broader determinants of health has become, at best, blurry.

There is no doubt that engaging in population health, population management and population medicine is an opportunity for health care providers to come together in collaboration with local stakeholders to improve health outcomes for the communities that they serve. 

We cannot help but wonder how much of an impact can providers have on their own?  How many outcomes are tied to the behaviors of the population and a populations’ ability to overcome social determinant barriers?  Who will be the greatest partners to providers in accomplishing this societal sea-change? 

We welcome your thoughts on the role of population health in your facility.

Contact:
Marty Gallegos
(213) 538-0777
mgallegos@hasc.org