Please: Don’t Say Population Health Again

Joel Splan
Joel Splan

Guest post by Joel Splan, chief executive officer, Galen Healthcare Solutions.

On the first day of HIMSS 2014 in Orlando, I stepped into a bewildering echo chamber. “We’re doing population health,” repeated everyone, be they physicians at a hospital whose EHR system my company implemented, the IT directors of other hospitals looking to update their EHR system or competing EHR experts. Everyone was interested in buying it, and everyone was interested in selling it. On one particular walk of the floor a colleague quipped, “Will there be a prize for the one millionth person to say ‘population health?’”

Despite this obsessive buzz nobody seemed able to define what population health is. It’s the proverbial elephant described by touch rather than sight. Is it a concept of health or a study of the various factors that affect health? Is it a course of action for the treatment of the population in its entirety or individual patients only?

The Affordable Care Act, which cites population health as an essential component of its mandate, aims to expand access to the healthcare delivery system, improve the quality of care, enhance prevention, make healthcare providers responsible for outcomes, and promote disease prevention at the community level.

All of this is commendable, but, in the end, what is population health? What does it look like? Will we recognize it if we achieve it? A friend of mine on the payer side observes that vendors claim it’s everything and providers don’t know exactly what they want it to be. Put those together and the term becomes meaningless.

There are additional questions about population health that remain unanswered. Is it an outcome, as the ACA approach suggests, or is it a foundation built on big data, analytics, ACO tools, bundled payments, systems consolidations or something else? At every HIMSS booth, the answer to these questions was a resounding “Yes.”

To me, that “yes” means “I’m not sure.” When everyone wants something but no one knows exactly what that something is, then something is likely to be sold as everything.

Why are providers so eager to buy, develop and believe in population health? Actually that’s easy to answer. They want to get value from their core EHR. Many of our customers at Galen Healthcare Solutions have EHR fatigue. With the implementations, the adoptions, the optimizations, meaningful use regulations and the dizzying changes in requirements such as ICD-10, who wouldn’t tire of dropping money into that pit?

There has to be a way to get real value out of this very substantial investment. After spending more than a decade on the provider side installing and optimizing the EHR, I sympathize with those who acknowledge the value of automating the documentation of a patient’s care, but who have no idea how to evaluate ROI.

In fact, it’s not going to be possible to assess the value of electronic health systems currently in place because these systems now function as a dumping ground for data. They have become enormous repositories for information, most of which is scattered and, as a result, cannot be applied in any useful manner. The data cannot be used because it is so diffuse and diverse. Nobody can stratify it. Nobody can analyze it.

What must be done? I believe we need to decide what the data should be employed for. To do that meaningfully, we ought to be thinking about the emerging value-based healthcare system. This new model demands that we focus on patient-centered care, that we identify actionable insights into a population, either small or large, and perform some kind of intervention to secure a beneficial outcome. It means we should no longer accept on faith that a vendor can enhance population health. We must demand a precise definition of a targeted problem and then obtain a clear picture of the ways proposed solutions will solve the problem.

We are at a turning point. The time has arrived for us to optimize our electronic health records — but that will require fresh perspectives, new ideas and a willingness to take disruptive actions. Such an approach is unlikely to come from those rooted in the past. It will require an understanding of the past – and a visionary, but practical approach to the future.

In short, physicians, IT directors, electronic health gurus and other interested parties must engage in concrete, practical discussions about population health that ask such questions as: are we trying to build an ACO, are we looking to bundle payments, or are we committed to driving outcome improvements? Or all three? In short, it’s not whether you are doing population health: it’s why.

So the next time someone claims to be a population health expert, or announces that he or she is selling population health, take an extra moment and ask what population health actually means. Ask for an explanation of the functionality being provided or the purpose of the offering. If they can’t explain it, then, maybe they’re just in that contest. (“We have a winner! The one millionth person to say ‘population health is….”)

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