A broader perspective is needed in an evolving environment of limited resources and a growing patient population
By Jay I. Pomerantz, MD – Executive Medical Director for Health Integrated

Several weeks ago, we discussed the value of disease management (DM). We also took a poll and asked if the current DM programs were meeting your expectations. Although not scientific, 89% of you responded that they were not meeting your needs while 11% just didn’t know. DM programs are a part of most health plans, but like you, many do not feel they are meeting the needs of the patient, physician and health plan – the goal of which is to improve overall health while reducing cost.

As I mentioned before, disease management may describe its own problem – disease and management. It is singular in focus, spotlights ‘an individual disease’, and does not put the patient – that is the whole patient, at the center of the conversation. Even the former Disease Management Journal has renamed itself Population Health Management – wanting to broaden their view and approach, and appropriately so. I agree.

Today’s health plan executive faces many different issues and therefore requires an integrated approach to better managing their patient population with information that can positively affect the quality of care, access to care, patient outcomes and associated expenses thus improving health while reducing costs throughout the system. If these goals are addressed, they will allow health plans to keep up with the dramatic influx of change anticipated over the next decade.

Population health management in contrast to DM, deals with the whole patient – taking a holistic view and a preventive approach. Unlike DM where a singular disease is the focus, population health management deals with the patient – all of the ailments and co-morbidities that might exist. These disease-state interactions, including physical and behavioral, are critical to understand and manage in order to improve the overall health of the patient.

Ann S. McAlearney, ScD, an Associate Professor at the College of Public Health at Ohio State, has written and lectured on the subject of population health management. In her book, Population Health Management: Strategies to Improve Outcomes, she discusses identification and segmentation of patient populations so to achieve the best of outcomes. She agrees with the notion that population management incorporates many different strategies like lifestyle, demand, disease, catastrophic care and disability management to name a few. The bottom line is that population management is not a program that can be successfully implemented without the buy-in and subsequent participation of all stakeholders – the health plan, physician practice, physician and the patient. All are crucial components.

Many of these programs also encourage the patient to become more involved in their own healthcare. The tools and informational access available to many patients today continues to advance. I shared some thoughts on this several weeks ago. Programs like the PCMH and ACO continue to be a key in this effort. The increasing availability and easy access by the patient to their EMRs, physicians and support services are critical to advancing the patient’s participation. Incorporating integrated case management provides a support mechanism for many patients new to this level of involvement. The difference though, needs to be built around a proactive and preventive approach, not the traditional episodic tactics which comprise much of current traditional patient management.

The current healthcare system will need to adapt and change so the services and approach reflect the evolving demographic. That said, the parallel effort soon to be enacted as a result of the newly passed healthcare reform bill, will increase the number of physicians specializing in primary care. Although this will not have an immediate impact, the intention and longer-term goal of increasing the number of physicians is essential. As well as increasing the primary care-focused students, curriculums are also being affected to reflect an emphasis on population health content. Case in point is Brody School of Medicine at East Carolina University. They have a full curriculum built around population health. One key though, is that they are emphasizing the interconnectedness and integration of health between the community, family and individuals.

Population health management for health plans today requires that the population most in need be first identified and targeted, a program implemented and as important, metrics tracked, analyzed and the required course corrections made. It is truly an integrated approach with the patient at the center. It seems that as healthcare continues to evolve in this environment where limited resources are being applied to a growing patient base, population health management is more important than ever. All of the ideas that have and are being implemented in health plans across the country, including the PCMH, ACOs, DM and others will have to be combined in an effective manner so we can continue to improve health and decrease costs.

What do you think?

Thanks for reading and I welcome your comments. Please contact me directly at pcmhdialog@healthintegrated.com or you can comment directly in the blog.

Best Regards,

Jay I. Pomerantz, MD

This entry was posted on Wednesday, June 9th, 2010 at 7:56 am and is filed under Population Health Management and Disease Management. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.