People have been talking public health for the last 200 years. But the publication of Simon Stevens’ Five Year Forward View now heralds a five year change phase for the NHS, one which could see health and social care fundamentally shift to managing the health of populations in a very different way.
What is population health management and why is it so important?
Imagine understanding the total cost of every individual in a community, understanding their health priorities and targets, understanding their outcomes and experiences - that's running a system for individuals not a system about individuals.
This is the fundamental point of population health management. It is about embracing opportunities to shift from understanding populations to understanding the individuals that make them up.
The NHS is undoubtedly already one of the best healthcare systems anywhere in the world, one which its patients are rightly very proud of and passionate about maintaining. But managing the health of populations differently does offer a chance for the NHS to go even further.
The difference to the current models
Population health management differs substantially to the current focus of healthcare in a number of key ways:
It means being able to describe health at both a locality level and a patient level. Regions and cities have been able to measure the distribution of measles, for example, in their particular area for many years. But by organisations taking charge for particular cohorts and building patient-centred information architectures, we will be able to identify details about all the patients who have had measles in that area and describe what happened before, their antecedents. We will be able to understand the consequences and outcomes of their measles treatments with a much higher degree of granularity and what kind of health resources were necessary to achieve their outcomes. The ability to describe at population level and patient level means a shift towards patient-centred care, rather than models based around the organisations that provide specific aspects of it.
Patient level understanding will open up possibilities around risk stratification, cohort management, case management identification and more. For example, it could enable more effective care to be planned for someone with dementia who also happens to be depressed or someone with a long term condition that also happens to live with someone with a long term condition. Health and care organisations could identify who those people are and deliver a particular set of service methods to support that particular cohort or combination of conditions.
An enhanced ability to identify opportunities to improve care - the difference between what hasn’t happened and what should happen, could lead to systematic improvements in healthcare provision. Equally improvements can be expected in efficiency, through an improved understanding of what is consuming expensive resources and a better ability to manage hospital acquired infections, readmission rates, and more.
Predictive analytics would also become feasible, moving from describing yesterday’s activity or today’s activity, to predicting what needs to be done in order to avoid it.
Making population health a reality through the forward view
Key to this is health and social care being able to link data across patient journeys, something the forward view may well now accelerate by encouraging innovation.
This landmark plan from NHS England’s chief executive has brought into focus topics that have been on the healthcare radar for years and even decades.
The essence of these topics is simple. We need a much deeper understanding of how to keep people well for longer, support people's wellbeing and keep people out of hospital unless genuinely necessary. We need to shift the focus of our care organisations from their current institution based outlook to much closer collaborations that combine primary, secondary and social care services focussed around the patient’s particular journey.
The spread of new models of organising healthcare delivery such as Multispecialty Community Providers (MCPs) and Primary and Acute Care Systems (PACS) outlined in Stevens' plan, may help to drive this change in focus.
These new ways of delivering care indicate a shift to actually making patient-centred care a reality. We will be better placed to examine patient level data - information around individual patient outcomes, patient cost, patient risk and patient journeys. There is a real chance for information architecture based on patients rather than organisations. This means a much more granular understanding around the complexity of the system of healthcare that will allow a far greater understanding of the impact of changes being made and care being delivered.
Looking overseas, sharing lessons
The challenges and even some of the solutions now facing the NHS in this shift are in fact very similar to those seen in other countries, with which there are great opportunities to partner and learn.
In the US, for example, accountable care organisations (ACOs) are already active, taking responsibility for the overall outcomes of a cohort of patients in a region, or a cohort of patients with a particular set of profiles.
In achieving this ACOs will also be tasked with building patient level data, measuring improvements in services and shifting to predictive analytics - redesigning their service provision along the way. They are changing the focus of US healthcare from delivering the best possible services whilst optimising profits, to one of improving the health and wellbeing of the resident population under their responsibility with reimbursements based upon value or outcomes rather than procedures.
Look beyond the very different funding mechanisms and there is much to be gained from sharing our experiences across the Atlantic. The hard sums we need to do in terms of risk stratification and predictive modelling are very similar, meaning that sharing lessons over the pond will be crucial into the future.
The fundamental issues facing healthcare provision are the same around the world; aging populations, increasingly sophisticated procedures, more exotic drugs, the treatment of more complex conditions. Increased funding is one answer, but there is minimal evidence as to its ultimate effectiveness - and, like a hammer, is not the only tool in the toolbox.