Friday, January 1, 2016

Population health, public health, community health — What difference does the terminology make?

Since the term "population health" was coined by David Kindig, MD, PhD, and Greg Stoddart, PhD, in 2003, there has been so much discussion about what it means in regards to healthcare delivery that the buzzword has become something of a linguistic eyeroll.
"For many in the healthcare delivery sector, the term 'population health' represents either the holy grail of effective healthcare delivery or is regarded as nothing more than the latest flavor of the month," said Leonard H. Friedman, PhD, professor and director of the Department of Health Policy and Management MHA degree programs at Washington, D.C.-based George Washington University's Milken Institute School of Public Health.
Some thought leaders in the healthcare industry just can't seem to get passed the semantics of "population health." In April, Dr. Kindig addressed the issue by writing a blog to suggest a second definition for the term. In June, the Milken Institute conducted a survey of 37 healthcare leaders about what population health means. And every day, I run into the debate of how to use the term in my own writing as a healthcare reporter — begging the question, are more terms needed to differentiate between population health genres?
Within the strategic focus Dr. Friedman described — the transition from individual care to care for whole communities — there are two main approaches to population health, according to Roy Beveridge, MD, senior vice president and CMO of Humana.
"Some people think about population health as just a payment methodology — they think about shared savings and reducing costs around the edges," said Dr. Beveridge. "When I think of population health, and when Humana does the same, we're talking about managing not just the periphery, but taking care of a population on a long-term basis and really affecting the health of that group."
Dr. Beveridge gave the example of caring for Type 2 diabetes patients. Using a financially driven definition, population health would mean considering the least expensive insulin or treatment plan. Using a broader, community-focused definition would mean trying to influence diabetes patients to make healthier choices regarding their nutrition and physical activities.
Even this example, however, demonstrates how multiple terms describing population health can get out of hand, even if it's well-intentioned. For some hospitals, the greatest population health challenge is diabetes, for others it might be drug abuse, homelessness or violent crime. If the industry began creating terms for every "type" of population health — financial, community-focused or otherwise — we could spend the rest of eternity hung up on the words rather than real actions that could improve peoples' health.
So does the industry need more definitions for "population health," or more terms in our lexicon to differentiate between various population health efforts? No. What the industry needs is to forget the semantics and just work on transitioning its strategic focuses from individuals to whole communities.
"The bottom line is that whether we use the term population health, community health or something else, all the stakeholders in the provision of healthcare must work together with the patient to keep people as healthy as possible over their lifespan," said Dr. Friedman.

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