A new analysis published in The New England Journal of Medicine, and looking at the policy, payment, and information technology elements around population health program development, concludes that healthcare leaders need to considerably up their game around all those elements, if they are to make population health management successful at scale.
As the authors, Aaron McKethan, Ph.D., Seth A. Berkowitz, M.D., M.P.H., and Mandy Cohen, M.D., M.P.H., note, in the article, entitled “Focusing on Population Health at Scale—Joining Policy and Technology to Improve Health,” speaking of such areas as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Housing Choice Voucher Program (Section 8), and other social welfare programs, “A growing body of research supports the value of investments outside health care for improving health and fiscal outcomes, and many pilot programs are investigating how to implement such an approach. On a population level, however, much work remains to be done.”
As the authors note, many of the combined policy and technology changes come together in the ongoing evolution of the North Carolina Medicaid program. They write, “A telling example comes from our own state of North Carolina. In 2017, North Carolina Medicaid covered prenatal and delivery services for 58,159 births — nearly half (48.4%) of the total births in the state. Yet 31% of these births were to mothers not enrolled in WIC (see graph), despite similar income eligibility criteria for WIC and Medicaid. Since WIC provides nutritional support from the prenatal period through five years of age and has been shown to improve participants’ health, this mismatch risks undermining the benefits of the prenatal, labor and delivery, and pediatric care that Medicaid supports.”
But, they note, “Moving from establishing pilot programs to addressing these issues at scale presents major challenges. Information technology in both the government and health care sectors lags behind what is needed to support seamless integration of Medicaid and other services and programs. Even new payment models explicitly designed to link reimbursement to health outcomes may not effectively stimulate performance of tasks such as WIC enrollment. Perhaps most important, addressing all the factors that affect health will require new ways of thinking, collaboration, and accountability on the part of both health care and government leaders. We suggest three considerations for advancing broader, sustainable initiatives that improve health and use fiscal resources wisely.”
Among the authors’ recommendations: human services programs need to be “integrated into a systematic population health approach,” one that coordinates workflows “that facilitate identification and enrollment of eligible patients”; “it will be important to promote both policy and information-technology innovations that make program enrollment seamless”; and, the researchers write, “[W]e believe policymakers should explicitly consider the effects of human-services programs on health and total cost of care. This approach will require developing rigorous evidence regarding the combined effects of health care and human-services programs as well as evaluations of new ways to integrate such services.”
They further state that, “As health care payments are increasingly tied to population-level outcomes, the sustainability and effectiveness of human services should be an increasingly important priority for health care leaders. SNAP resulted from a political coalition of rural, conservative advocates for farmers and urban, liberal advocates for alleviating poverty; we envision a similar partnership between health care leaders taking on risk for population health and cost-related outcomes and human services leaders supporting the same populations.”
