Healthcare Is Not Equal for All – We Need Population Health 4.0

The following is a guest article written by Sita Kapoor, Chief Information Officer at HealthEC.

Public Health 4.0, or Population Health 4.0, is the recognition of health as a global entity and the focus on identifying and eliminating health disparities, unnecessary costs, and comorbidity. Unlike the previous three phases of public health, the focus in 4.0 is on population health management.

As the healthcare industry moves toward a more holistic approach to medicine and value-based care (VBC), the impact of population health management on individuals and communities at large is invaluable. Social determinants of health (SDoH) and the corresponding data can guide providers in their response to chronic care management, treatment costs and long-term health benefits in the communities they serve.

Ultimately, the focus should be on just that—the communities. This article outlines key considerations for building your Population Health 4.0 checklist.

Step 1: Manage chronic conditions that have been neglected. 

Chronic diseases cost the United States approximately $3.8 trillion a year, according to the Centers for Disease Control. In Pop Health 4.0, providers get a jump start on managing these diseases within their communities and work to identify the root causes, such as tobacco use, poor nutrition and lack of exercise.

Getting a grasp on chronic diseases will not only save the U.S. economy trillions of dollars, but it will also save lives. Among its host of benefits, management of chronic diseases leads to:

• Cost savings—Americans with chronic disease pay approximately five times that of a person without chronic disease.
• Fewer hospitalizations and ER visits—When properly treated, these visits decrease.
• Fewer prescriptions—As a general rule, Americans are overmedicated, and lack of chronic disease means fewer prescriptions.
• Better quality of life—This includes education and job opportunities as well as better livelihood overall.

Step 2: Ensure equity in care.

Breaking down the silos that exist in our current economy of healthcare can be a challenge. As the COVID-19 pandemic has revealed, the disparities often seem endless: vaccine distribution, community outreach, virus prevention and SDoH surveillance just to name a few.

Patients need to be examined through a community lens, whether considering a single county, a suburban area or even several counties grouped together. This helps to ensure that providers and physicians take a more holistic approach to equity in care. Establishing partnerships and liaisons with community-based providers is an effective way to hold one another accountable and make sure everyone receives the care they need. Examining factors such as finances, proper treatment, clinical guidelines, transportation and accessibility is also extremely important.

Step 3: Support health systems to proactively address population needs.

As more patients turn to value-based care, whether through the implementation of telehealth, home health or other options that become available, it is more important than ever for providers to have a trusted mentor.

For example, if you are a physician working on the clinical side of patient care every day, this might include confiding in a trusted physician who specializes in data. Addressing the needs of a population demands that providers understand the complexities and predetermining factors associated with that group. Health systems can learn a lot about their patients by looking at data and using analysis to provide patients the care they need.

Step 4: Integrate necessary public health into an organization’s population health program.

Another way to think about public health, or population health, is in terms of health and human services. As mentioned in step 3, data collection can lead to care plans that benefit the community tenfold.

The amount of data available now compared with what we had five years ago is incredible. What began primarily as claims data has evolved to include clinical data, lab data, prescription data, and most recently EMR data. When we combine all these types of data, we can build a snapshot of the community’s health and achieve our goal of eliminating disparities.

Conclusion

The steps outlined above are a starting point down the path of Pop Health 4.0. Like any meaningful endeavor, it will take work and persistence to achieve healthcare equity. However, the outcome is well worth the sacrifice. With more data, knowledge and collaboration, we will move toward a more integrated, equal healthcare system for all.