Population Health – the how

I continue to hear strategy pundits say they either don’t know what population health means or that population health doesn’t exist.

If they are confused by the definition or existence of population health, they’ve been asking the wrong people. Clinicians who have actually delivered Population Health at the bedside or in the exam room, rather than individuals who’ve merely read about it, are the better sources for understanding value-based healthcare.

Here’s my proof:

  1. If we define population health simply as lower total cost plus higher quality, and
  2. If we accept the AHIP / NCQA / Consumer Reports data showing which health systems consistently deliver the highest quality outcomes, and
  3. If we accept years of proprietary Aon-Hewitt data or other observations that Kaiser Permanente (KP) produces a 12-25% lower total cost of care than local competitors when benefit-to-benefit comparison is accomplished, then
  4. We can say not only is KP an excellent example of Population Health, it’s been doing it successfully for 75 years, ever since Dr. Sidney Garfield and Mr. Henry Kaiser began prepaid healthcare (Dr. Garfield received 10-cents per week for each employee to prevent and treat illness and injury, improving the lives of those hardworking men and women).

So the assertion by Nate Kaufman and others that population health is vaporware is not supported by the evidence.

How Kaiser Permanente (KP) does what it does is the real insight, the real question.  The how is clearly not easily transferable; otherwise KP’s local competitors would compete more effectively for top honors.

I also hear assertions that how KP does what it does is due to care protocols, or a single enterprise-wide EMR, or that Permanente physicians are employed. In fact there are many delivery systems in the US that have one or more of those attributes, and some that have all three of those attributes, yet their performance is variable.

Instead, I assert that how Kaiser Permanente does what it does is due to physician practice patterns that differ substantially from fee-for-service (FFS) and that those practice patterns are the result of (1) physician leadership, (2) physician culture and (3) systemic workflows that reduce the duration of time between onset of illness and definitive resolution of its cause.

Improving practice patterns is hard for any health system, and real physician leadership is a requisite.  That’s not easily understood by persons who have not led physicians.

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