Vive la révolution in population health management

In a guest blog, Andi Orlowski of Imperial College Health Partners explains why population health management has become so important for health systems all over the world – and why it is different from the previous approaches we have taken in public health or within the NHS.

Blog post

Published: 19/06/2019

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

What is population health management?
“Population health management improves population health (the health of an entire population) by data-driven planning and delivery of proactive care to achieve maximum impact.”
Source: Population health management flatpack (2018)

Population health management is the new health care trend du jour, not just in the NHS as a key part of the Long Term Plan, but as a global phenomenon across health systems all over the world. Why? Because it helps system leaders best manage resources for their populations and deliver value. It helps them to plan for, and proactively intervene in, long-term health risks and outcomes.

This may sound somewhat familiar, but population health management is different from the approaches we have taken before in public health or within the NHS. Where public health has traditionally looked at promoting, protecting and prolonging healthy life through coordinated programmes (normally offered to the whole population), population health management focuses on key outcomes for identified groups. Often these groups share more specific common characteristics, not just a disease diagnosis.

Population health management also differs from what we have historically been doing in the NHS. It focuses our resource planning on wider or social determinants of health, and requires us to look at the healthy population, where in the past we may have focused more on the sick or those that already consume health care resources. It equips us to take a risk-management approach – addressing inequalities in care and intervening more actively to promote wellbeing and prevent ill health.

Improving value

Population health management also helps us address value when resourcing care. It allows us to choose the most efficient intervention and identify who would benefit most across the care pathway, while also enabling us to compare entire pathways.

Could the hypertension care pathway offer even more value if it were to be disproportionately resourced compared with chronic obstructive pulmonary disease, for example? Hypertension interventions offer some of the best return on investment in medicine, but is there room to further improve? How much would it cost to drive that improvement? Are there economies of scale?

And could money be better spent on preventing a risk that’s already been identified? That could mean getting a handyman to fit grab rails for the frail population at risk of a fall (or medication reviews or vision assessments in the home) before they have fallen, rather than paying for more surgeons to do more hip surgeries after they do.

This way, population health management tries to address the triple aim of health care, better experience and better outcomes as efficiently as possible.

The potential of population health management is unlocked by data insights

Along with population health management comes population health analytics. By that we mean analysing linked datasets covering the whole population, and which consists of three building blocks.

First, access to linked and integrated data, like is the case in north west London. A shared electronic record that allows access to appropriate, timely patient information is critical. And it can’t just be health data either. For us to understand and then address social determinants of health, datasets from outside primary and secondary care are essential. Linking data, primary and secondary care to community health care, social services, mental health and local authorities – and hopefully in the future wider public services – will enable some of the more complex analytics to take place.

Second, information governance is key. Getting access to and agreeing the purpose for sharing this data early on is paramount. Engaging the population, ensuring they are involved in why and how their data will be used, is critical to maintaining trust.

Third, analytical methods – such as risk stratification, gap analyses and population segmentation – can offer a picture of the health and wellbeing of different populations and communities, helping to identify the different challenges they face.

Other aspects of population health management – such as ‘impactability’ models – may be less familiar and are the new avant-garde. Being able to identify where we can intervene within a primary or secondary care setting is very helpful – spotting gaps in a traditional care pathway, such as a missing foot exam for an uncontrolled diabetic. But the power really lies in identifying those populations and individuals most amenable to change – finding those impactful moments across the pathway.

Such models can help us evaluate potential interventions, old or new, and identify which is going to be most effective for each population. Which form of preventative care best matches each patient's characteristics? If the gap in care is a high-risk patient with atrial fibrillation not being treated with an oral anticoagulant, which anticoagulant should we offer? Which option provides the better adherence and outcomes, and guarantees the return on investment? We can also conduct health equality impact assessments to ensure that any interventions are not inadvertently reinforcing health inequalities.

Population health management is for everyone

As more organisations adopt population health management, there is the opportunity to look within our teams to see what analytical capabilities exist. There are enthusiastic and hugely capable analysts, sitting in our health and social care institutions, ready and willing to take on the exciting challenges of population health management. These people, more often than not, are part of the population they are supporting, and no one has more ‘skin in the game’ than someone whose child or parents will be directly affected by the decisions made.

Andi Orlowski is the Deputy Director of Business Intelligence at Imperial College Health Partners. Please find more population health resources here.

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust. 

Suggested citation

Orlowski A (2019) “Vive la révolution in population health management”, Nuffield Trust guest comment.