This Quiet Revolution Is Turning Health Care Upside Down

I spent 25 years practicing medicine as a cardiologist. During that time, I liked to believe that my patients listened when I recommended they lose weight or quit smoking, took their medications as prescribed, and for all intents and purposes, followed doctor’s orders.

As a physician, I liked to believe I was having an impact on the lives of my patients. And many times, I was. But I’ve been on the other side of the equation for a little more than 10 years now, and one of the things I’ve learned as a health plan CEO is that it’s often what happens outside the doctor’s office that has the biggest impact on a person’s health.

Recent studies have found that just 20 percent of a person’s overall health is determined by the actual care they receive. That means the other 80 percent is the result of genetics, lifestyle choices, and socio-economic factors. You’ve also likely heard the statistic that 5 percent of Americans consume 50 percent of all health care resources. This 5 percent is a complex group, coping with a series of costly conditions, including diabetes, high blood pressure, mental health, and substance use disorders.

As a doctor turned health plan CEO, I’ve often wondered if we could cut costs and improve the health of this group simply by taking better care of them.

Let’s take diabetes for example…

The American Diabetes Association estimates the nationwide cost to treat diabetes at a whopping $327 billion dollars, up 26 percent in the last five years. The rising prevalence and costs associated with the disease are putting a major strain on health systems and patients nationwide, including right here in the Capital Region. But for many people, this disease is completely preventable.

Where there are challenges, there are opportunities

That’s where a strategy known as population health management comes into play. If your doctor has access to information suggesting you’re at risk of developing diabetes, he or she can work with you on a weight-loss plan, which may include exercising more and eating better. Your physician might also recommend a series of follow-up visits to track your progress. Sounds simple, right? The problem is that most doctors are busy seeing patients, and keeping tabs on everyone is not easy.

Population health management often provides physicians with additional support in the form of case managers, care coordinators, pharmacists, and analysts, all of whom work in concert to identify patients with gaps in care and those at risk for unnecessary hospitalizations. Population heath management may also include changes to a practice’s workflows, processes, and technological capabilities.

Health plans – like CDPHP – are eagerly filling the gaps in care to drive population health innovation. Health plans are investing time, resources, and staff to manage chronic conditions, like diabetes, between doctor’s visits.

Today, population health is the focus of nearly every stakeholder in health care. The management of a population’s health – that is, the utilization of data, the coordination of clinical care for improved health outcomes, and the collaboration of providers and payers to ensure higher quality care – is the core of a value-driven health care system.

In order for a society or population to reach its health potential, it needs support from all facets of the health care system – from the groups helping to manage and coordinate care, to the entities driving improved behaviors and practices, to the organizations connecting care, and improved adherence in between. All throughout the health care system, tremendous innovation is occurring to help drive better health through population health management.

At CDPHP, we used to say we are improving the health of our community, one member at a time. Now, I’m proud to say we’re also doing it one population at a time.