04/17/2018

Social Determinants Are Changing Population Health

The rise of structural interventions

Population health was defined in 2003 by David Kindig and Greg Stoddart, who described it as the health outcome of a group of individuals, including the distributions of such outcomes within the group.  Today, I see the majority of companies - and that includes providers, insurers and care management companies - equate population health with actions taken at the individual level to achieve those outcomes. For example, we find a group of people with diabetes, find out who has gaps in care and get to each one of them through in-person, phone, video or digital interactions. Because we focus on a cohort of people with diabetes, we say we are doing population health. As technology advances, we are developing new modes of interaction that are cheaper in unit cost and have greater reach (enabling us to access a broader group of people) or technologies that make for a better consumer experience. Much of the innovation I see though is still focused on making interactions better one person at a time. While this focus is important (and even critical), it leaves important opportunities on the table.  

True population health acts at both an individual and a structural level

Here’s an exaggerated example to make this point. Let’s say there is a four-way stop sign intersection with a high number of accidents every year. The individual (one person at a time) approach could result in putting ambulances right next to the intersection. That would be a great way to drive value and save lives. A better idea may be to have caution signs just before the intersection to prevent the accidents from happening. Or, even better, may be just to replace the whole intersection with traffic lights, cameras and a delay between green lights. Or, still better yet, may be to not let the roads intersect at all - let one pass over the over and skirt the entire problem. All of these could work, but the degree of structural intervention increases dramatically in the latter cases. The structural intervention in this example is one that changes the external context (the intersection) in order to change the outcome (traumatic injury and death).  

Please select this link to read the complete article from LinkedIn.