Post on 19-Feb-2022
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POPULATION HEALTH MANAGEMENT: An Emerging Imperative Population Health Sciences Colloquium
Stanford University September 26, 2013
Kenneth W. Kizer, MD, MPHDistinguished Professor and Director,
Institute for Population Health ImprovementUC Davis Health System
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Presentation Objectives Highlight the need to focus on population health from
the national perspective Offer a possible KISS construct for how to think about
advancing Population Health Sciences nationally and locally
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Established as a new independent operating unit in the UCDHS with no funding and 1 FTE in mid‐2011
By Aug 2013, had developed a diverse portfolio of funded activities >$70 M and >115 FTE and consultants
Serves as a resource for: Health care reform Clinical quality improvement Health leadership development Creation of actionable clinical intelligence Health policy development, analysis and implementation To date, has primarily focused on assisting health‐related
government agencies and philanthropies design, implement, manage and/or evaluate programs
Promotes understanding of the multiple determinants of health and of health outcomes being a function of the totality of one’s circumstances
New value‐based health care payment models require that population health management be a core competency of health care provider organizations
Institute for Population Health Improvement
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Provide technical assistance and thought leadership in quality improvement to the state Department of Health Care Services for Medi‐Cal (California’s $60B/yr Medicaid program) Medi‐Cal Quality Improvement Program Evaluate CA’s Delivery System Reform Incentive Payments (DSRIP) Program Design the CA‐specific Evaluation of the California Medicare‐Medicaid Dual
Eligible Demonstration Program Manage operations of the California Cancer Registry Manage the California Health eQuality (CHeQ) Program ‐
California’s ONC‐funded Health Information Exchange Development Program
Provide technical assistance and support for multiple CDPH statewide chronic disease prevention and surveillance programs
Conduct a statewide assessment of surgical adverse events Conduct population health research projects
Approaches to prevention of prescription opioid use (with CHPR) Use of the Oncotype Dx Assay in Medi‐Cal beneficiaries with breast cancer
Selected IPHI Activities
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Investigate the feasibility of developing Community Paramedicine in California
Manage the California Health Policy Forum Assist and support CDPH achieve national accreditation Develop basic QI training for all CDPH employees Support California Health & Human Services Agency in developing a
CMMI‐funded Payment Reform Model for the California $2.3M 6‐month planning grant received in Mar 2013 Anticipate submitting a $60M 3‐year implementation proposal in early 2014
IPHI asked to join the hACT for the new $1B HHS/CMS Health FFRDC managed by MITRE
Establishing a Center for Veterans and Military Health Developing an Integrative Medicine and nutritional genomics
program Other
Selected IPHI Activities
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Population health refers to the net health status or outcomes of a defined group of
people as a result of the many determinants of health, including health care, public health interventions, and social and environmental factors.
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Population health management refers to purposeful actions taken to influence the health outcomes of a defined group of
persons through coordination, integration and alignment of health care, public health
interventions, and the social and environmental determinants of health.
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Addressing 3 questions is central to developing national and local strategies for advancing Population Health Sciences and improving population health.
1. Why is population health important?2. How can the multiple determinants of health
be most effectively influenced to optimize health?
3. Who in the population needs to have his/her health determinants influenced and in what ways?
Why is Population Health Important? The state of a population’s health provides the foundation for
its productivity, creativity, happiness, security and viability. US population health is not improving comparable to other
developed nations, and in an increasing number of areas is stagnant or deteriorating.
The rising cost of US health care is not sustainable and is the single biggest threat to the nation’s economic future.
The primary business of health care today is managing chronic conditions, and the clinical course of most chronic conditions is materially influenced by poorly understood genetic factors and behavioral, social and environmental factors outside of medical care.
75% of all health care expenditures are for managing chronic conditions 40% of Medicare patients have 7 or more chronic conditions
The cost of care is closely correlated with the number of chronic conditions.
Up to 75 Percent of US Youth Ineligible for Military ServiceLack of Education, Physical Problems Disqualify MostBy Robert Longley, About.com Guide
Health of U.S. Workforce Declining and Driving Up Employer Costs, According to New Index from Thomson ReutersOverweight and Obese Have Largest Impact on Employers’Healthcare Expenditures
Ann Arbor, MI, April 14, 2011 – The unhealthy behaviors of the U.S. workforce cost employers an average of $670 per employee annually, according to the new Thomson Reuters Workforce Wellness Index.
Determinants of Preventable Mortality*
*McGinnis JM, et al. Health Affairs 2002; 21(#3): 78‐93
Determinants of Preventable Mortality Percent
Behavioral factors 40%
Genetic and gestational factors 30%
Social circumstances 15%
Medical care 10%
Environmental circumstances 5%
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Improving access to and the delivery of health care has a limited ability to
positively affect population health, but understanding population health needs
has the potential to substantially influence access to and the delivery of
health care services.
Cohen, S. and Uberoi, N. Differentials in the Concentration in the Level of Health Expenditures across Population Subgroups in the U.S., 2010. Statistical Brief #421. August 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://meps.ahrq.gov/mepsweb/data_files/publications/st421/stat421.shtml
Table 1: Distribution of Health Expenditures for The U.S. Non-Institutionalized Population, By
Magnitude of Expenditures % Of U.S.
Pop. Top 1% 5% 10% 50%1970 26% 50 66 961977 27% 55 70 971980 29% 55 70 961987 28% 56 70 971996 27% 55 69 97
Derived from Berk& Monheit ,The Concentration Of Health Expenditures, Revisited Health Affairs 2002; 11 (4):145-149
50% of the population accounts for 3% of expenditures
Figure 1: Population risk pyramid and average costs per tier
From A. Sengupta. Beyond Care, Inc
Where on the cost curve do you get the most benefit and ROI from population health management?
Figure 2: Population risk pyramid and distribution of costs per tier
From A. Sengupta. Beyond Care, Inc
Figure 3: Annual growth in medical costs after inpatient discharge, with increasing segmentation
From A. Sengupta. Beyond Care, Inc
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Optimally leveraging technology to enable and expand workforce
capabilities and to make care more patient‐centric requires a deep
understanding of population health needs.
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Notwithstanding the need for and benefits of population health management, the proverbial ‘elephant in the room’ is that it is not in the financial interests of many providers to pursue PHM at present.
The question for many providers is when will
payment methods create the financial imperative to
develop the infrastructure and capacity to
operationalize population health management.