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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

WHAT IS THEINSTITUTE FOR POPULATION HEALTH

IMPROVEMENT?

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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.

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How can the multiple determinants of health be most effectively influenced 

to optimize health?

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.  

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Who in the population needs to have his/her health determinants influenced 

and in what ways?

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. 

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The future is not what it used to be!