Integrating Population Health in Medicine
By: Peter Weir, MD, MPH | Nov 28, 2017 11:00 AM
Peter Weir, MD, MPH
At the Intensive Outpatient Clinic (IOC) at University of Utah Health, we welcomed our first patient on February 6 this year, a young man on Medicaid who had been in and out of the emergency room and was close to losing his apartment. His repeated visits to the ER flagged him as a “high risk/high need” patient so we invited him to come see us at the IOC.
“I was going to the ER way too many times. [Someone] called me and said ‘Hey, how about you come talk with us?’ and so I made an appointment and I’ve been coming here ever since. … I’ve noticed a big change in my life [and health] because of them. … I’m losing some weight … changing my diet. I’ve also noticed that there are some mental health changes as well; I feel a whole lot better about myself. Now I’m in control of my health, with the added help. They actually want to see me succeed in what I want to do, and I’ve never had someone do that.”
Population Health Methods Lead to Better Care
Behind the young man’s improved health is a compassionate team of providers delivering high-value, continuous, and coordinated medical care for patients who have multiple, chronic, complex conditions. Our main objective at the IOC, a clinic within Population Health, is improving health and reducing costs by managing patients with a “high touch” model. We want to empower patients to take control of their own health. Although narrow in its focus, the IOC is an example of population health in action.
We apply population health methods to our care in order to keep patients healthier and out of the hospital — starting with those who utilize the system the most and can be treated more effectively with some personalized attention.
And this is how people get better.
The aim of population health is to improve the health of an entire human population. It allows us to consider health inequality and inequity and what responsibility we, as an academic medical institution, have when it comes to delivering health care to all — not just those who can afford and access it.
Doubtless many would argue with this sentiment. But buying into that sentiment and changing the health care system are sizably different tasks. The reality is health care is not incentivized to be this efficient nor proactive. Hospitals and physicians are not paid to keep patients out of the hospital. However, University of Utah Health, as an integrated health system, has started identifying areas around the health system where we can apply a population health perspective. We have multiple examples of this happening already, and as other departments begin to see outcomes improve, we expect to identify even more areas of improvement.
Opportunities Within Our Integrated Health System
Erin A. S. Clark, MD, Assistant Professor of Obstetrics and Gynecology, just completed a two-year clinical trial of 200 low-risk expectant mothers. Half the women in the study checked in remotely, via telehealth access, for up to half of the 15 prenatal visits normally required by maternal health care metrics.
Five key, in-person visits — including the first and last prenatal visits and routine labs and ultrasounds — still went on as planned.
In the end, outcomes and patient satisfaction were just as good as “traditional care.” Looking at one population of people — expectant mothers — Dr. Clark and her team questioned the current dogma around maternal health care and discovered that mothers can spend less time in a hospital or clinic and still receive similar outcomes. This saves time, money and energy for both patient and provider.
The University Neuropsychiatric Institute’s (UNI) HOME Program is another example of a population health model serving a specific population. Kyle Bradford Jones, MD, and his team at the HOME Program manage a patient-centered medical home that provides medical and full mental health services including psychiatric care, behavioral supports, and case management for individuals with developmental disabilities.
Dr. Jones and his team combine primary care with behavioral and psychiatric care together in a medical home model. This integrated, team-based care approach has resulted in inspiring outcomes for a vulnerable population. The increase in approaching patients from a comprehensive medical, psychiatric, and social perspective allows many of these patients to remain in a home setting, where many patients heal better, rather than in a hospital or institution.
"Precision Medicine For Neighborhoods"
Population Health is not a new concept, but there is no set definition for this area of health care. Perhaps the definition that gets to the heart of our goal at U of U Health comes from James Michener, MD, at Duke University School of Medicine. He calls it “precision medicine for neighborhoods.” Dr. Michener argues for using methods of improving the health of communities, including identifying opportunities for improvement; engagement with community groups, practices and agencies; development of innovative strategies; and measurement of outcomes.
As an academic medical center, our mission and responsibility is to make the future better. We think about forthcoming generations and we plan for their success. We test, implement, measure, tweak, and improve the path for others to follow. As our population ages, health care policy is uncertain, and the rate of chronic disease keeps rising.
To borrow one more phrase from Dr. Michener, it’s time for us to “seize the moment to integrate population health in medicine.” It is time for us to prepare for what’s coming, not just because it is financially responsible, but because it is the right thing to do.
Peter Weir, MD, MPH
Guest blogger Peter Weir, MD, MPH, is the Executive Medical Director of Population Health.