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February 10, 2014

Private health care finds population health

As the ACA is implemented, the American health care system is moving from its previous fee-for-service model to one that is more of a value-based purchasing model. In other words, for the first time, insurance companies have a financial incentive to keep population segments healthy, and they’re passing that pressure on to health care providers.  It’s no longer enough for clinicians to treat illnesses; they now must make a concentrated effort to screen at-risk patients and design preventative health care regimens. For example, instead of simply prescribing insulin to diabetic patients, providers are expected to catch at-risk patients in the pre-diabetic stages and stop the disease in its tracks with tools like exercise plans and referrals to specialists like dieticians.

To help them in their new population health mission, health IT companies like Cerner are designing services to focus on analyzing patient population health needs—but does their “population health” match public health’s definition?

To Cerner—and, by extension, the medical provider organizations it services—populations comprise, for the most part, the patients for which the insurance company is responsible. If Joe Schmo isn’t covered by Acme Insurance Company, then to Acme, he simply doesn’t exist.  Our country’s private insurance model necessarily limits a company’s view of the lives for which they are responsible. Public health understands “population” as being all of the people living within a defined geography or particular risk group. We must ask how the more limited definition of population will impact the insurance companies’ transition into the role of population health insurer and the health care organization’s transition into role of population health manager. When a “population” is not an all-encompassing term, then whole population segments are excluded, which can only fuel existing health coverage disparities and deepen the health rift between the haves and the have-nots.

Public health seems to have a unique responsibility – we speak on behalf of the entire population. If we wish to forge into an equitable future, public health practitioners must learn to work side-by-side with these new stakeholders to identify health care gaps and alleviate disparity. While building new partnerships isn’t easy, the need has never been greater.

David A. Ross, ScD

President/CEO of the Task Force for Global Health, former director of PHII