Population Health Essentials for Physicians

Net U.S. healthcare spending exceeded $2.9 trillion in 2013, or over $9,000 per person. CMS has projected that net healthcare spending will increase by 5.6 percent in 2014 to $3.3 trillion. At 17.9 percent of the U.S. Gross Domestic Product this nation spends far more on healthcare than any other country in the world in terms of dollars, percentage of GDP, and per capita spending. Yet, it ranks "dead last" in quality, outcomes, access, and a number of other metrics at a per capita cost of about twice as much when compared to 10 other First World countries according to Forbes.

Undeniably, the U.S. healthcare delivery system is failing and falling further behind. The Affordable Care Act is not healthcare reform, it is insurance reform. While it does little to address the root problems with the healthcare delivery system, it does identify what is needed to do so, referred to as the "Triple Aim" (increased quality and outcomes at a lower cost).

Socialized medicine is an equally poor payment solution, but planners got one thing very right - they improved their delivery system's quality and efficiency by focusing on the health of their overall population stratified by disease.

Of course, access to physicians, particularly specialists, and imaging diagnostics is a persistent problem that degrades outcomes. Nonetheless, 10 major developed countries including the U.K. and Canada beat the U.S. on virtually every quality metric by a country mile at about half the cost.

In simple terms, population health is managing groups of patients as a whole while treating patients one at a time. Stratification, or identifying groups of patients with similar diagnoses and focusing on closing gaps in care specific to those diagnoses, is the first step.

Stratifying and grouping identified patients by risk is the second step. Using diabetics as an example, grouping can include pre-diabetics, single morbidity diabetics, and poly morbidity diabetics as a broad classification.

The overarching goal is to slow progression to greater complexity by using best practices for each classification and tools such as organized intermediate nutrition and activity programs between physician visits.

The challenge for many physicians is tracking patient compliance with requirements for quality care such as retinal visits, labs, medications, and so forth. For others, it will be identifying the groups themselves. For all, it will be identifying gaps in care and communicating with patients to fill them while complying with HIPAA regulations in time to ensure that care requirements are met.

The challenge for policymakers, planners, and legislators is to target regulation to enable rather than control. Issues such as EHR manufacturers extorting high fees to permit interoperability with other software that can make the job easier for physicians, flaunting existing requirements for standardized databases, and insufficient or rudimentary report generation need to be regulated and the regulations to be enforced. HIPAA needs to be updated. Government needs to get out of the way. It isn't working.

For everyone, funding coverage for all Americans is no further away than using good old American ingenuity and inventiveness based on common sense.

Or, maybe we can at least get on par with Norway.