As health care continues to trend towards provider-driven, value-based reimbursement instead of fee-for-service arrangements, insurers are pushing population health data management services. Although there is not a consensus about the proper definition of the term, large insurance companies such as UnitedHealth Group, Aetna, Anthem, and Blue Cross Blue Shield are dedicated to making it a mainstay. According to Forbes, population health is now a multi-billion dollar business.
So, what is it?
In 2003, an article published in the American Journal of Public Health noted that there was not a precise definition of the term. The concept, first more widely discussed in Canada before trickling to the U.S. and becoming ever more popular, seemed to be focused on the “determinants of health of populations.” The article’s authors proposed the definition of “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” They believed that the field included health outcomes and the patterns of determinants, such as medical care, interventions, genetics, and components of social and physical environments. Fast forward to 2015, and a George Washington University Master of Health Administration blog notes that there is still not an agreed-upon definition.
The blog’s authors received 37 definitions of “population health” from health care leaders. They referenced the 2003 journal article definition and found that some leaders complained that the definition failed to acknowledge the role of health care providers. Although there is still not a consensus, many viewed population health as an opportunity for parties involved in health care to collaborate to improve the health outcomes of entire communities.
The Robert Wood Johnson Foundation issued a five-part series in 2013 on the topic in an effort to further explore the definition of population health. The series featured quotes from health care leaders, and a clinical “population medicine” perspective emerged, which focused on creating categories to allow the cost-effective allocation of health care resources. One leader stated that they intentionally managed patients “in terms of clusters” for managing chronic illnesses. The series also noted that those with a public health focus tended to start with geographic populations and then consider interventions. Another leader pointed to community characteristics, such as food and physical environments, as a focus point beyond a populations aggregate health status.
Health Catalyst stresses that population health and public health are two different things. While population health is focused on finding the connection between health outcomes and determinants, public health is concerned about societal efforts to ensure healthy conditions.
A growing field
A study conducted by the RAND Corporation, a research organization committed to addressing public policy challenges, found that physicians need more assistance in gathering information on patient populations. For a practice to find success with alternative payment models, more resources should be directed to data management and analysis. That’s exactly the gap several large insurers are trying to fill.
Health Catalyst points out that health insurance companies were mostly concerned about population health prior to the implementation of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Payer care management involved analyzing claims data for populations, then targeting at-risk individuals’ doctors, suggesting that gaps in care be addressed. This approach had several issues, as it was based on claims data instead of actual clinical information. Now, providers are driving population health as the holders of useful clinical data.
The need for more population health services is reflected by UnitedHealth’s growing business, Optum. The health services platform seeks to improve the health care system with its Optum360™ revenue cycle management solutions. According to Forbes, UnitedHealth attributed Optum’s growing revenues partially due to “business expansion in population health management services for payers.”
Aetna has its own population heath provider engagement system, known as Healthagen. Aetna has invested over $1.5 billion in Healthagen, and expects the business to grow even more after the proposed Humana acquisition. Humana has its own Transcend and Transcend Insights businesses to simplify population health management. Humana hopes to have three quarters of Medicare Advantage (MA) beneficiaries covered under a value-based model by 2017, and hopes to use the Transcend organizations to achieve this goal.