Healthcare - have we forgotten someone? ... the actual consumer?

by Rose Rohloff

One important step healthcare leaders have not done - ask the consumer, those individuals who make up the population - what is the public’s understanding or desire for Population Health. Therefore, I went to the public to ask and listen to them.

 The intention of my June hfm business intelligence (BI) column* was to gauge how well the industry has standardized definitions by conducting an informal survey of leading providers, consultants, and vendors. It was refreshing that so many respondents were eager to participate, and they showed care for wanting to improve the industry. After reviewing a wonderful broad range of great responses, one striking point stood out: The healthcare industry has not clearly defined Population Health.

Lacking a uniform definition makes it difficult to define when healthcare has succeeded, to establish key performance indicators (KPIs) for monitoring progress, to determine which solutions lead to that success, and most important to educate the population on what initiatives and goals are being offered to help them. After performing the industry survey, I thought about one important step healthcare leaders have not done - ask the consumer, those individuals who make up the population - what is the public’s understanding or desire for Population Health.

With this in mind, I wanted to conduct a survey of 100 non-healthcare people across the country, of various ages, a range of industries, and regardless of political affiliation. Each person was asked:

• Have you heard the term Population Health before? Yes/No
• What does Population Health mean?

​Many people looked confused upon being asked those questions and stated they have never heard the term before, while others provided an immediate description. Although the survey showed the lack of any definitive definition, and verified the general lack of understanding of the concept, it showed how much the public wanted to talk about Population Health, with several people engaging me in conversation to find out what the industry is doing and asking, “What is the actual definition?”  *https://www.hfma.org/BIgoals/

Survey Results

Overall Breakout by Age, Gender, Industry & Definition Grouping

Exhibit 1: Gender 50:50, Age Grouping, and Age Group by Industry and Gender

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Have you heard the term Population Health before? Yes/No

Exhibit 2: , Answers Grouped into Categories

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Have you heard the term Population Health before? = Yes
​What is your understanding of the definition?

Exhibit 3: non-generic definitions provided according to industry.

Exhibit 4: Demonstrated confusion about definition - answers grouped into categories.

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The majority of responses were vague, generic definitions; the following are non-generic definitions provided according to industry.

• Numeric: The marketing-recruiter is an owner of a recruitment company that focuses on IT placement.
• Organization/Government, agenda: This respondent stated his understanding was in reference to population control, or culling of animals (as defined by Merriam-Webster “to control the size of a group of animals by killing some animals”), and is being applied to our population.
• Happy people – health status: These respondents were two recent high school graduates who stated they learned about Population Health from an advanced placement (AP) class and it is about people being happy and healthy.​

In the hfm article, I proposed that the industry standard definition needs to include “a partnership with the community of health seeking persons” including “putting data into the hands of patients and encouraging them to share accountability for health outcomes by choosing healthy lifestyles, following health regimens, and seeking health education.” As the public survey shows, we in the industry need to ascertain their understanding, and have a collaborative relationship for population health management with a clear definition and public education regarding solution offerings.

Have you heard the term Population Health before? = No
​What would be your understanding of a definition?

It was refreshing to come across so many in the public who have the desire for health care discussions and want to understand what is transpiring with the changing environment. It was additionally refreshing to see how many want the right information to make knowledgeable decisions.   

Exhibit 5: No response general

Exhibit 6: No numeric/metric

Exhibit 7: Org, World, Mental

Exhibit 8: Self, Environment, Health

As a general finding, respondents between the ages of:
16-17 Wanted to convey input.
18-20 Had general apathy regarding the topic and generic input without additional inquiry.
30-40 Showed the highest desire to participate and have conversation regarding – the largest group with children and facing older parents with increased health concerns.
50-60 Wished to participate with continued conversation regarding what is happening in the industry with more defined ideas of what the term means.
​70-90 Were an active and health conscious group being very productive in their communities and had a desire to learn about the topic.

Summary

The bottom line of my hfm article and this survey, healthcare loves to create ambiguous terms and focus spending on generalities without quantifiable results, and focused on the masses - not on individuals.

​There is a quote attributed to Sam Walton, “There is only one boss, the customer. And he can fire everybody in the company from the chairman on down, simply by spending his money somewhere else.”

While performing inquiries of the public, I have spoken to many people who shared the desire to control their own health decisions along with integration of standard and holistic medicine, and unfortunately several who are currently seeking health care in other countries. ​

A veteran health care consultant and nurse summarized this by responding:

I read your recent article in HFMA Defining BI Goals for Coordinated Care and Population Health. You are spot on with the questions and approach the healthcare community should take, but do not, with population health strategies. It will not be surprising to see how many resources are used by healthcare systems and providers in their attempt to ‘manage their population’s health’ while the population continues to choose which provider (s) to receive care from during sickness and health.  Until 2017 and 2020 when the FFS reimbursement model begins to shift, I suspect we will see outcome changes in larger healthcare systems that are engaged in an ACO and HMO model, but not significant enough across all healthcare systems.

It is time to go back to a care for healing, or as the quote in the movie People Will Talk, "I heal sick people" environment again, not with a general population, socialized medicine approach, but an individual focus once more for sustaining health. 

Addendum: all answers by age groupings