WE NEED A BUSINESS MODEL FOR POPULATION HEALTH

Transcription

1 WE NEED A BUSINESS MODEL FOR POPULATION HEALTH IMPROVEMENT David Kindig MD, PhD University of Wisconsin-Madison School of Medicine and Public Health IOM Public Health Strategies Committee May 4, 2011

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3 The fundamental assertion of this book is that population health improvement will not be achieved until appropriate financial incentives are designed for this outcome. Kindig 1997

4 County Health Rankings: Factors Considered

5 Your Recommendation #6 advance the use of predictive and system-based simulation models to understand the health consequences of the underlying determinants of health

6 JAMA August 25, 2010

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8 From Determinants to Investments: THE Population Health Question In a resource limited world (nation, community) what is the optimal per capita investment and policy strength across sectors (health care, public health, health behaviors, social factors like education and income, physical environment) for improving overall health and reducing disparities?

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10 Redirecting resources means redirecting someone s income most students of population health cannot confidently answer the question Well, where would you put the money? Evans and Stoddart, 2003

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12 Pay for Population Health Performance Challenges Population Health Metrics Financial Incentives and Unintended Consequences Coordination Across Sectors Resistance to Resource Reallocation Triage Trap

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16 Certainly the huge large variation in health outcomes we see across states, counties, and communities is the result of different levels of financial investment and policy incentives over time; these natural experiments should give us incentive and investment guidance for a population health business model...kindig and Isham 2011 draft

17 Research is needed to estimate at the community level the per capita level of investment in each of the determinants of health and their related programs and policies beyond which health does not increase at all or very much, and suggest targets or benchmarks for each community given its current level of health and health producing factors. Kindig and Isham 2011 draft

18 Chapter 3 of your Report unified guidance to build an actionable set of additional indicators to support community decision-making with respect to local health promoting initiatives DOES/COULD THIS INCLUDE OPTIMAL FINANCIAL AND POLICY STRENGTH INDICATORS?

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20 Preventing Chronic Disease Special Issue September, 2010 Incentives for Population Health Improvement 1. Principles to Guide the Development of Population Health Incentives (Haveman) 2. Understanding the Production of Population Health and the Role of Paying for Population Health (Mullahy) 3. Using Social Marketing to Manage Population Health Performance (Rothschild) 4. Making Better Use of Policies and Funding We Already Have (Baxter) 5. Paying for Performance in Population Health: Lessons from Healthcare Settings (Asch & Werner) 6. Realizing and Allocating Savings from Improving Health Care Quality and Efficiency (Fox) 7. Accountability Metrics and Paying for Performance in Education and Health Care (Witte) 8. Population Health Rankings as Policy Indicators and Performance Measures (Oliver) 9. Learning from the European Experience of Using Targets to Improve Population Health (Smith & Busse)

21 Where is the financial and policy strength data for community level analysis like this?

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24 Sources of Dependable Financial Support 1. Health in All policies more from what we are already spending in other sectors Making Better Use of the Policies and Funding We Already Have Raymond J. Baxter 2. From savings from health care Community Benefit reform and ACO shared savings 3. Government and foundations 4. Businesses understanding the business case Kindig and Isham 2011 draft

25 SOLID PARTNERSHIPS AND REAL RESOURCES What is required is a coordinated effort across determinants between the public and private sectors, as well as financial resources and incentives to make it work. Kindig JAMA 2006

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27 Key Outcome Improved Health (As Measured by a Summary Measure of Health) Health Partners 2014 Health Driver Diagram Health Care Health Behaviors Socio-economic Factors Environmental Factors Primary Drivers Healthy Lifestyles Preventive Services Acute Care Chronic Disease End of Life Cross Cutting Issues Tobacco Non-use Activity Diet/Nutrition Appropriate Alcohol Use Advocacy Other Community Projects Advocacy Other Community Projects Central to our Mission and Capabilities, High Control Central to our Mission & Shared Capabilities, & Control Aligned with our Mission & Limited Capabilities & Control

28 What Is Needed Now? 1. A more fully elaborated business model 2. Data and methods and $$ for community level financial and policy strength analysis 3. Potential policy packages for communities, given their outcomes and determinants profile 4. Dependable revenue streams 5. Possibly an ongoing IOM Roundtable on Population Heath Improvement financing and strategies

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30 References Kindig DA. Asada Y, Booske B. (2008). A Population Health Framework for Setting National and State Health Goals. JAMA, 299 (17), Kindig DA. (2007). Understanding Population Health Terminology. Milbank Quarterly, 85 (1) Kindig DA. (2006). A Pay-for-Population Health Performance System. JAMA, 296 (21), Booske BC, Rohan AM, Kindig DA, Remington PL. (2010). Grading and reporting health and health disparities. Preventing Chronic Disease, 7(1), jan/08_0235.htm. MATCH essays in Preventing Chronic Disease July, September, and November 2010 issues Kindig, DA, Peppard PE, Booske BC. How healthy could a state be? Public Health Reports 125(2): ,

31 For more information _2007.htm David Kindig, MD, PhD Emeritus Professor of Population Health Sciences Emeritus Vice Chancellor for Health Science University of Wisconsin/Madison School of Medicine and Public Health 610 Walnut St, 760 WARF Madison, WI