How the Candidates Can Weigh In on Population Health

Watching March Madness (Go Villanova!) ads and the accompanying Political Silly Season news have alerted the Population Health Blog to the very real possibility that its state's late primary may play a role in the presidential sweepstakes.

While the PHB ponders what to do with its vote, it naturally thought about the candidates' positions on "population health." 

In no particular order and as a public service to the campaigns' search for talking points (and "dog whistles"), the PHB offers the following statements for their consideration, just in case the topic comes up......

Mr. Trump: Believe me, I've studied this far greater than anyone else and population health would have terrible ratings if it weren't for me.

Bonus question on electronic health records (EHRs): We have to EHR how bad it was a disastrous deal amateur hour believe me.

Mr. Cruz: The words "population" and "health" do not appear in the U.S. Constitution and this will end on day 1 when I become president.

Bonus question on EHRs: I cannot find the letters "e," "h" or "r" in the U.S. Constitution either, and it's not just because of the handwriting.

Mr. Kasich:  We did population health in Ohio when I was governor and while I chaired the Ways and Means Committee in Congress

Bonus question on EHRs: We did EHRs in Ohio and while I chaired the Ways and Means Committee in Congress.

Ms. Clinton:  We will build on the success of Obamacare by investing in population health through legislation that offers a tax credit to offset its cost that will be available through the exchange to assure that all families will not exceed a premium threshold under current law while incentivizing expansions of the program through all 50 states with a matching initiative over several years.

Bonus question on EHRs: I never knowingly sent confidential patient information or received anything marked HIPAA protected at any time. But under my plan, physicians will be able to use private email accounts to communicate with their patients.

Mr. Sanders: Population health, like a college education, solar power and frozen yogurt is a basic human right.

Bonus question on EHRs: That too.

Not to be undone, two other recent fixtures in the PHB television universe have weighed in on population health....

Charles Barkley (taking a break from his half-time college basketball commentary): It's turrible that people see that (unintelligible) Krispy Kreme that don't understand how if (unintelligible) people have eaten too much.

Joanna Gains of HGTV's Fixer Upper (a PHB spouse refuge from the TV craziness): Let's face it: Fixer-uppering chronic conditions with population health is possible with the affordable use of vintage twists that accent an existing space and give an illusion of depth with a favorite hue.  Try some mottos, mirrors and oversize remnants that group together and transform drabness to healthiness.

The Latest Health Wonk Review Is Up!

A straightforward summary of savvy health policy blogging awaits you over at ACASignups.net.

 

This HWR is timed with the sixth anniversary of the Affordable Care Act.  Topics include narrow networks, assisted suicide, misprescribing, balance billing, healthcare workplace violence, moonshots and the controversies over morcellation.

No association, or cause and effect?  You be the judge!

Busting Through the Healthcare Performance Frontier

Breakthrough!

The costs of business performance - for example, customer delight, reputational excellence, high worker satisfaction, workplace safety, leadership diversity, environmental sustainability or reducing social disparities - are typically viewed through the lens of a zero-sum game. 

In this classic world view, achieving profitability means cutting performance, while pursuing high performance reduces profits. The relationship between the two variables can be displayed as a curve:

Population Health Blog readers can find out more about this here.

Most firms in the real world operate on the "A" curve.  Different firms under different circumstances make dozens, if not hundreds, of decisions on a day-to-day basis involving trade-offs that move them along the curve that extends along the profitability and performance continuum.

Examples of healthcare companies that moved up on the curve at the expense of performance include the Veterans Administration and Turing Pharmaceuticals.  At the other end of the curve, the understandable unwillingness of some hospitals to walk away from their community service obligations may have led them to bankruptcy.

The "B" curve represents the theoretical limit for greater profitability and performance using the current business model.  In other words, as companies maximize all opportunities and minimize all inefficiencies in their existing business models, they can move the curve up and to the right.  That is what all management, executives and boards can define and aspire to.  That "B" curve is known as the "performance frontier."

Examples of healthcare companies that moved toward the "B" curve? You can find more about them here.  If they're hospitals, they fill beds with short lengths of stay and high patient satisfaction.  If they're clinics, they maximize billing revenue and minimize waiting lists.  If they're an ACO, they manage risk by contracting for an actuarially optimum population while pursuing the Triple Aim.

  

The "C" curve beyond the established frontier is what becomes possible with transformational innovation, superb leadership or both. Examples outside of healthcare include Apple under Steve Jobs and Tesla under Elon Musk. Firms that create value by inspiring employees, new products and innovative processes not only benefit from even greater profitability, but offer enhanced performance. 

In "C" level healthcare settings, the top-line growth and decreasing costs would be accompanied by better measures of customer/patient well-being, community burden of disease, worker engagement, leadership diversity and improvements in social determinants of health.

While the Population Health Blog eagerly awaits reports of frontier-busting healthcare providers, it offers a few observations:

1. Healthcare organizations have generally not done a good job in defining and measuring their performance metrics.  They've also not made them part of the C-suite's DNA or placed them prominently on their governing boards' agendas. If they did, breakthroughs would become more likely.

2. The EHR's primary functions of billing and documentation will never get healthcare organizations to the C curve.  This is not part of a breakthrough strategy.

3. In contrast, big data, risk stratification, mHealth and machine intelligence have the economic/business potential to identify risk, channel the right care, circumvent high cost service options and rationalize decision-making, but could also increase performance through the engagement of consumers, increasing access to more care options, reducing disparities and minimizing provider busywork.  These are the ingredients for a breakthrough to C-curve level performance that is only just beginning.

4. By the way, another ingredient for high healthcare provider performance can be found here.

5. Last but not least, the leadership of many innovative health technology companies already intuit much of this.  They're looking for partners that are not just looking for "B" level performance, but want to bust through the performance frontier. 

Image from Wikipedia