Disclosures
• NIH 1 P20MD00687501 ($5.5M)
• NIH S21MD012474 ($10M)
• NIH 1P20CA192994-01A ($1.1M)
• New York ECRIP ($1.26M)
• Endowed Chair in Nephrology (3.4M)
• SUNY Health Network of Excellence ($150k)
• US patent # 9556235: F11 Receptor antagonists
(peptide 4D) as therapeutic agents in vascular
disorders. www.vasocuretherapeutics.com
Conflicts of interest: None
• Background and definitions
• Rationale for population health
• Evolution and how is it done, a quality and cost
perspective
• Populations health determinants and implications for
social determinants of health
• Summary
Public Health: the science and art of preventing disease
at the population level
Population Health: the science and art of controlling disease by
monitoring performance measures in
preventing, diagnosing and treating chronic
disease at the population level
OECD 2017: https://data.oecd.org/healthstat/infant-mortality-rates.htm#indicator-chart
OECD 2017: https://data.oecd.org/healthstat/life-expectancy-at-birth.htm#indicator-chart
USA
Men: women gap 4 years
Black: White gap 5 years
Murphy Sl, et al, NCHS Data Brief ■ No. 328 ■ November 2018
https://www.cdc.gov/nchs/data/databriefs/db328-h.pdf
OECD 2018: https://data.oecd.org/healthres/health-spending.htm
USA: $8,500
OECD: $3,322
Expenditure ratio: 2.6
French EB, et al, Health Affairs VOL. 36, NO. 7, 2017:
https://doi.org/10.1377/hlthaff.2017.0174
• <1980’s: Fee for service
• 1980’s -2000: Birth and proliferation of managed
care organization
• 2000s-: • Accountable Care Organizations (risk sharing)
• Medical Homes
• Pay for performance (incentive-based payments)
• Value based payment systems
• Population Health (reduce cost, improve outcomes and
experience)
• Precision Medicine
Example:
Patient A and B have Heart failure, both receive reminder calls
for visits but patient B is depressed and does not answer phones
How do you design care for patient B to make sure medical
interventions are as effective as patient A?
The goal of population health is to reach the same outcome
in both patients, therefore the care plans will be enhanced for
patient B as ff:
• Visit compliance
• Medication adherence
• Mental health interventions
• Social determinant of health
Technology Analytics Care
Coordination
Healthcare Effectiveness Data and Information Set (HEDIS)
National Committee for Quality Assurance (NCQA)
Quality Cost
Payers
(Insurers)
Hospital systems
Physician practices
Societal/social characteristics
Adapted from, Alvin R, et al: https://doi.org/10.1111/j.1749-6632.1999.tb08123.x
Societal determinants of health are defined as
conditions in the social, physical, and economic
environment in which people are born, live, work, and
age.
https://www.healthypeople.gov/2010/hp2020/advisory/societaldeterminantshealth.htm
Economic Stability
• Poverty• Housing security and Stability• Employment• Food Security• Transportation
Education
• Early Childhood Education and Development
• High School Education• Enrolment in Higher Education• Language Literacy
Social and Community
Context
• Social Cohesion• Civic Participation• Perceptions of Discrimination and
Equity• Incarcerations/Institutionalization
Health and Health Care
• Access to Health Care-gaining entry into the Health System
• Access to Primary Care/Trusted Provider
• Health Literacy
Neighborhood and
Environment
• Affordable/Quality Housing• Environmental Conditions• Access to Healthy Foods• Crime and Violence
Source: Adapted from Healthy People 2020 , US Department if HHS, 27 July 2019
Health Inequities: differences in health outcomes between groups of people
that are considered preventable or unfair
http://interactioninstitute.org/equality-vs-equity-the-gift-that-keeps-on-giving/
PROBLEM: Central Brooklyn has high unemployment rates, food stamps, physical inactivity,
number of murders, preventable diseases
AIM: To “bring health and wellness to one of the most disadvantaged parts of the state.”
Investment: $1.4 billion to fight “entrenched pockets of poverty” in a comprehensive way
• $578 million for subsidized housing • $700 million, allocated in 2015, for a new health care system • 8,800 Health living related projects
➢ oyster reef restoration project ($400,000), ➢ 22 community gardens ($3.1 million), ➢ fresh food programs ($1.8 million) ➢ new 407-acre state park
PROBLEM: Unnecessary and costly emergency room visits by Medicaid/eligible patients
AIM: To reduce unnecessary admissions by 25% through transforming the health system with
eventual goal of value-based payment
Investment: $6.4 Billion used to develop a new delivery structure
• Managed Care Organizations• 25 new Performing Provider Systems in NYS
• Health Homes• Hospitals Other Providers• Community Based Organizations
System Transformation Projects (Domain 2): • Create Integrated Delivery system (PCMH, APCM, Health Home, medical village)• Implement Care Coordination and Transitions of Care (PC in EDS, Transitions of care, etc.)• Connecting Settings (Patient Navigators, telemedicine, Patient activation activities, housing)
Clinical Improvement Projects (Domain 3): • Behavioral Health (Integrating PC and BH, medication adherence, withdrawal management, ,
etc.)• Cardiovascular (Million Hearts campaign)• Diabetes, Asthma, HIV AIDS, Perinatal care, palliative care, renal care
Population-Wide Projects for Prevention (Domain 4): • Promote mental Health and Prevent Substance Abuse)• Prevent chronic disease (smoking, etc.)• Prevent HIV and STDs• Promote Healthy Women, Infants and Children (reduce premature births
The development of a society can be judged by:
✓ The quality & fairness in the distribution of population health
✓ The degree of protection provided to the disadvantaged
Reduce Costs (Costs between 2003-2006)
Combined costs of health inequities and premature death in the U.S.= $1.24T
30.6% of direct medical care expenditures for people of color were EXCESS
costs due to health inequities
Increase Revenue
✓Healthy workforce is a productive workforce
✓College education for all would result in $1 trillion of savings
LaVeist, Gaskin, and Richard, 2009; Dow and Schoeni, 2008
2018
• The cost of healthcare in the USA is simply too high and not
sustainable long-term
• Many strategies have been employed to reduce healthcare costs
but are largely symbolic and not effective
• Population health strategies, founded on value-based payment
systems, offers a promising method to improve quality, reduce
cost and improve patient experience
• Addressing social determinants of health in a population health
strategy is critical to its success, particularly in health of
underserved/disadvantaged populations