A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert.
It strikes me that, in order to answer the Affordable Care Act’s call for us to aggressively pursue population health, we must first understand what the recipe calls for.
Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the population.
In our radically changing industry, where health systems and academic medical centers are increasingly rewarded on the value achieved (i.e., appropriateness of tests and therapies ordered and the health outcomes achieved), the synergy between individual data (e.g., clinical, socioeconomic, genetic, environmental) and population health is key.
With the science and business of genomics moving forward at breakneck speed, and the digital technology industry keeping pace, we are rapidly approaching a time when gene sequencing performed in a physician’s office will inform the choice of therapy for each patient — and every patient will have a Web-enabled cell phone where such medical information can be stored and health behaviors can be tracked.
Here are a few more essential ingredients in the recipe:
Evidence. We must replace the “art” of medicine with medical practice based upon a robust body of evidence — a feat requiring dramatic change in current practice, wherein a mere 20% of clinical decisions made at the bedside are evidence-based.
Such evidence is being accrued by means of global clinical trials involving tens of thousands of patients.
Electronic systems. We must retool our electronic systems to provide the data we need to optimize patient treatment. For example, we need to create registries with collective data on target populations (e.g., patients with chronic conditions such as diabetes and hypertension) to better understand which therapies and interventions are most appropriate for which patients.
Population-based “big data.” Today, private industry is developing sophisticated health and fitness applications that deliver behavioral messaging and interventions to large targeted groups at a relatively low cost.
We must harness this “big data” input by millions of people who are beginning to track their own health status and manage their own conditions and organize it to help deliver care at the individual patient level.
Medical education. We must shift the medical education paradigm away from the traditional approach (a single patient with a single problem for whom treatment is determined by “guesswork” based on the clinician’s experience) toward a model that incorporates population-based data and research evidence as well as “personalized” information to better understand and treat each patient.
Obviously, the recipe for population health is fraught with complexity and will likely take time and effort on the part of the healthcare industry’s “top chefs.”
Nevertheless, for those of us who practice medicine, positive change will come when we are able to reconcile population-wide, evidence-based recommendations with individualized care that is guided by each patient’s unique genetic makeup.
David B. Nash is founding dean, Jefferson School of Population Health, Thomas Jefferson University and blogs at Nash on Health Policy and Focus on Health Policy.
