The Centers for Disease Control and Prevention (CDC) estimates that chronic diseases, including heart disease, cancer, diabetes and mental health conditions, are responsible for 90% of the $3.5 trillion spent on healthcare in the U.S. each year.
Experts had been warning of healthcare’s unsustainable trajectory long before COVID-19; with the health and economic effects of the pandemic likely to reverberate for years to come, things could get worse. Although figures for new cancer diagnoses dropped during the COVID-19 emergency period, so too did those for preventive screenings and healthcare utilization in general. The unfortunate likelihood is that these diseases, diagnosed further into their progression, will have poorer outcomes — and be much costlier to treat and manage.
Turning the Tide With Population Health Management
Population health management shows promise as a means of mitigating the pandemic’s health and economic impact. Though precise definitions and approaches vary, population health management broadly focuses on improving the health outcomes of groups of people. It aims to improve the healthcare experience and the overall health of populations while reducing the cost of care, advancing what is widely known as the healthcare triple aim.
An effective population health management strategy uses personalized engagement tactics and comprehensive care management to meet patients where they are in their healthcare journey. This requires deep insight in order to understand who in the population is most at risk and in what ways, informing targeted interventions that proactively address those risks before they become severe and costly health problems.
A Deeper, Broader Understanding of Health
Healthcare data alone does not provide a complete picture of a person’s health; rather, it is the culmination of physical, behavioral and social determinants of health (SDoH) that influence outcomes. Understanding this complexity of factors and, more so, leveraging this insight to affect outcomes is the work of population health analytics. As defined by Duke University's Fuqua School of Business, population health analytics is “the application of quantitative methods … to reach more sophisticated insight about groups or determine the most optimal strategies for treating health issues within that group.”
To be most effective, population health analytics should be applied both prospectively and retrospectively. Predictive analytics enable healthcare organizations and care teams to proactively identify and address health risks, while retrospective analyses work backwards to understand how those risks influenced a particular outcome and assess the effectiveness of interventions.
In the Fight Against COVID-19, Knowledge Is Power
Although we are dealing with an unprecedented health crisis, one thing we have learned is that it has vastly different implications for different groups. From the start, it was clear that elderly and comorbid populations faced the greatest threat of severe outcomes and death from COVID-19. However, it has since become evident that there is far more at play than age and underlying illness, as the pandemic has had a disproportionate impact on minorities and socioeconomically disadvantaged groups.
Population health analytics can provide insight into the healthcare experiences of these different populations as well as the non-clinical factors — i.e., SDoH — contributing to the risk of severe illness. This is vital not only to improving outcomes in the interim of widespread COVID-19 vaccination, but also preventing and better managing the many other, likely worsening, morbidities that exist outside the realm of the pandemic.
Analytics in Action
Data is crucial to understanding the health of populations; analytics is key to unlocking its potential in improving the quality and cost of healthcare. Overcoming barriers to data use and leveraging advanced analytics tools to inform effective outreach strategies and care plans will help to enable healthier populations today, while creating a more sustainable trajectory for the future.
Throughout the COVID-19 crisis, HMS has shared a number of population health management and cost containment strategies for healthcare organizations, government healthcare programs, at-risk providers and other healthcare stakeholders.
Our full blog series, COVID-19 tool kit and other resources to help navigate the current and future healthcare landscape can be found on our website at HMS Health Ideas.