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How Population Health and Care Quality Relate

David Nash, MD, MBA, launched the second annual Health Care Quality Congress 2019 with his session entitled, “Population Health and Quality: Two Peas in a Pod,” where he discussed how managing population health can help improve health care quality. He first asked attendees, “How did we get into this mess and where do we go from here?”

Dr Nash began by explaining the issues currently facing health care including its need to reallocate and the many tough decisions it faces. He then explained that the conceptual framework of population health is influenced by health outcomes, health determinants and policies, and interventions. Among health outcomes and their distribution within a population, morbidity, mortality, and quality of life of a patient are impacted. 

Noting that health care waste comes in three categories: behavioral, operational, and clinical, Dr Nash said that out of roughly $3 trillion of spending, there is $1 trillion in waste.

“Opportunities to eliminate wasteful spending in health care add up to $1.2 trillion of the annual $2.2 trillion spent nationally. When we reduce error, we reduce waste,” he stressed.

Dr Nash noted that the definition of population health varies in that the original definition encompassed health outcomes and their distribution within a population but it also focused on health determinants that influence distribution impacting medical care, socioeconomic status, and genetics, and policies and interventions that impact social, environmental, and individuals’ determinants.

Further, according to Dr Nash, health determinants that influence distribution—including smoking, unhealthy diet, physical inactivity, and alcohol, which account for roughly 40% of all deaths—impact medical care, socioeconomics, and genetics. Finally, policies and interventions that impact health determinants impact social, environmental, and individual aspects of a patient.   

According to Dr Nash, the US currently spends 2% of health care spending on population health. He explained, however, that chronic disease, which equals 80% of total disease burden, has no dedicated federal funding stream. 

He explained that the major themes moving forward should include transparency, accountability, and “no outcome, no income.”

Dr Nash said in order to meet these themes, the health care system must change the culture. He explained that this is a multistep process that includes practice-based evidence, reducing unexplained clinical variations and slavish adherence to professional autonomy; continuously measuring and closing feedback loops, and engaging with patients across the continuum of care.  

Dr Nash ended the session with a quote from John P Kotter from Harvard Business School: “The institutionalization of leadership training is one of the key attributes of good leadership.” In response to this quote, Dr Nash translated it into his own words saying: “One of the obligations of the leaders of today, is the training of the leaders of tomorrow, and that’s what you and I are doing here today, tomorrow, and the day after.” —Julie Gould

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