Improve Population Health

Dec 26, 2011, 1:00 PM, Posted by David Kindig

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by David A. Kindig, MD, PhD, co-director, RWJF Health & Society Scholars program at University of Wisconsin-Madison and emeritus professor of population health sciences, UW-Madison School of Medicine and Public Health.

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From a population health perspective, my first reaction was… why is the question about health care resolutions? Since it is not the major determinant of health, shouldn’t our attention be elsewhere?

On reflection, however, I do have several wishes for the New Year in the health care domain, which is, of course, one—if not the primary—determinant of health.

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1. Continue Don Berwick’s [former Director of the Center for Medicare and Medicaid Services, or CMS] aggressive attack on the 30 percent waste in the health care system. Thirty percent of $2 trillion is a lot of money, and could go a long way if deployed for the other determinants of health.

2. Continue to push Triple Aim advocates to fully embrace the third aim of population health improvement. It is often an afterthought or imperfectly conceptualized with all the emphasis on the Double Aims of cost and quality. Continue to support the beginning work of the Population Health group in the CMS Innovation Center to develop and incentivize these ideas further, with particular emphasis on the metrics for monitoring progress in the Third Aim.

3. Find ways to redirect part of the savings from health care waste into population health improvement.

Public and private grants aren’t adequate; what is needed is dependable forever revenue streams. Promising opportunities are a community share of Accountable Care Organization shared savings as well as reform of IRS Community Benefit regulations as the number of uninsured falls.

4. Develop robust models in which health care organizations can work with other private and public partners for local multisectoral population health improvement policy and funding. Insist that the federal National Prevention Council take leadership in showing how such health in all collaboration might work at the Federal level, including the federal healthcare delivery and financing components.

Health care isn’t the main determinant of health but it enjoys privileged financial and social status. As Mt. Sinai CEO Kenneth Davis said in the November 22 New York Times, “improving population health and reducing hospitalizations are everyone’s goals, but hospitals can only provide part of the solution. In order to lower costs, we need to invest in social support services outside of our health care institutions. By doing so we will improve the nation's health and meaningfully bend the health care cost curve.”

Let’s see much more concrete population health leadership from health care organizations in 2012.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.