This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
In just a year and a half, the 2020 presidential election will be upon us. And as with every campaign so far this millennium, health care is sure to be a hot topic once again.
Ever-rising costs, elusive accessibility and the future of the Affordable Care Act are sure-to-be-debated health care issues. But a too-often overlooked problem is a pragmatic one: Why aren’t we getting an acceptable bang for our health care buck?
The United States spends more on health care than the rest of the top 11 industrialized countries, yet we come in at no. 11—dead last—in meaningful health outcomes, such as life expectancy. This despite spending more money per capita on health care than any other nation.
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And sadly, that result is typical for us; the U.S. has finished 11 out of 11 in meaningful health outcomes every year since 2004.
You might ask how we can we spend so much on health care but still do so poorly. It’s a fair—and troubling—question.
I believe part of the answer is that we’re not proactive enough in U.S. health care. One way we can correct that is to more uniformly adopt the proactive approach embodied in population health.
Social Determinants Matter
Population health is a model for improving patient care quality and experiences while reducing costs. It focuses on all the determinants of health, including the social determinants, and the need to better address prevention and other external factors. These “determinants” include access to food, financial security, safe housing, transportation, education, access to adequate behavioral health support, and necessary assistance to counter adverse childhood events.
Think about the last time you visited a health care facility. Were any of the determinants above addressed during your exam, consultation or procedure? Hopefully yes, but we don’t uniformly address these as often as would be beneficial. A population health framework is promising because it encourages all stakeholders to look at the conditions into which people are born, grow, live, work and age, and determine how changes can be made within vital areas to improve their future health outcomes.
Here’s how a population health approach can make a difference:
I once witnessed the care of a patient who suffered from chronic obstructive pulmonary disease, which blocks airflow to lungs and makes it difficult to breathe. Over the course of a particularly hot Texas summer, he was admitted to the hospital time and time again—racking up more than $60,000 in medical expenses. Doctors were treating his breathing problems repeatedly, but they did not understand why the patient continued to have trouble.
One population health–oriented physician dug a bit deeper, holding in-depth conversations about the patient in the hospital—and later, having a team member visit his home. There, it was discovered that he lived without an air conditioner. A caring individual purchased and installed a $400 air conditioner for him, and his hospital visits stopped.
In essence, $60,000 in treatment costs could have been avoided almost entirely if the social determinant of his health issue—the lack of air conditioning—was pursued and discovered earlier.
More Attention to Prevention
And therein lies the problem. In the U.S., we treat health issues that arise. But we don’t spend much time trying to prevent them.
The U.S. health care system is designed to follow a transactional model that emphasizes excellence in highly complex and interventional care. This means if you’re in need of treatment for cancer or a heart transplant, the U.S. health care system is the place for you. Nobody does “hard” cases better.
However, when it comes to delivering less complex, “block-and-tackle” care, which accounts for up to 90 percent of the care in this country, our health care system is not as consistently excellent. And what we are lacking seems, on the surface, to be so simple—such as immunizations, promoting good nutrition and physical activity, and supporting active engagement for health outcomes.
With respect to active engagement, our new population health approach at Cleveland Clinic has us striving to move beyond “reactive” care. Rather than just simply addressing individual patients’ needs on a visit-by-visit basis, our Community Care program is leveraging a wealth of data and an expanded care team to proactively address the health needs of populations. That means if we haven’t heard from a patient in a while, we will—with their preauthorized consent—reach out to them to discuss their current health status and determine appropriate care steps, if any.
Population health principles require health care providers to consider how social circumstances drive patient behaviors and outcomes. We have to think about our patients’ lives outside of medical facilities, including their ability to afford medication and access nutritious food, and whether they have reliable transportation to and from their medical appointments and pharmacies.
By examining the factors outside of the hospital or the primary care office, health care stakeholders can more readily address all factors that are responsible for negative health outcomes, and in turn build a health system that responds to those conditions in a holistic manner.
That’s an approach that should get everyone’s vote.