Population health and precision medicine have often been pitted against each other due to differences inherent in their approaches to health management, but the COVID-19 pandemic has shed a bright light on both, highlighting some potential intersections that may not have been so obvious in the past. In this article I’ll look at some of these connections, and some of the solutions we already have in healthcare IT to take advantage of the opportunities in it.
Defining population health and precision medicine
When President Barack Obama announced during his 2015 State of the Union address that the government was launching the Precision Medicine Initiative, a debate began about whether and how PM and Population Health Management could coexist in the American health system. Although there are countless definitions of both terms, the following provides a good starting point:
- Population Health Department refers to the process To improve clinical health outcomes for a defined group of individuals through improved care coordination and patient engagement supported by appropriate financial and care models.
- precision medicine About Matching appropriate medications or treatments For the right people, based on a genetic or molecular understanding of their disease. It is an approach to patient care based on the idea that one person’s illness is not necessarily exactly the same as that of another person who appears to have the same disease.
The problem we are looking at is rooted in the definitions above: Population Health Management seeks to improve the health of a specific group through patient engagement and better coordination of care, while precision medicine targets medications and treatments for individuals based on molecular and genetic aspects. You might expect the ending of the previous statement to be, “…and the twins will never meet,” but that may not be the case.
The broad and comprehensive public health approaches that have become necessary in trying to defeat the COVID-19 pandemic have reignited this debate, highlighting one of the intersections between the two: the social determinants of health. Social determinants of health have long been a major issue in managing population health, and the COVID-19 pandemic has exposed and exacerbated some of them, including the following:
- Large disparities in morbidity and mortality due to age, race, and wealth.
- Sudden food insecurity among large social and economic segments of the population with high rates of temporary and long-term unemployment.
- The widespread lack of broadband Internet access necessary to facilitate telehealth.
On this latter determinant, when non-urgent in-person care ceased and telehealth began to dominate, many elderly and poor people found themselves deprived of ongoing health care services due to a lack of broadband Internet access. The situation often exacerbated their chronic conditions. The online access issue will be a critical key moving forward as telehealth and healthcare analytics become more important for both health systems and consumers in managing population health.
Implications for health care
Soon after the emergence of the Precision Medicine Initiative, in a widely cited position gamma discussion article, Moeen Khoury and Dr. Sandro Gallia He noted where the conflicts and opportunities lie in the potential of precision medicine in population health: “Pitting the health of individuals over the health of the population threatens to widen the unnecessary gap between medicine and public health.
“Population health planning requires that the effective use of resources be directed toward the people most at risk. Stratification of the population into groups at risk for multiple chronic diseases can provide more efficient and effective prevention and treatment strategies and possibly reduce the cost of care.”
The authors also noted that precision medicine is not just about genetics, drugs, and diseases, commenting, “The same technologies and big data that drive precision medicine forward are ushering in a new era of precision public health that goes beyond the personalized treatment of individuals with disease.”
Prior to the emergence of the pandemic, a concept called “micro public health” had already developed and was loosely defined as “an emerging system that uses broad population-specific data to provide the right intervention to the right population at the right time.” Accurate Public Health Initiatives may become a bridge Between population health and precision medicine.
Accurate population health solutions
Population health is about population health, compiling data from thousands or even millions of people to provide an overall trend. Precision medicine is about you, the individual, how you react to certain drugs, your genetic code and a host of other personal data points. On the surface, healthcare analytics appears to be a comprehensive solution in both areas, because you collect data on populations and individuals to suggest courses of action.
Powerful healthcare analytics and information technology are integral to the high level of patient engagement and management needed to improve outcomes in dynamic population health management, but you need people to manage and operate it.
By focusing so much on analytics, the extent to which we involve individuals in their care is often overlooked. Analytics is the mechanism by which we engage the person, so you first want to decide how you want to engage the patient before using analytics to facilitate those interactions.
What do we say or do to engage these people to ensure their voices are heard? How do they feel about their experience with their service providers and the health systems they interact with? Is it easy for them to schedule care and communicate with their doctors?
Population health management is vital to the health of hospitals, health systems, and all service providers in a value-based, consumer-centric care environment, and to their relationships with the communities they serve. Providers can improve both population health and precision medicine by leveraging the patient experience — understanding the “who, what, why, and where” of a patient before moving on to the technology platform they use to enhance that experience.
Part of ensuring effective patient participation in population health and precision medicine is ensuring physician participation. Will the doctors feel satisfied and happy caring for these patients? This discussion of engaging clinicians continues in my next article, which addresses the process, healthcare information technology, and the roles of the process in solving one of the pressing challenges as we emerge from the pandemic – clinical burnout. Please stay tuned…
Sam Hanna Resident Executive Director and Associate Dean for Healthcare, Technology and Innovation Management at American University. As noted in the introduction to this series, All of the articles In this new series you will identify a problem, study the problem and its implications for healthcare, and then offer potential solutions.