Whatever happened to Population Health Management?

Posted : April 16, 2024 -

5 minute read by

Jane Johnston, Independent Health & Care Data and Analytics Consultant. Executive Director for Membership Services, AphA

David Howell, Joint Director for Strategic Insight and Analytics, NHS Surrey Heartlands ICS.  Director, Quantum Analytica

Population health management (PHM) improves population health through data-driven planning and the delivery of proactive care to optimise health outcomes. It is essentially about:

– moving from a largely reactive system (that is responding when someone becomes unwell)

– to a much more proactive system (that is focusing on interventions to prevent illness, reduce the risk of hospitalisation, and address inequalities in the provision of healthcare)

These words have been taken from NHS England’s own good practice guidelines as the gold standard for systems to work towards in their integration, and equity of health and care, thus improving the health and wellbeing of our citizens.

PHM does not just consider health, it also considers the wider determinant factors of health such as deprivation, education, employment, housing, isolation, air quality, access to open spaces, to name but a few.

PHM is not a new concept.  In 1879, George Cadbury created the village of Bourneville as he was appalled at working class living conditions and wanted to provide decent housing for his workers.  Loyal and hard-working workers were treated with great respect and relatively high wages and good working conditions; recreational facilities and access to open spaces.  Cadbury also pioneered pension schemes, joint works committees and a full staff medical service.  Cadbury understood the difference wider determinants and equity make to health and wellbeing.

Nearly 100 years later, in August 1980, the United Kingdom Department of Health and Social Security published the Report of the Working Group on Inequalities in Health, also known as the Black Report.  This Report showed in great detail the extent of which ill-health and death are unequally distributed among the population of Britain, and suggested that these inequalities have been widening rather than diminishing since the establishment of the National Health Service in 1948. The Report concluded that these inequalities were not mainly attributable to failings in the NHS, but rather to many other social inequalities influencing health: income, education, housing, diet, employment, and conditions of work. In consequence, the Report recommended a wide strategy of social policy measures to combat inequalities in health.

Skip forward 40 years to the 2020/21 Operational planning guidance, and every annual planning guidance published thereafter right up to the 2024/25 guidance published at the end of March.  They all comment on the necessity for systems to work together to deliver effective PHM, the premise being this approach is the way forward by using advanced and predictive analytics to deliver transformation, tackling inequalities and taking preventative approaches, providing a model health and care system.  Afterall, the NHS wants to lead the world in health data and analytics, and the June 2022 strategy Data Saves Lives; Reshaping health and social care with data evidenced that if we unlock the incredible power that our health and social care data possesses, we can bring the future forward, and make us all healthier and safer, as demonstrated in our approach to fighting coronavirus.

Given all the above, it is with increasing concern that not only are we witnessing the failure of systems to prioritise and increase funding in supporting the delivery of PHM, but some systems are actively disinvesting, a likely consequence of managing the short term cost management reductions.

The spring budget allocated £3.4 billion to be invested in digital and data, however all the central strategies and guidance published since then only refers to investment in digital. Without specific mention, data and analytics and ergo, PHM, have been missed out of the conversations.

A growing number of systems now have ‘PHM dashboards’.  Using a PHM lens, these dashboards have segmented and stratified the population for existing conditions, giving place based multi-disciplinary teams (MDT’s) a targeted list of patients for intervention and condition management.  This is the tertiary level of PHM that mainly helps systems focus on admission avoidance by managing known conditions and avoid exacerbation.

There is an alarming misconception by those that sign off how we target resource, especially that needed to advance our analytical and data science skills, that it means we have cracked PHM, so further investment is sidelined in favour of the more celebrated digital cousin.

Although these solutions are more targeted with an element of prediction, this is not the secondary and primary prevention levels that PHM aims to achieve through increased use of AI and improved data science and actuarial roles needed to drive forward a move to more predictive and prescriptive analytics. Furthermore, these systems lack any meaningful ability to evaluate outcomes and learn from what has worked well.

In some systems it is suggested that the GPs can deliver PHM, however there is huge pressure on the already understaffed primary care workforce.  Leaving PHM to GPs will lead to massive failure in delivery of predictive analytics because 1. They don’t have the time and 2. Their focus would be in their registered patients to plan condition management.

This won’t address the whole system pathway failings or provide the intelligence and insights the Integrated Care Boards (ICB’s) need to tell them where resource should to be directed, be it financial, workforce or estates, and in which healthcare sector such as primary or secondary, mental health, community or social care. This tertiary prevention level will not cover the financial modelling requirements, or work towards prediction and prevention in next 5 years, 10 years or 20 years from now.

The need for predictive modelling and a move towards prevention has been evidenced nationally and internationally and mooted by Health & Social Care as the way forward.  Huge amounts have been invested in the Federated Data Platform (FDP) which has assured support for the delivery of population health.  But whatever architecture or infrastructure we adopt, without the analysts and the development of the right skills to make sense of the data and provide the intelligence and insights to support evidence-based decision making, then PHM and the power it holds will fail.

All the investment in digital and tech, such as that afforded through the FDP, will give us no more than we already achieve through retrospective reporting and simple extrapolation.  We may have vastly more data, but no meaningful advancements made to get to the root of core problems affecting our populations.  We need system leaders to be educated in the importance and relevance of the analytical workforce, in order for systems to achieve transformational nirvana, which is highly achievable but without dedicated focus, likely improbable.