To fulfil the potential of population health management, the NHS needs to rethink its structures

The recent Big data, big change: Using patient data for population health management event held by the Royal Society of Medicine was a great opportunity to participate in discussion about variation in healthcare outcomes and the role of data in setting local health priorities and in improving outcomes.

At Dr Foster, we devote an increasing amount of time and resources to population health management. By identifying trends and characteristics that indicate a patient should be managed as part of a cohort for a given condition, we can proactively prevent illness, allocate resources more effectively, and improve operational efficiency. But for this vision to become a reality, there are barriers to overcome.

In his keynote presentation ‘The vision for population health – The NHS long term plan’, Professor Sir Muir Gray, founding director of the Oxford Centre for Triple Value Healthcare, said that defining the optimum allocation of resources is at the heart of the local integrated care challenge. He pointed out that if population health management is to succeed in supporting local organisations to be more effective, the NHS will need to rethink the way it is structured.

The traditional, linear structures do not lend themselves to the network-style thinking of this technological era – setting up more agile networks could, Sir Muir said, be of enormous value when it comes to outlining local healthcare priorities.

Sir Muir told the audience that healthcare systems need to focus on placing the family or individual at the centre of planning, rather than the knowledge owner, or medical provider. This idea forms the ethos of population health in the NHS Long Term Plan, similarly, viewing it as an enabler of integrated care.

Sir Muir also highlighted diminishing marginal benefit for health and social care. There is a point (point of optimality) where benefit minus harm reaches its highest point and then after that it starts to decrease. He asked the audience to discuss examples in healthcare and medicine where there has been overuse such as chemotherapy and specific drugs such as statins and opioids.

A further challenge is that it is unclear who is responsible for allocative efficiency in an Integrated Care System (ICS). Perhaps, then, it would be beneficial to have a system-level role that is separate from budget and politics, solely engaged in bringing together multi-disciplinary teams and citizens to make local decisions on the allocation of resources.

Sir Muir listed five core outcomes that need to be achieved as part of population health:

1. A culture of stewardship, with a governance process that promotes collective responsibility
2. Agreed definition of population sub-groups with a common need and optimal allocation of resources
3. A value framework for the system for each population sub-group
4. Development of networks to deliver the system
5. Each individual supported to make decisions to optimise personal value

An example of how this can work in practice was cited by Dr Bob Klaber, Consultant Paediatrician and Director of Strategy and Imperial College Healthcare NHS Trust. He highlighted a project in North West London to help children with asthma access the right services based on their acuity. The starting point for the project was that only children with highest acuity should be referred to the high acuity service at Brompton. Children with lower acuity would see more relevant primary and community-based services.

The team used data analysis and knowledge transfer between multi-disciplinary teams such as pharmacists and community workers to create the Child Health GP Hubs Asthma Radar. This is a similar approach to some of the work Dr Foster is doing to identify patients who have not received optimal treatment – where these are gaps in care that the clinicians can act on.

The prospect of using population health management as a way to set local health population priorities and then use data to create actionable insight is exciting, but Sir Muir is right – for it to truly work the NHS needs to think about the structures and how these may require changing. If nothing changes, it could limit the ability of ICSs to deliver on the promise of proactive, person-centred care.

The prospect of using population health management as a way to set local health population priorities and then use data to create actionable insight is exciting, but Sir Muir is right – for it to truly work the NHS needs to think about the structures and how these may require changing. If nothing changes, it could limit the ability of ICSs to deliver on the promise of proactive, person-centred care.

You can find out more information about Dr Foster’s work in population health management service here.