Heavy re­liance on data, part­ner­ships essen­tial to im­prov­ing pop­u­la­tion health

Modern Healthcare - - GUEST EXPERT - By Dr. Roy Bev­eridge and Dr. An­drew Renda

From the dis­cov­ery of an­tibi­otics to the grow­ing field of ge­nomics, con­stant break­throughs have re­shaped medicine. De­spite our ad­vances, we are caught in the re­volv­ing door of re­ac­tive medicine’s fo­cus on treat­ing acute ill­ness in­stead of a proac­tive ap­proach pro­mot­ing prevention and health.

We’ve be­gun to change our per­spec­tive, from a pri­mary fo­cus on treat­ing dis­ease to one that looks be­yond the doc­tor’s of­fice to the so­cial de­ter­mi­nants of health in com­mu­ni­ties we serve.

For ex­am­ple, in 2015 roughly 16.1 mil­lion Amer­i­can adults ex­pe­ri­enced de­pres­sion, and 15.8 mil­lion house­holds strug­gled to get enough to eat. The cost bur­den of these so­cial de­ter­mi­nants of health on the U.S. health­care sys­tem is equally im­por­tant. In 2014 alone, roughly $160 bil­lion was spent on di­rect and in­di­rect health-re­lated costs re­lated to food in­se­cu­rity and hunger in the U.S.

Faced with these is­sues, it is dif­fi­cult for many peo­ple to get healthy and stay healthy. We must broaden our per­spec­tive on the clin­i­cal care model to solve for these so­cial, psy­cho­log­i­cal and eco­nomic is­sues in­flu­enc­ing health and well-be­ing.

The new fron­tier of medicine in­cludes both prevention and treat­ment of chronic con­di­tions, with a fo­cus on long-term out­comes. Ad­dress­ing these so­cial de­ter­mi­nants will be­come a pre­req­ui­site for suc­cess­fully prac­tic­ing value-based care. The ques­tion: how do we pre­pare for this fu­ture?

In 2014, Hu­mana de­clared a Bold Goal ini­tia­tive—to im­prove the health of the com­mu­ni­ties we serve 20% by the year 2020. To track our progress, we use the Cen­ters for Dis­ease Con­trol and Prevention’s Healthy Days sur­vey tool to mea­sure an in­di­vid­ual’s men­tal and phys­i­cal “Un­healthy Days” in a 30-day pe­riod.

Our 2017 Bold Goal re­port shows that from 2015 to 2016 we had a 3% im­prove­ment in Healthy Days across our Bold Goal com­mu­ni­ties. San An­to­nio, our most ma­ture com­mu­nity, saw a sig­nif­i­cant 9% in­crease in Healthy Days, sur­pass­ing the 2017 im­prove­ment tra­jec­tory goal.

The CDC has mea­sured Healthy Days for more than 20 years. In that time, the na­tional trend line has re­mained rel­a­tively con­stant, show­ing a slight up­ward trend in re­cent years. With our large sam­ple size and ap­pli­ca­tion of val­i­dated sta­tis­ti­cal meth­ods, com­bined with our strate­gic work and physi­cian and com­mu­nity or­ga­ni­za­tion part­ner­ships, we ex­pect to see con­tin­ued im­prove­ments in Healthy Days.

To achieve our goals, we use a com­bi­na­tion of clin­i­cal and phar­ma­ceu­ti­cal data, sur­vey-based Healthy Days re­sponses, and Robert Wood John­son Foun­da­tion data on so­cial de­ter­mi­nants of health. Equipped with this knowl­edge, we gain a deeper un­der- stand­ing about per­ceived health, chronic con­di­tions and the bar­ri­ers to health such as food in­se­cu­rity, phys­i­cal in­ac­tiv­ity and so­cial iso­la­tion.

Com­mu­nity health is in­cred­i­bly com­plex, but an ef­fec­tive so­lu­tion boils down to a sim­ple for­mula: match­ing the in­ter­ven­tion to the pop­u­la­tion. Un­der­stand­ing all the el­e­ments and how they work in uni­son re­quires in­sight that is only pos­si­ble by lever­ag­ing all avail­able data and con­nect­ing com­mu­nity needs with a di­verse set of lo­cal and na­tional part­ners. Then, it’s about set­ting goals to meet those needs.

These in­sights are fur­ther lo­cal­ized by work­ing with physi­cians and other clin­i­cians, as well as not­for-profit, for-profit and faith-based or­ga­ni­za­tions in our com­mu­ni­ties. An­a­lyzed in ag­gre­gate, this data has en­abled our team to pin­point the most sig­nif­i­cant so­cial de­ter­mi­nants of health that are pre­vent­ing our mem­bers from ex­pe­ri­enc­ing more Healthy Days. We have iden­ti­fied food in­se­cu­rity, so­cial iso­la­tion and lone­li­ness as op­por­tu­ni­ties to cre­ate more Healthy Days and have acted ac­cord­ingly.

We re­al­ize it takes time to as­sem­ble the mov­ing parts re­quired to ad­vance com­mu­nity health and have an im­pact. It’s also re­quires that or­ga­ni­za­tions span­ning lo­cal gov­ern­ments, academia, so­cial ser­vices, clin­i­cal care and oth­ers work to­gether to ad­dress so­cial de­ter­mi­nants.

Pop­u­la­tion health takes a sus­tained com­mit­ment from all of us to help peo­ple live health­ier lives, both phys­i­cally and men­tally.

Dr. Roy Bev­eridge, left, is chief med­i­cal of­fi­cer at Hu­mana and Dr. An­drew Renda is di­rec­tor of its Bold Goal pro­gram.

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