Population health management is high on the health agenda with good reason. Its potential to help inform preventative, sustainable care is huge. But how best to harness this potential and make early, tangible progress, is less obvious. Helen Seth, director of business intelligence and provider management at NHS Arden & Greater East Midlands CSU looks at the issues.
Moving business intelligence services away from traditional, transactional performance management activities to a much broader approach that can support integrated care is not simply about new tools, the latest technology, or a tweak to current processes. Population health management (PHM) has significant implications for all of us, whether we’re analysing and interpreting the data, or acting on its insights. So how do we rise to the challenge?
What is population health management?
In brief, PHM refers to the bringing together of health and care related data to identify similar populations by the care they need and how often they are likely to require it. This information can be used to help inform decision making around those interventions that are most likely to improve physical and mental health outcomes through an increased focus on prevention.
To achieve this requires analytical skills that can support a whole spectrum of analyses including descriptive, prescriptive and predictive and calls for a broad skill set of data science, mathematics, health economics and public health. The result? A much richer understanding of the wider determinants of health and their potential (and actual) impact on disease burden. The benefits? Robust evidence to inform reactive and proactive intervention and a better understanding of likely short, medium and longer-term impact.
Early progress has been made by linking health and social care data to inform commissioning decisions but there is real scope to go further, faster, for example by overlaying housing data and/or wider social-economic data. This would not only help all stakeholders associated with emerging integrated care systems (ICS) but communities themselves to own and take action to prevent illness and the social isolation often associated with some of the most vulnerable. This is already starting to happen elsewhere. To illustrate, in Bremen, Germany, Deutsche Post has implemented a befriending scheme that means that when the local postman delivers post to someone identified as socially isolated, they knock on the door and check they are okay.
So, what is standing in the way of progress? In my view, it is the complex interplay of people, process and technology, with people holding the most pivotal role.
Leading a revolution
First and foremost, we must recognise the shift to PHM for what it is – a highly complex, programme of change. Tools and technology play a role, but success starts with effective, leadership. An adaptive leadership approach which can build trust, show empathy and nurture risk appetite within complex working environments will be critical to success in supporting and empowering teams to approach problem solving differently.
PHM isn’t a ‘quick fix’ and change will not happen overnight. It will require a cultural shift in how we address current and future analytics capacity and capability. There will also need to be an appetite to broaden skill sets and work differently with academic institutions and commercial organisations to ensure PHM as an approach can be embedded. This not only means supporting today’s leaders but nurturing tomorrow’s so that we can make an active contribution to ICS development moving forward.
Whatever our ambitions, robust information governance, clarity on the legal basis for secondary use of data and assurance around appropriate agreements are of paramount importance. As ICSs are established and primary care networks (PCNs) evolve, this complexity will be increased and will require very close management.
At NHS Arden & GEM CSU we are increasingly supporting emerging partnerships at STP, ICS and PCN level, advising on the procedures to be followed to ensure the right governance is in place across partnerships and people know who is responsible for what. It’s not straightforward, but it is possible. By embracing and overcoming these challenges, we will be able to build a more complete picture of health and care needs and plan services accordingly.
Making it work
Delivering large scale change in the NHS is never easy, particularly when you’re looking to integrate what has traditionally been a highly fragmented system. And we’re not just talking about the NHS. Ultimately, we want a complete picture including community, third sector and social care data so that together we can radically improve how services are commissioned and how integrated care is delivered in the short, medium and long term.
The tools and technology to support population health are developing at pace. As NHS professionals, the focus is now on us as leaders to work together, build trust and draw on our respective strengths to support this exciting shift towards preventative care. The question is, are we up for the challenge?
Helen Seth is director of business intelligence and provider management at NHS Arden & Greater East Midlands CSU. Follow them on Twitter @ardengem