Population health for the 21st century

Source: NHE July/August 2018

NHS Partners Network (NHSPN) chief executive David Hare discusses the themes covered at his organisation’s Confed18 panel debate on population health management and integrated care. 

Population health management and integrated care was the key theme at this year’s Confed18 in Manchester, with no fewer than nine events looking at this issue over two days. It’s the issue of the day for the NHS, and there wasn’t a spare seat to be had at the NHSPN’s session, ‘Supporting the NHS with population health management and integrated care.’ 

But what sort of support does the NHS need to make sure that patients can benefit from effective population health management?  

NHS England’s ‘Five Year Forward View Next Steps’ document set out a clear objective for the NHS to “deploy, or partner with third-party experts, to access rigorous and validated population health management capabilities that improve prevention, enhance patient activation and supported self-management for long-term conditions, manage avoidable demand, and reduce unwarranted variation.” Or in simple terms: targeting the ‘right patient’ in the ‘right way’ at the ‘right time.’

The concept of population health management is still in its infancy in the NHS and represents a real step change in the culture and practice of how healthcare is organised, not least at a time when the NHS is facing significant funding pressures and workforce shortages. 

NHSPN therefore asked a panel of experts to shed some light on this, including Optum’s Dr Martin McShane; Centene’s Jonathan Lewis; Dr Stephen Shortt from Nottinghamshire Integrated Care System; NHS England’s director of national system transformation, Jacquie White; and the Nuffield Trust’s CEO Nigel Edwards, with three key themes emerging from the session. 

First, the issue of integrated care is not without controversy, and much of the public debate has centred around fears that accountable or integrated care will mean a change to core NHS values. We know this isn’t true, and the Health Select Committee recently stated clearly that integrated care is certainly not a vehicle for NHS privatisation.

However, as Jacquie White pointed out, having one simple definition of population health management which is clearly understood will go a significant way in reducing the public’s fear about what these changes really mean. 

Part of the challenge here is to keep patients at the heart of the discussion – ensuring that coordination of services helps meet people’s needs and does not result in large, unresponsive provider monopolies. The Nuffield Trust’s Nigel Edwards made it clear at the event that competition and choice are not incompatible with integration, and we need to think harder about how to make choice and personalisation work in new models of care. 

Improving data analytics was another key theme. There is huge potential in using NHS data to work out where we can make the biggest difference in improving a local population’s health. This means tracking a population’s current health needs as well as future ones, and focusing on prevention wherever possible to facilitate greater prevention. Jonathan Lewis, from Centene, noted that turning the NHS into a health system in which everything is driven by patient data represents the biggest shift from our current ways of working.

However, there was also agreement from the panel that having the most sophisticated data systems in the world will only get you so far. The health service is made up of people, not 1s and 0s, and so bringing together clinicians and other health professionals to get behind change as the NHS moves towards more integrated care will be key. This is not a simple task, but as Dr Stephen Shortt said, the key to making change across health and care systems is by believing it is possible.

So what can we conclude from NHSPN’s session at Confed18? An open and diverse provider market which puts patients at the centre of care; an unwavering focus on collecting the best possible data; and the need to get clinicians and other health professionals on board to make any real and lasting change will all be crucial. 

Population health management isn’t a panacea and will not give you all the answers to improving your local population’s health needs. But as our panel reflected, what it will do is tell you what questions to ask. 


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