Are You Misusing The Term "Population Health?"

Based on the latest study findings, there are plenty of ways to mistakenly use the term "population health."

While the words are perhaps two of the most-spoken among leaders in the past year, the exact meaning of the phrase is unclear.

For instance, back in 2003, David Kindig, MD, PhD, a population health thought leader, wrote that the term was being more widely used "but often without clarification of its meaning and definition," according to the study. He said increased use of "population health" without a precise meaning could "render the term more confusing than helpful."

More than a decade later, it seems the healthcare industry — and accountable care organizations, specifically — are facing the same challenge. A qualitative interview study led by a researcher from New York City-based Weill Cornell Medical College found many people who work in ACOs and public health agencies view the terms population health, public health and community health as the same or similar.

"For a few [interviewees] it appeared to be the case that they had not distinguished between the three phrases before, and reactions during the interviews varied from intrigue to bemusement," according to the study via BMJ.

The findings are based on 39 interviews total, 29 with Medicare ACOs and 10 with public health agencies. The median interview time was 32 minutes. Below are the most common perceptions for each of the three terms.

Population health
People working for ACOs most commonly defined or referred to "population health" as a defined group of patients. Sometimes these were directly described as the ACOs' "attributed" patients or those for whom the organization was at risk for financially, and sometimes as the ACO host organization's patients more generally.

The second most common perception of the phrase "population health" was that it referred to all the people living in a geographical area. Researchers found this view to be more common among interviewees from public health agencies.

Public health
The most common view of "public health" was as something that is delivered by the government, such as a health department at the county or state level, according to the study. The view of public health as communicable disease control, or health promotion and prevention, was also commonly expressed.

Community health
On a related note, the term "community health" was most commonly viewed as referring to the local or neighborhood level, often implicitly referring to health in the context of small geographical areas.

As one ACO executive said:

"Community health, I think, is closely allied with both of those [population health and public health] but it's taking it down a level, I think, and it's looking at a particular community or neighborhood or geographic area and looking at ways to improve the health of that community."

Study authors said that, a decade later, "another warning should be sounded about the use of the phrase 'population health' by ACOs and the healthcare delivery system more widely." Use of the phrase "population health" to refer to a defined group of patients is misleading, though well intentioned, they wrote. The misuse could divert attention from the social determinants of health within geographical areas and to the resources and measures needed to improve the health of a geographical population.

"It could be useful if people working in ACOs and other healthcare delivery systems had a more accurate term to refer to what they are trying to do," the study authors concluded. "Perhaps they could use the phrase 'population of attributed patients' when discussing the health of their ACO patients. The phrase 'population health' could be reserved for uses that relate to the health of the population in a geographical area." This would help distinguish the two ideas but let staff know there may be overlap.

More Articles on Population Health:
5 Enablers for Population Health Management
5 Myths Surrounding the Business of Population Health Management
Health System C-Suiters, Meet the Chief Population Health Officer


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