The healthcare industry is on the verge of a radical transformation led by advances in precision health and genomics, the science which looks at how an understanding of human genetics can apply to the development of innovative treatment solutions for a variety of diseases, particularly cancer, but also ailments like heart conditions and diabetes. Genomic research and Genome Technology are expected to seriously disrupt the current delivery models for public health, replacing the one-size-fits-all approach with more personal approaches to treatment based on the Genomic DNA sequencing of an individual.
Key to understanding this revolution is the concept of Population Health Management and its practical application at both a macro and a micro-level.
While the concept of population health lacks a precise definition, it is widely accepted as referring to the healthcare outcomes of a population and the distribution of those outcomes within it. Whilst populations are often thought of in geographic terms, population health can also refer to particular groups or cross-sections of society – employees, ethnic groups, the disabled, or senior citizens, for example. The population health outcomes of these groups are relevant for government policymakers and healthcare organizations, to name but a few.
Population Health Sciences combine expertise in primary care medicine, social and behavioral science, biostatistics, clinical research studies, epidemiology, disease control and prevention, and public health.
Organizations like CDC (Centers for Disease Control and Prevention) work with government programs, federal agencies, state health departments and a range of external partners to identify, evaluate, and implement practices based on evidence-based genomics to prevent and control major chronic, infectious, environmental and occupational diseases in the USA.
There has been some blurring of the lines between what is meant by public and population health, and, for some, the distinction remains a divisive one. Whilst some may define public health in the broadest sense as the “health of the public,” in reality, the level of care and resources that governments can provide is not even sufficient to deal with day-to-day clinical care and treatment, let alone address wider determinants like levels of income, education, and the health care system itself. These belong more fully to the purview of population health.
Population Health Management is using data collected from defined segments or groups of the population – such as the elderly – and analyzing it in order to manage specific diseases within that group, thereby standardizing the clinical approach, improving health outcomes, and driven cost the overall cost of health management.
The long-term key to success with Population Health Management solutions is getting patients themselves to engage and begin to accept responsibility for their own care management and health screening. This means not waiting until they are ill, or when they have a disease, but identifying how they live now might be harmful to their long-term health, and adjusting their behaviors accordingly – by eliminating junk food from their diet, or cutting down their alcohol consumption, for example.
In practical terms, it may mean patients should be willing to take a genetic test in their own home, and sending a blood or saliva sample to one of the genetic testing labs that have sprung up around the country where their genome sequencing can be accomplished. Based on their genetic make-up, predilection to certain diseases or illnesses can be determined, and appropriate health regimes discussed with their primary physician to mitigate the long-term effects.
Like many health improvement models, Population Health outcomes have two broad goals – to improve the overall health of a population and to eliminate or reduce disparities within it. In simple terms, improving the overall health of the population means increasing the average lifespan and the quality of those years of life. Eliminating or reducing disparities means breaking down the population into sub-categories, such as race or ethnicity, gender, geography, genetics or socio-economic class, looking at population health trends within that group, and designing specific medical programs to address certain health issues.
Another concept that is gaining increasing currency when it comes to health management is Precision Health, which looks at differences in people’s genes, environment, and lifestyle, in order to select suitable medical treatment for them, such as immunotherapy for cancer patients. The data from Genomic research is an important determinant of Precision Health.
While there are those who believe that Population Health and Precision Health are two totally opposite concepts – one is concerned with the health of an entire population, whist precision medicine is focused on individuals within that mass, in reality, they are complementary.
That is because precision health is able to help identify small segments of a population that may be at risk of a rare disease, or who might need education and additional screening so that they are not at increased risk of chronic or fatal disease. Smokers, and workers in hazardous industries like petrochemicals, are two such examples.
Genomics is the study of a person’s entire genes (the genome), including the interaction of genes with each other and with environmental stimulus. Applying genomics to population health initiatives has the potential to improve the understanding of diseases amongst medical professionals and healthcare administrators, improve public health in general, and reduce health disparities. It is also likely to promote an interest in genomic research and the benefits of a genetic test, not only amongst Population Health Organisations but within society at large.
The main goal of Population Health is to enable health services to be delivered to patients in a transparent and systematic fashion, so as to improve the overall health of the population.
It aims to shift the emphasis from the expensive treatment of existing diseases and conditions to programs and initiatives focused on concepts like wellness and self-sufficiency, to try and prevent or minimize the occurrence of illnesses occurring in the first place.
It requires a re-purposing of health care systems so that they move away from a hospital-based model based on acute care to a more holistic approach that emphasizes prevention, and engages the patients themselves for better disease management and prevention. The money will be redirected into systems away from emergency care beds to long-term care programs, rehabilitation, and public health initiatives. The investment will also be required by Healthcare Organizations into more Precision Health Testing and into Genome Research in general.
Meanwhile, at the individual patient level, precision medicine can then be applied to improve long-term health outcomes.
Value-based care is a delivery model whereby doctors and health care providers are based on the health care outcomes of patients. They are rewarded for helping patients improve their own health, and reduce their exposure and risk to chronic disease, adopting the philosophy that prevention is better than a cure. This approach differs from the traditional fee-based service model where healthcare providers are paid for the services they deliver. In other words, quality is emphasized over quantity.
With medical costs increasing, Centers for Medicare and Medicaid Services (CMS) population health programs aimed at limiting spending, and redirecting where, in the patient lifecycle, money is spent, are becoming increasingly prevalent.
Value-based care and Population Health actually go hand-in-hand. Using data gathered from Genome Sequencing and Precision Health Testing, as well as patients themselves, enables population health trends to be evaluated over time, and suitable programs devised to improve the health of particular segments. And, combined with Precision Medicine which is focused at the individual level, helps improve patient outcomes at both the personal and the overall level.
Value-based care and population health are, thereby, inextricably linked. CMS population health initiatives, for example, have been aimed at cancer patients, chronically ill children, and programs to reduce the number of surgical injuries in US hospitals.
With healthcare organizations increasingly adopting the Value-based care model, they are looking to Population Health Analytics Companies to help them supply direct care to patient populations. They have varied roles, but their principal responsibilities include data aggregation and analysis, administration and financial reporting, the design of tools to foster patient engagement, and similarly with clinicians.
There are a number of Population Health Analytics Vendors on the market – and, because it is a rapidly growing market, new population health start-ups are appearing every day – so there is an increasing choice from which healthcare providers can choose.
Services provided by these vendors range from Population Health IT (increasingly using AI Population Health algorithms)
However, based on various independent studies that have been produced, the following companies consistently are rated highly:
Whilst Population Health as a concept is an important driver of health care system reform, one barrier to its more widespread acceptance has been its broad scope and definition. To clarify some of this ambiguity, therefore, it would be appropriate to state that population health trends and programs are focused on wellness and good health, as opposed to illness. It involves an orientation at the population rather than the individual level, understanding the needs and solutions through engaging with the community, and addressing health disparities in vulnerable and at-risk groups. Partnerships can then be formed with healthcare organizations, and clinicians to take corrective actions.
Population Health Sciences have an increasingly important role to play as public health systems struggle to cope with the burden of an increasingly aging population, and the prevalence of diseases such as heart conditions, cancer, diabetes, and the medical conditions associated with obesity. The ability to analyze the health of a particular group or sections of society means it is now possible to produce a more targeted range of solutions and treatments than ever before.
Population health initiatives can save lives because they can identify those most at risk and encourage early intervention. And, at the same time, the adoption of value-based care and population health models is encouraging a switch from cure to early-stage prevention to improve individual health outcomes and reduce health care costs.
At the same time, there is a greater awareness amongst the public at large about health, and their personal responsibility for their own welfare and that of their families. People now know about DNA testing, and whilst they may not know – or even care – about the science behind Genome Research – there is a greater willingness to use a Precision Health Test home kit to take a sample of blood or saliva to take a Genetic Test and send them off to Genetic Testing Labs.
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