†On November 13, 2014, Gregg S. Meyer, MD, MSc, Chief Clinical Officer of Partners HealthCare System, gave the annual David Blumenthal Lecture at the Department of Medicine Grand Rounds, Massachusetts General Hospital. His talk, “Population Health 3.0,” began by remembering Dr. Blumenthal’s prediction in a 1991 New England Journal of Medicine Sounding Board that U.S. health care reform would only happen after costs rose to 15% of our national wealth. Dr. Meyer noted that in 2012 health care costs rose to 17.2% of the U.S. gross domestic product; however, we do not see improvement in U.S. population health for those massive expenditures. Clearly, the time for reform is now.
Before considering how U.S. health care should change in the future, Dr. Meyer reviewed lessons from prior attempts at “reform.” Tightly managed care, where access to physicians was strictly controlled, was soundly rejected by the public 20 years ago. Subsequent efforts to engage patients in their own care management and linking them with care providers through information technology have not stemmed the growth in costs or improved population health. The next phase in population health management and improvement will require promoting wellness and preventing chronic conditions.
Dr. Meyer then discussed each of four opportunities to improve population health: better care coordination; engaging populations who are not currently linked to longitudinal health care delivery; improving end of life care planning and services; and reintegration of behavioral health and oral health with primary care. While there is no perfect formula to pay for this set of services, Dr. Meyer said, it is clear that providing high quality patient centered care appropriately and efficiently wins. So the challenge is how to provide and finance great care. Furthermore, factors that historically have been viewed as outside the purview of health care providers – the social determinants of health – must now be considered thoughtfully.
To make these points, Dr. Meyer described a series of initiatives that have successfully been implemented to improve population health in communities around the country. For example, the Respecting Choices ACP (Advanced Care Planning) Program at the Gundersen Health Systems in Wisconsin is a community wide program that helps individuals, families, and health care practitioners plan for end of life care. This has increased respect for patients’ end of life care preferences and has decreased futile life-saving efforts. In Seattle, the Walkable and Bikable Communities (WBC) project has supported construction of walking and biking paths; subsequently, Seattle residents demonstrated significant improvement in both their physical activity and mental health, with a reduction of depressive symptoms. Dartmouth Hitchcock leaders were shocked to learn public perceptions that their staff was overweight; this caused considerable introspection about improving employee health. The organization banned sugary drinks and eliminated fried foods in its cafeteria. Dartmouth Hitchcock estimates that these bans eliminated 4.7 million calories, which translates into almost 1,400 pounds of body weight.
Dr. Meyer ended his talk by assuring the audience that while health care cost escalation is of great concern, things could be worse. Increases in the consumer price index for college tuitions and new home prices ha <more...>