Population Health MGMT 2

Population health management –
Plan of the lecture

1) Why are ageing and population health
management so closely related in the policy
debate?
2) Conflicting definitions of population health
(management)
3) Population health management and the «triple
aim» movement in the US
4) How to avoid the «triple fail» situations
5) Implementation problems of the «triple aim»
in the US
Health services research – Gianluca Fiorentini
Population health – References used
1) Kinding «What are we talking about when we

talk about Population health», Health Affairs
2015
2) Berwick et al. «The triple aim», Health
Affairs, 2008
3) Lewis et al. «How health systems could avert
triple fail events», Health Affairs, 2013
4) Whittington et al. «Pursuing the triple aim: 7
years later», Milbank Quarterly, 2015

Ageing and Population Health Mgmt
- The problems of sustainability are not due to
ageing alone, but to a lack of coherence in using
different policy tools (funding, organization,
regulation of professions, governance of R&D)
- Political and professional problems in defining
essential and appropriate care (fight against
«waste»)
- Acute care absorbs excessive resources with little
gains in terms of quality-adjusted life expectancy
- Inappropriate incentives and lack of organization
models in primary care to deal with chronic
illnesses (need for a pop health mgmt
Chronic Care and Population Health Mgmt
- Chronic patients require tailored models of care
and new expertise (research and education) to
cope with their specific needs (e.g. poly-
pharmacy)
- The financing and the organization of services
should rely more on vertically integrated models
linking primary, intermediate and secondary
care
- More emphasis is required on prevention
(primary and secondary) with more reliance on
self-care
- Need to avoid excessive medicalization (eg, is
Reforms and Population Health Mgmt
To implement this re-organisation some «new»
ideas have been collected and labelled «Pop Health
Mgmt»:
- central role of patients (education, self-care);
- performance targets in terms of health outcomes
(not volumes) to design part of the payments;
- payment mechanisms based more on capitation
(not fee for services or activity based);
- specific incentives for primary care
organizations and for vertical integration;
- budgetary solutions to integrate health and
social care for a given area (mostly for public
Population Health - Kinding 2015




Population Health and Triple Aim - Kinding
2015



Additional references on the concept of
Population Health Management:
- Kinding and Stoddard, American Journal of
Public Health, March 2003, Vol 93, No. 3
- Kings’ Fund, What does improving population
health really mean?, 2017
- Sharfstein, The Strange Journey of Population
Health, The Milbank Quarterly, Vol. 92, No. 4,
2014 (pp. 640-643)

Triple Aim – Institute for Healthcare improv
2008

Triple Aim - IHI 2008 – Motivations

Triple Aim - IHI 2008 – Slow improvements

Triple Aim - IHI 2008 – Broader system of goals

IHI 2008 – A tragedy of the commons

McDonough Medicare for all – Millb Quart 2019
George Santayana’s famous quote—“Those who
cannot remember the past are condemned to repeat
it”—comes to mind when considering prospects for a
“Medicare for All” or single-payer health system
revolution. There is history here demanding attention
that goes beyond President Harry Truman’s ill-fated
effort in the late 1940s.
Since 1994, four states have taken a cold, hard, and
serious look at single payer and backed off, three via
voter ballot initiatives and one by legislation.
Collectively, they offer a compelling “starter’s
package” of case studies on Medicare for All.
McDonough Medicare for all – California 1994
Voters rejected Proposition 186 — the California
Health Security Act—by 73% to 27%.
The California initiative would have been financed
by new taxes on employers, individuals, and
tobacco products.
Kaiser Family Foundation concluded that the defeat
was “largely the result of voters’ attitudes against
‘big government’ and higher taxes
Leading opponents included insurance companies,
business organizations, and hospitals who outspent
proponents by $9 million to $2.7 million.
McDonough Medicare for all – Oregon 2002
Voters rejected Measure 23 — the Healthcare
Finance Plan Amendment — by 78.5% to 21.5%
The constitutional amendment would have been
funded by progressive income taxes on individuals
of up to 8% and by payroll taxes on employers
from 3% to 11.5%.
Opponents included insurers, businesses, the state
AFL-CIO, hospitals, and nurses, who outspent
proponents by an estimated $1.2 million to $95,000
— most of the latter being spent on signature
gathering.
McDonough Medicare for all – Colorado 2016
Voters rejected Amendment 26 — Colorado Care
— by 78.8% to 21.3%.
The system was to have been funded by a new
10% payroll tax split between employers and
workers and by a new 10% tax on all
nonpayroll income.
Supporters were out-funded by opponents $4.1
million to $917,715. Most opposition funding
came from the health care industry, including $1
million from the insurance giant Anthem.

IHI 2008 – Population of concern

IHI 2008 - Triple Aim – Integrator

IHI 2008 - Triple Aim – Primary care

IHI 2008 - Population health managment

IHI 2008 – Population health managment

IHI 2008 – System integration

Triple Aim – System integration

Triple Aim – Precedents - IHI 2008

Triple Aim – HMOs’ failures - IHI 2008

Triple Aim – Encouraging signs - IHI 2008

What it takes for success? - IHI 2008

Tests of success - IHI 2008

Triple Fail – Lewis HA 2013

Triple Fail – Lewis HA 2013

Examples of triple fails – Lewis HA 2013





Planning phase – Lewis HA 2013

Operational and feedback phases – Lewis 2013








Triple Aim – Inst. for Healthcare Improv. 2015



1 Define a population - IHI 2015

1 Need for leadership (the integrator) - IHI 2015

1 The role of the «system integrator» - IHI 2015

1 The role of the «system integrator» - IHI 2015

1 Common purpose - IHI 2015

2 Scale of services – Stratification - IHI 2015

3 Learning system for Triple Aim - IHI 2015

Triple Aim - Conclusions - IHI 2015

Triple Aim – Progress elusive - IHI 2015

Population Health MGMT 2

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Population health management –

Plan of the lecture

1) Kinding «What are we talking about when we

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

Health services research – Gianluca Fiorentini

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