I’d like to start doing an intermittent series of posts about how PHM is being implemented around the world. I think one can get tunnel vision focusing too much on how things work in their own backyard, so I figured it might be productive to zoom out a bit. PHM has so many moving parts that it’s unlikely that any one country or even region has thought of every possible angle.
Well then, what better way to begin this little odyssey than by looking at how the World Health Organization views PHM? Great idea, I thought. But, oddly enough, when you type “population health management” into the search engine on the WHO website, you get nothing.
One might think that this comes down to semantics. Maybe, one might say, PHM is an American term. But no, that’s not the case as I’ll detail below. The term “population health,” a closely related but distinct term, does return quite a few hits on the WHO site. But again, even though there is some overlap between PHM and population health, there does seem to be a consensus that they’re two distinct concepts.
Anyway, we have to delve a little deeper to find where the WHO comes down on PHM. After doing some legwork, I discovered that the organization has segmented its literature on different PHM frameworks into discreet sectors.
The sector I’ll focus on in this post is Europe. I’m sure there are plenty of good examples that demonstrate how the WHO envisions PHM rolling out across Europe, but the best breakdown I could find was in the form of a document called “The European Framework for Action on Integrated Health Services Delivery: an overview.”
The strategy outlined in this document shares many similarities with ones laid out by U.S. organizations such as the Institute for Healthcare Improvement (and their influential “Triple Aim”), the AHA, and others. Interestingly but perhaps unsurprisingly, elements such as “Stratifying health needs and risks,” “Identifying the determinants of health,” and “Linking provider payment mechanisms to performance” feature prominently in both the European and American approaches to PHM.
What seems a bit different on the surface, however, is the emphasis that European countries, along with the WHO, place on the concept of “co-locating” services. A good definition of “co-location” can be found on the website for the Rural Health Information Hub, a group supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services (HHS). They define the term like this:
Co-location refers to services that are located in the same physical space (e.g. office, building, campus), though not necessarily fully integrated with one another. Co-location can involve shared space, equipment, and staff for health and human services; coordinated care between services; or a partnership between health providers and human services providers. Co-location can streamline referrals, increase access to care, and increase communication between different providers.Source: https://www.ruralhealthinfo.org/toolkits/services-integration/2/co-location
This idea of co-locating services can be found in the subtext of most materials on PHM implementation in the U.S. But I’ve noticed that it seems to take on more paramount importance, and is more explicitly mentioned, in literature about the European approach to PHM. For example, the King’s Fund in the UK did a great video about the country’s vision for rolling out PHM over the next few years. At about the 29:30 mark of the video you’ll find one of the panelists discussing the key nature of co-location to the overall vision.
Another terrific example of the concept of co-location and PHM pops up in a case study, endorsed by the WHO, where PHM strategies were deployed in an Austrian municipality called Schwaz in 2016. The introduction to the case study notes the crucial importance of building community to optimize people’s health:
…co-location of services increased coordination and improved access for vulnerable groups; shared living spaces, group activities and cooperative initiatives within the House of Generations generated a sense of community, fostering a supportive and inclusive environment for vulnerable groups…Source: https://www.integratedcare4people.org/practices/319/house-of-generations-schwaz-a-one-stop-shop-for-providing-health-and-social-services-in-austria/
As the case study describes, in the early 2000s “the Municipality of Schwaz observed a narrowing of family structures within its ageing population.” I take this to mean that a breakdown of the family unit was becoming worryingly obvious, especially among vulnerable groups. Adding to this already concerning situation, a “fragmented organization of local health and social services, coupled with a lack of coordination between the various actors involved, hindered the system’s ability to respond to increasing demands.”
So the city took action.
To ensure better coordinated service delivery, by 2007 they’d built a “’one-stop shop’ for health and social services.” I won’t go into the details, but building up an infrastructure where people’s health needs can be met all in one place, and where their care is consequently more tightly coordinated, has fostered a strong sense of community spirit that has led to an overall improved quality of life for residents.
In all the talk of coordinating care in the U.S., there seems to be less of an emphasis on the proximity of that care. Part of this is no doubt due to the vastly geographically larger nature of the U.S.; indeed, it’s not unheard of for people to travel from one state to another, driving hours each way, in search of quality care. Because their populations are smaller in European countries, and because (in my estimation) mobility from one city to another isn’t as integral to the culture as it is in the U.S., organizing coordinated care around local communities to cultivate healthier lifestyles is more of a natural fit in Europe. Still, there’s something to be said for incentivizing people to forge stronger bonds in their local community, and this seems to be the guiding principal for much of the work in this space across Europe.
Stay tuned for more installments in this series. I’m excited to learn more about how other regions are handling this shift to more targeted, coordinated care, a trend which seems to be taking root across the world.