What does the “population” in PHM actually mean?

I’ve been reading quite a bit about population health management (PHM) lately since the concept seems to be taking on increasing importance in medicine. PHM has been around for decades, but only now is it catching everyone’s attention, particularly in light of COVID which has laid bare the serious flaws with the U.S. medical system.

Bottom line: the medical system likely can’t continue in its present form without delivering worsening levels of care to large swaths of the American public. So it’s of paramount importance for people to be incentivized to live healthier lifestyles to avoid them ending up in the hospital system for as long as possible.

For me, when trying to get my mind around an enormous topic like PHM, it helps to start with first principles. In the case of PHM, in my opinion, that takes the form of asking who is the “population” in “population health management”?

Well, the answer to that question depends on who you ask. As part of their Medicaid and Public Health Partnership Learning Series, the Association of State and Territorial Health Officials (ASTHO) released a document titled “Public Health and Population Health 101” which I find helpful.

As their website states, ASTHO is the “national nonprofit organization representing public health agencies in the United States, the U.S. Territories, and the District of Columbia.” Because of the constituency they represent, their view is pretty comprehensive. To me, this document provides the best breakdown of the differences between public health and PHM — and the best parsing of the word “population” within that definition — that I’ve come across yet.

Here is what ASTHO says about what the word “population” means to different groups, and why, because of this range of views, it’s so challenging at this point to nail down a definition of PHM:

For example, public health officials, community organizations, and business leaders often use the word “population” in the geographic sense, because they work in terms of geographic units (e.g., federal, state, or county.) This usage differs from how “population” is used in the clinical healthcare system, which often more narrowly refers to patients using a facility within a specific time period, members of an insurance plan, or patients being treated for a specific diagnosis.

And then there are insurers, particularly Medicare and Medicaid, who have their own definition:

Medicaid typically uses the term “population” to refer to the total population of Medicaid beneficiaries (a subgroup of the total United States population) or a specific subgroup of beneficiaries, like pregnant women, children, seniors, individuals with disabilities, or dual eligible individuals. Medicaid serves its part of the population by constructing health plans and reimbursing providers.

So, as you can see, it may be a while before everyone has a clear picture of what the terms “population health” and “population health management” mean. At the end of the day, I suspect that the terms will go away at some point, replaced by more precise terms that better align with the various stakeholders involved.

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