Defining Population Health

For the last 15 to 20 years, there has been widespread use of the term “population health.” Though it is often used, there has been debate about its definition.

Public health advocates, academics and officials have defined population health as the “focus on the aggregate or population dimension, as distinct from the health of an individual (the focus of clinical medicine).” Health providers and payers typically have defined it in more narrow terms, often emphasizing the need to improve the health of their existing patients.

Given the conflicting definitions, it is no wonder that in many circles, the use of the term and discussions of population have begun to attenuate. This is unfortunate as there are some important concepts that are embedded in the idea of population health, regardless of the perspective.

One key concept that should not be lost in this debate is accountability. Depending on your vantage point (e.g., public health department vs health system), the definition of populations for which there is accountability and the consequences of failing to deliver on this accountability differ. Public health departments are accountable for all the residents in their geographic catchment area, and the consequences of public health’s failure to prevent illness and promote wellness is the cost to society of their poor health.Cost, in this instance, may be measured in financial, quality of life and moral terms.

In contrast, payers and providers are accountable for the health of individuals covered by the health plan or patients cared for by the health system, respectfully. In either case, the consequence -- or risk as it commonly referred -- of poor health is an increase in the financial cost of care and reputation.

Most recently, these multiple vantage points have begun to merge creating a more harmonized version of accountability. This coalescence may be related to any of four factors: (1) a growing appreciation that social determinants of health (SDOH) affect the total cost of care for a population (e.g., Medicare Advantage plans now able to include SDOH as a supplemental benefit) ; (2) the IRS mandate contained in the Affordable Care Act that not-for-profit hospitals provide a community benefit; (3) increasing demands by employers for a healthy and productive workforce; and (4) the dwindling funding for public health departments necessitating greater collaboration between health systems and public health departments.

As a former healthcare executive and public health practitioner, my hope is that the debate around population health and the loss of enthusiasm for the term does not slow the opportunity to take advantage of the growing alignment between public health and medical care in their notion of accountability. With this alignment, we will see greater investment in preventive health, mental health, SDOH, community health, consumer health and outpatient services by those with the deepest pockets—insurance companies and large health systems.