Disclosures

• NIH 1 P20MD00687501 ($5.5M)

• NIH S21MD012474 ($10M)

• NIH 1P20CA192994-01A ($1.1M)

• New York ECRIP ($1.26M)

• Endowed Chair in Nephrology (3.4M)

• SUNY Health Network of Excellence ($150k)

• US patent # 9556235: F11 Receptor antagonists

(peptide 4D) as therapeutic agents in vascular

disorders. www.vasocuretherapeutics.com

Conflicts of interest: None

• Background and definitions

• Rationale for population health

• Evolution and how is it done, a quality and cost

perspective

• Populations health determinants and implications for

social determinants of health

• Summary

Public Health: the science and art of preventing disease

at the population level

Population Health: the science and art of controlling disease by

monitoring performance measures in

preventing, diagnosing and treating chronic

disease at the population level

OECD 2017: https://data.oecd.org/healthstat/infant-mortality-rates.htm#indicator-chart

OECD 2017: https://data.oecd.org/healthstat/life-expectancy-at-birth.htm#indicator-chart

USA

Men: women gap 4 years

Black: White gap 5 years

Murphy Sl, et al, NCHS Data Brief ■ No. 328 ■ November 2018

https://www.cdc.gov/nchs/data/databriefs/db328-h.pdf

OECD 2018: https://data.oecd.org/healthres/health-spending.htm

USA: $8,500

OECD: $3,322

Expenditure ratio: 2.6

French EB, et al, Health Affairs VOL. 36, NO. 7, 2017:

https://doi.org/10.1377/hlthaff.2017.0174

• <1980’s: Fee for service

• 1980’s -2000: Birth and proliferation of managed

care organization

• 2000s-: • Accountable Care Organizations (risk sharing)

• Medical Homes

• Pay for performance (incentive-based payments)

• Value based payment systems

• Population Health (reduce cost, improve outcomes and

experience)

• Precision Medicine

Example:

Patient A and B have Heart failure, both receive reminder calls

for visits but patient B is depressed and does not answer phones

How do you design care for patient B to make sure medical

interventions are as effective as patient A?

The goal of population health is to reach the same outcome

in both patients, therefore the care plans will be enhanced for

patient B as ff:

• Visit compliance

• Medication adherence

• Mental health interventions

• Social determinant of health

Technology Analytics Care

Coordination

Healthcare Effectiveness Data and Information Set (HEDIS)

National Committee for Quality Assurance (NCQA)

Quality Cost

Payers

(Insurers)

Hospital systems

Physician practices

Societal/social characteristics

Adapted from, Alvin R, et al: https://doi.org/10.1111/j.1749-6632.1999.tb08123.x

Societal determinants of health are defined as

conditions in the social, physical, and economic

environment in which people are born, live, work, and

age.

https://www.healthypeople.gov/2010/hp2020/advisory/societaldeterminantshealth.htm

Economic Stability

• Poverty• Housing security and Stability• Employment• Food Security• Transportation

Education

• Early Childhood Education and Development

• High School Education• Enrolment in Higher Education• Language Literacy

Social and Community

Context

• Social Cohesion• Civic Participation• Perceptions of Discrimination and

Equity• Incarcerations/Institutionalization

Health and Health Care

• Access to Health Care-gaining entry into the Health System

• Access to Primary Care/Trusted Provider

• Health Literacy

Neighborhood and

Environment

• Affordable/Quality Housing• Environmental Conditions• Access to Healthy Foods• Crime and Violence

Source: Adapted from Healthy People 2020 , US Department if HHS, 27 July 2019

Health Inequities: differences in health outcomes between groups of people

that are considered preventable or unfair

http://interactioninstitute.org/equality-vs-equity-the-gift-that-keeps-on-giving/

PROBLEM: Central Brooklyn has high unemployment rates, food stamps, physical inactivity,

number of murders, preventable diseases

AIM: To “bring health and wellness to one of the most disadvantaged parts of the state.”

Investment: $1.4 billion to fight “entrenched pockets of poverty” in a comprehensive way

• $578 million for subsidized housing • $700 million, allocated in 2015, for a new health care system • 8,800 Health living related projects

➢ oyster reef restoration project ($400,000), ➢ 22 community gardens ($3.1 million), ➢ fresh food programs ($1.8 million) ➢ new 407-acre state park

PROBLEM: Unnecessary and costly emergency room visits by Medicaid/eligible patients

AIM: To reduce unnecessary admissions by 25% through transforming the health system with

eventual goal of value-based payment

Investment: $6.4 Billion used to develop a new delivery structure

• Managed Care Organizations• 25 new Performing Provider Systems in NYS

• Health Homes• Hospitals Other Providers• Community Based Organizations

System Transformation Projects (Domain 2): • Create Integrated Delivery system (PCMH, APCM, Health Home, medical village)• Implement Care Coordination and Transitions of Care (PC in EDS, Transitions of care, etc.)• Connecting Settings (Patient Navigators, telemedicine, Patient activation activities, housing)

Clinical Improvement Projects (Domain 3): • Behavioral Health (Integrating PC and BH, medication adherence, withdrawal management, ,

etc.)• Cardiovascular (Million Hearts campaign)• Diabetes, Asthma, HIV AIDS, Perinatal care, palliative care, renal care

Population-Wide Projects for Prevention (Domain 4): • Promote mental Health and Prevent Substance Abuse)• Prevent chronic disease (smoking, etc.)• Prevent HIV and STDs• Promote Healthy Women, Infants and Children (reduce premature births

The development of a society can be judged by:

✓ The quality & fairness in the distribution of population health

✓ The degree of protection provided to the disadvantaged

Reduce Costs (Costs between 2003-2006)

Combined costs of health inequities and premature death in the U.S.= $1.24T

30.6% of direct medical care expenditures for people of color were EXCESS

costs due to health inequities

Increase Revenue

✓Healthy workforce is a productive workforce

✓College education for all would result in $1 trillion of savings

LaVeist, Gaskin, and Richard, 2009; Dow and Schoeni, 2008

2018

• The cost of healthcare in the USA is simply too high and not

sustainable long-term

• Many strategies have been employed to reduce healthcare costs

but are largely symbolic and not effective

• Population health strategies, founded on value-based payment

systems, offers a promising method to improve quality, reduce

cost and improve patient experience

• Addressing social determinants of health in a population health

strategy is critical to its success, particularly in health of

underserved/disadvantaged populations