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PAYMENT REFORM, SCALABLE, CONNECTED, FUNDED

The areas most likely to improve in population health are areas touched by payment reform that rewards such improvement. IHI notes that there has been an increase in government funding for reimbursement for things like transportation – in measurable ways, that is one tactic that can improve care coordination, preventive care and, frankly, follow through for people who would otherwise not have the ability to access care.

I also think, by virtue of the connections being deliberately built between and among caregivers and community resources, with the understanding of social determinants of health and challenges to the system for the disadvantaged in mind, it will result in more general overarching improvement. I think this improvement will be hard to measure, and for good reason: we now understand that each individual faces his/her own set of circumstances, and requires an individualized approach. This is not a one-size-fits-all. And the results will be seen in individual lives, whether that means a person who did not have a job now has one; a person who did not have housing now has it; a person who did not have a controlled chronic condition now has control of it; a person got preventive care that found their disease at an early stage, etc.

Specific population health projects that are scalable are more likely to be successful, which is something we learned in this course and something we may intuitively know – small projects, smaller impact; big projects, bigger impact. But we need to keep in mind that many smaller projects are targeted to specific needs of specific populations; they are a good testing ground for how a project will far on a larger scale.

And, very specifically, I think funding directed to public health efforts is absolutely key. I am hopeful the opioid crisis will begin to improve in the future. I’m linking to a press release below from the company I work for, Purdue Pharma, which says it’s Plan of Reorganization (which has been approved by the Bankruptcy Court), “charts a path for more than $10 billion of value, including 100% of Purdue’s assets, to be delivered to claimants and communities across the country affected by the opioid crisis.” It goes on the say “the vast majority of proceeds will be used to abate the opioid crisis; these funds cannot be diverted to other purposes. The Plan will deliver more than $10 billion in value, including providing, at cost, millions of doses of potentially lifesaving opioid addiction treatment and overdose reversal medicines.” And “Purdue will be dissolved. All its assets will be transferred to a new company after emergence from Chapter 11 that will be held to the highest standards of conduct, including a prohibition restricting the promotion of opioid products to healthcare professionals. The new company will ultimately be owned by a new National Opioid Abatement Trust established for the benefit of the American people.”

Access to care

As mentioned in my second post the quadruple aim is considered the compass to optimize health system performance and achieve the goals of population health. Improving patient experience and access to care represents one of the important components. Access to care has different facets, from expanding medical insurance coverage to physically providing care within the wall of the clinic to patients’ homes.

The Affordable Care Act is the most significant expansion of health insurance coverage in the United States since the implementation of the Medicare & Medicaid programs in 1966. Residents with low-income have been the primary beneficiaries of this expansion (1). Further expansion of health insurance will provide better access to primary care providers and access to prevention measures such as vaccinations and cancer screenings.

The implementation of Patient-Centered Medical Home will allow access to care beyond the walls of the clinic with care teams evaluating the different aspects of health for the sickest patients without the need for a clinic visit.

The expansion of the use of technology under population health will support improvement in access. For example, the use of wearable technologies or remote monitoring devices will allow monitoring patients from their homes without having a clinic visit. In addition, the expansion of Telemedicine services will continue to allow access to services that are not available locally.

The collection and analysis of data will continue to improve, allowing healthcare workers to identify disparities in care and targeting these populations with improved access and needed services.

REspond to these two ideas under first question

CHRONIC DISEASE MANAGEMENT, ACCESS TO CARE

According to the Commonwealth Fund, we continue to have a high chronic disease burden, compounded with an obesity problem, and an ongoing access issue, with people not receiving timely, high quality care. I believe this stems largely from systemic healthcare financial issues. I don’t see these abating in the future.

According to Bresnick (2016), spending (risk-adjusted Medicare dollars) on chronic disease management doesn’t match the problem in many states. She notes, “The states with the highest rates of typically costly chronic diseases like heart failure and diabetes aren’t always the ones spending the most on managing these conditions.” She goes on to describe that about 16% of Medicare patients in Texas and Oklahoma have heart failure, and it costs approx 23K per person per year to manage in Texas, and approx 21K in Oklahoma. I think we need to do a better job through population health efforts to manage peoples’ chronic disease.

Access to care will remain a problem that has overall negative impacts to population health. According to Rosenberg (2019), rural health continues to worsen – a problem compounded by system issues in the healthcare system and within reimbursement. Specifically, many rural hospitals have closed due to their shrinking inpatient volume, higher Medicare/Medicaid populations which are underfunded, sicker patients and less access to technology and less ability to recruit high-level providers. Rural health clinical also face these unfortunate financial realities.

Social media and Mental Illness

The area of population health likely to worsen is evaluation and treatment of depression and anxiety. Although much attention is being paid now to mental health and mental health related issues, we have an immense shortage of practitioners trained to handle the crisis. The crisis is also getting worse by most statistics. Social media is a large contributor to this, and as we continue to move as a society to more and more automation and less and less human interaction, I think we will see this epidemic become even worse.

In an article in Cureus, the authors astutely point out that because use of social media is relatively new, more studies need to be done to assess the effect it truly does have longitudinally. However, they point out that, “Social media is a new study that is rapidly growing and gaining popularity. Thus, there are many unexplored and unexpected constructive answers associated with it. Lately, studies have found that using social media platforms can have a detrimental effect on the psychological health of its users. However, the extent to which the use of social media impacts the public is yet to be determined. This systematic review has found that social media envy can affect the level of anxiety and depression in individuals. In addition, other potential causes of anxiety and depression have been identified, which require further exploration.” (Karim, 2020) Another article by Susan Wu at the University of California in 2019 came up with a similar conclusion. (Wu, 2019). A paper featured in the Child Mind Institute correlates social media with perceived isolation, self-esteem, less healthy activity, disrupted concentration, and sleep deprivation and depression. (Miller)

In our current situation, one in five adults already suffers from some form of mental illness and only 43 percent of those received treatment. (Dowling, 2019) A study published in 2019 estimated that one in 6 children suffers from mental illness and nearly half of these children did not receive treatment. (Whitney, 2019) An article in the AAP Journal states that “22% of teenagers log on to their favorite social media site more than 10 times a day, and more than half of adolescents log on to a social media site more than once a day.2 (Links to an external site.) Seventy-five percent of teenagers now own cell phones, and 25% use them for social media, 54% use them for texting, and 24% use them for instant messaging.3 (Links to an external site.) Thus, a large part of this generation’s social and emotional development is occurring while on the Internet and on cell phones.” (O’Keeffe, 2011) As this was 10 years ago, I have no doubt that the number is higher now. The same article goes on to describe what they termed “Facebook depression”, a phenomenon where the intensity of the online world causes children to exhibit signs and symptoms of depression

Although at this time, there are many confounding factors, and more studies need to be done, there is certainly a “general correlation between social media use and mental health problems.” (Keles, 2020) We all know that correlation is not causation, but I do believe that the depression rates that we are seeing now are only the tip of the iceberg of self-esteem issues and social isolation that can stem from heavy use of social media.

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