Scaling Up on Population Health

January 14, 2019

In a perspective article recently published in the New England Journal of Medicine, authors Aaron McKethan, PhD, Seth Berkowitz, MD, MPH, and Mandy Cohen, MD, MPH, call for increased investment in new population health strategies that incorporate social services to improve health outcomes.

In the article, the authors note that while scientific and technological advances have delivered significant health benefits in recent years, other factors—including social, psychological, and economic influences—can be just as powerful in determining whether people are able to live healthier lives and access the kinds of care and services they need. By addressing these social determinants of health, it may be possible to provide better access to care and achieve better outcomes while controlling or even reducing costs.

The authors, whose affiliations include Duke University (McKethan), the University of North Carolina (Berkowitz), and the North Carolina Department of Health and Human Services (Cohen and McKethan), point out that existing federal and state programs often have the potential to successfully address these social determinants. But the difficulties of coordinating disparate programs and ensuring that services are appropriately matched to those who need them can present major challenges—especially when healthcare and social services occupy separate spheres of activity.

Citing an example from North Carolina, the authors note that out of more than 58,000 births covered by Medicaid in 2017, nearly a third were to mothers who had not enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) despite being eligible for the program, which has been shown to provide better health outcomes for children.

 “Failure to make practical progress on these steps risks undercutting the value of our large and growing investments in health care services. But getting them right will enable a coordinated system that uses all available avenues to improve the health of populations.”

– A. McKethan, S. Berkowitz & M. Cohen

The authors propose three overarching considerations for scaling up population health approaches in a sustainable fashion. These include 1) coordinating work processes in ways that help match individuals with needed services without creating additional burdens for clinicians and other healthcare workers; 2) developing and continuously evaluating policies and technologies designed to facilitate enrollment in potentially beneficial programs; and 3) collecting evidence about the effects of these measures on outcomes and costs. They also note that while these ideas have been tested in pilot programs, scaling them up to achieve meaningful impact will require new thinking about financing, vision, and collaboration on the part of multiple stakeholders who are committed to breaking new ground.

The article appears in the January 10th issue of the New England Journal of Medicine.