Managing Population Health in the Age of Pandemics

The need to manage the health of our population has never been more mission critical.  And the need to do it well has never been more self-evident.

COVID-19 is not the first nor will it be the last pandemic the world will ever face.  Viruses evolve and get more sophisticated every year. Has our ability to manage the health of our population gotten more sophisticated?  Or have we been stuck in a biomedical model whose cracks become a mile-wide when people, communities, companies, and countries are faced with the need to align beliefs, lower barriers to the right behaviors, increase barriers to the wrong behaviors, and coordinate action at all levels of influence to leverage better outcomes.

Sound impossible?  It is not! The model for such coordination has been around for at least 20 years, as has the research that calls out the limitations of the biomedical and even the biopsychosocial models of population health management.  People, their health, and their health outcomes cannot be separated from their physical environment, the culture of their community, and the policies that govern their lives. This is the social ecological model of population health management, and when you align interventions at all levels of influence, the likelihood of sustained good health of your population increases ten-fold.  The social ecological model recognizes that only 20% of health outcomes is related to medical care, and that the other 80% is related to the ‘three B’s: the beliefs and behaviors of individuals and the barriers they encounter at a community, policy, and cultural level to act in their own best interest.

If the social ecological model is known, and research supports exponentially better outcomes following this model, why don’t communities, companies, and countries embrace it?  Lack of will? Possibly. Lack of insight into the beliefs, behaviors, and barriers? Likely. Lack of foresight? Absolutely. Think of it this way. To protect and advance the health of a population, we must address the behaviors of individuals, communities, and governing authorities and we must address the tactics/logistics in place at the individual, community, and governing levels to elicit the desired behaviors.  When all six of those boxes are checked, you have powerful alignment and extraordinary success (you flatten the curve). When some of those boxes are not checked (ignoring social distancing rules; lack of access to essentials; no clear guidelines on distribution of support and services within a community), then you have escalating cases and costs…poor health outcomes.  

We can clearly see the power of alignment in flattening the curve with COVID-19, but will we carry the power of alignment forward beyond the current pandemic?  Will we understand that the daily practice of discerning AND influencing behaviors is mission critical to designing policies and systems to support the desired behaviors at all levels (individual, community, governing), lays down the critical foundation of a healthy population, inoculates the population against devastating health outcomes in the event of a crisis, and allows for rapid response in the face of the unexpected.

What does that mean post-pandemic?  Our communities, our employers, and our governing authorities should be looking well beyond the transactions of medicine, payers, and payment policy to ensure the health of their people and flatten their healthcare cost curve.  They should be looking to routinely measure and understand their people’s beliefs and behaviors. They should be seeking to design tactics, logistics, and policies to lower barriers/incentivize the right behaviors and raise the barriers/disincentivize the wrong behaviors.  Initially, it may seem the harder path to take, but if we can flatten the curve of COVID-19 following the social-ecological model, we most certainly can flatten the cost curve of healthcare: the stakes are just as high even if they don’t feel as “emergent”. If we get in the habit of managing the health of our populations effectively, then not only do we lower the cost of chronic care, but we also protect people against the devastating consequences of the next pandemic virus.

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