Steve How and Paul Midgley, of the Wilmington Healthcare Consulting Team, explore how the NHS is taking an increasingly holistic approach to care
In a bid to improve patient outcomes and reduce health inequalities for entire populations – including people who are not currently in need of treatment – the NHS is embracing a concept known as ‘population health’.
The NHS hopes that this proactive approach, which involves looking at a wide variety of factors that can affect an individual’s health, will help to reduce future demand on its services in an era where the number of people living with multiple chronic conditions – many of which are preventable – is on the rise.
What influences health?
The healthy life expectancy gap between the most and least deprived areas in the UK is 19 years. Interestingly, however, just 10 percent of the population’s health and well-being is linked to access to healthcare. The remaining 90 percent is believed to be influenced by a variety of other factors ranging from diet to housing, money, family and friends. The NHS wants to better understand these variants in order to keep healthy people well, nip illnesses in the bud and improve the management of existing conditions.
For this to happen, a number of basic building blocks must be in place regarding infrastructure. These include digitalised care providers and a common health and care record. Advanced analytical tools and software and system-wide multi-disciplinary analytical teams, supplemented by specialist skills, will also be needed to gather the intelligence needed to design new care services.
Integrated care models will be key to enabling a population health approach within specific localities
Population health management
Population health management is the term used to describe the delivery approach that enables healthcare systems to better organise care pathways. It involves the segmentation and risk stratification of groups of patients, followed by impactability modelling to identify local ‘at risk’ cohorts. While segmentation and stratification identify people most at risk of needing future care; impactability revolves around predictive analytics and goes a step further in trying to identify people who could most benefit from particular interventions, allowing for more effective, personalised treatment plans.
In terms of progress, Sustainability and Transformation Partnerships (STPs) have a clear plan in place for population health management and they are beginning to engage with GPs and other key stakeholders. However, the 14 Integrated Care Systems (ICSs) are much further down the line and working in formalised integrated teams that include social care and the voluntary sector with easy access to secondary care.
The prevention agenda and pharma
Pharma must begin to think across the whole system in order to understand how the wider determinants of health could affect where and how money is spent. For example, in the future, it might be argued that improving conditions in damp housing e.g. with the use of anti-fungal paint would be more effective for managing and preventing illness in people with respiratory problems than drugs, and critically both approaches are funded from the same budget and strategic plan.
To engage with the NHS on the prevention agenda, pharma could consider wrapping its value proposition around a service that adds real value to the NHS rather than simply providing a product. Indeed, the wider system benefits that such a service could deliver may mean that it offsets the cost of a more expensive product for a particular cohort of patients.
On the issue of diet, for example, pharma could review patient care around this topic for diabetes and other conditions. This could provide valuable insights for population healthcare management programmes and lead to a quicker uptake of appropriate drugs for appropriate patients, resulting in improved outcomes.
Segmenting ‘at risk cohorts’ of patients is another key way in which pharma can support population health management. This could involve exploring the complexity of a condition, such as diabetes, which can have many variables. Gathering data around different stages could be invaluable in helping to ensure that patients receive the right treatment at the right time and that costly complications are avoided.
The development of cost-effective tests to predict disease and associated care pathways that enable proactive action to be taken in the form of appropriate lifestyle changes or drugs is also very important. Helping the NHS to develop these kinds of pathways could bring considerable savings.
Understanding the many factors that can influence an individual’s health and using this intelligence to develop new integrated care models that help to prevent illness, reduce the risk of hospitalisation and tackle health inequalities in defined cohorts of patients is key to the future sustainability of the NHS.
These new and innovative ways of working are unlikely in the short term to see a reduced reliance on drugs but will lead to an increased emphasis on more holistic ways of improving the nation’s health, such as changes in diet, exercise and living conditions. Pharma must view these changes as an opportunity rather than a threat and ensure that disease prevention is at the heart of its business strategy.