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The Duplicity of the present-day Population Healthcare and actuality of Personalized Medicine

Originally published by Data Driven Investor on Medium

Photo by Manuel Joseph from Pexels

Public health is the science of disease prevention, health promotion, and prolonging life for every individual through organized efforts and informed decisions of communities and persons. For the past couple of centuries, it has been solely implemented utilizing a collective approach thru the identification of health outcomes of a group of individuals or population and their associated distribution trend. The 20th-century healthcare system shifted from personal medical thrust into a socioeconomic and political phenomenon by captivating the profiled attitude. Over time, the evolving medical service revolt was idealized to denote itself as part of the social program, thus making it the state’s primary responsibility to ensure enhanced quality of care for its citizens. Consequently, further catalyzed the course for private healthcare professionals to wash their hands of public health and preventative maintenance. Today time and again, we appreciate the radical evolution of public aid standing of the civic averment that healthcare is indeed a human right. Since a right applies to everyone, it has become a significant conflict through the requisition of the discriminatory population health system driven via collective social determinants vs. individual Contributing factors. The held conviction imperiled leaving out the minority in limbo because they don’t opt into a set of simulated benchmarks.

Lastly, the public health leaders have put forward a supplementary restructured account of the healthcare delivery model designed to display a predefined outline of social determinants or factors that categorically affect human health outcomes, like smoking, drug use, poverty, etc. Thus, accordingly, produce a set of action plans or protocols. The new model is designed to incentivize physicians and healthcare workers from the continuum of disciplines to engage the patient population related to those determinants to a healthy lifestyle. Even so, the incentive offered is the merit-based reimbursement contingent on positive patient outcomes.

Modern population health is the fusion of personalized healthcare and traditional population health. Though it may sound captivating and may even serve as a path in the positive direction, but is far from perfect.

Comparatively to population health, the personalized healthcare’s primary emphasis is the individuals, their unique risks, choices, lifestyles, and goals. The present blend model is the imitation scheme that speaks for public health issues with personal guise, under the canopy of population health structure. It creates fake profiles of commonly encountered health challenges, like smoking.

For the past couple of decades, a group of professionals calling themselves “the leaders in population health” have taken it upon themselves to ensure the wellness of their communities. Their principal goal is to work with payers and other healthcare professionals to develop a spectrum of services, initiatives, and health indicators to improve patient compliance with treatments while help promotes wellness. Interestingly enough, every leader has their own unique style to engage with their close community participants. But all flare the notion that they must, in fact, take healthcare to the patients by positioning them at the center of public health efforts; hence the latter is indeed the bread and butter of personalized healthcare.

Current challenges

Most health organizations struggle to influence patient behavior by improving the population health within their communities. Not surprisingly, to meet such resistance, even though their prime intention is to personalize medical care. Enough, not every patient in this model would benefit from enduring the guidelines artificially generated commencing a limited set of profiled shared determining factors.

A survey conducted by modern healthcare media, sponsored by Envolve Healthcare, showed that almost all modern healthcare delivery systems lack enough health determinants. They also experience difficulty engaging patients in wellness programs- the two primary components of a personalized approach in their health model. Imperative to understand is the definition of value, health, and quality of medical care beforehand one can conceptualize why those leaders are struggling with optimal patient engagement.

The quality of service rendered in medicine is reflected by objective and subjective traits of fulfillment Based on patient concerns at a given physician office visit at a particular time, scenario, and place. Quality is the driver of value for an actual encounter, hence defined as the efficiency and precision of tackling “Individual determinants” (vs. social determinants). Therefore, leaders’ failure to meet their primary mission contradicts significant unfocused determinants and unaddressed patient problems.

Value-based reimbursement would make for the individual clinical meet-up contrary to the value set by administrative technocracy. Likewise, educated Patient engagement will be effectively achieved through the doctor-patient bond, not through protocol-driven, statistically validated conveyance.

The present-time population health has shifted its focus from a nationwide or statewide target group to smaller county or smaller population subgroups. This reform was intended with the hope of maximizing patient engagement and keeping the marginalization of the minority well-being to the least under not benefiting from the approved guidelines.

The unique challenges that current leaders face represent a reflection of the diverse constituency base in every community and their specific social and individual determinants. At the disguise, they may all share the same general principle of “patient resistance to engage,” but when broken down, each leader will come up against the unique contentions of their own.

Preparing for a value-based reimbursement paradigm will not suffice to create “standard “social determinants. Instead, it will need an understanding of what an issue means for individual patients within the context of a given living environment. To assess a quality necessitates a point of reference or comparison. A specific reference point in population health is likelier than not underrepresented for some patients in a given profile. All individuals have their own personal determinants and “points” of comparison to quality and value. These include improving the Lifestyle program, Care coordination for chronic disease, and after hospital discharge, Medication adherence that can represent hundreds of more unequal individual factors if broken down.

Big picture

Population health is failing miserably to define 21st-century healthcare requirements. This merely is the byproduct of the increased knowledge base, and plenty of information, liberty of individual expectations, and most of all size of the multidisciplinary progress we have made in science and technology. It’s time to accept the bitter truth of outdated population health. It has functioned reasonably well for two centuries, as it has proven to be cheap as long as the citizens follow the cookie-cutter scheme, downside leaving out the minority group and vulnerable at limbo. The proponents of population health are seemingly reluctant to admit the prevailing needs to reform by the false presumptuousness of feasibility challenges associated with personalized healthcare. Yet, they are radically implementing value-based models and patient engagement programs that are nothing short of a hybrid of population and personalized healthcare. Such a system may indeed serve well in the short run as the transition scheme, but if the transition does not occur in a prompt fashion destined to fail in the long run.

To recapitulate, public health is a discipline of preventing disease, prolonging life, and promoting health for everyone. It must be implemented through a well-organized system. As important as public health’s role is and despite its prerequisite for taking a position at the center of patient and physician interaction, it doesn’t seem to be the case. Over time, it has been the mythical belief that physicians are not public health experts. On the contrary, their role is indeed fundamental to efficient public health delivery. Patients also have taken the passive part by following what the government bureaucrats enforce upon them. On those grounds, social movements have evolved, including Anti-vaccination groups. Through their bureaucratic takeover, the medical service and public health disconnect have transformed the Hippocratic personalized medicine into the rigid population health. Today what we witness entails the clash of administrative autocracy and liberated individual mindset.

We have the wrong people leading mistaken solutions for bad reasons in the off-beam system. Neither industry data scientists nor Executives are in any position to occupy healthcare leadership. The pure science-based approach by the so-called “Leaders of the population health” will inevitably have shortfalls, therefore premature to take the individual factors out of the public health equation. A leader’s duty is not exclusive to the ownership of protocols, guidelines, or policies. Still, it is the person who builds a personal relationship with the patient. It can use the right resources available to extend the optimal service from prevention, diagnosis, and treatment to education and building a rapport within such framework- something lacking from current medical practice and one of the reasons for patient distrust and non-compliance.

Today’s healthcare lacks synergy between role and skill within its workforce. The attention of the physicians is inefficiently diverted to manage paperwork and complying with ridiculous government mandates, while those who should be doing the administrative work act as the leaders of public healthcare. The mark with this picture is the poor assignment and distribution of skills and talents.

Solution

Healthcare systems need to step out of habitual profiling and grouping determinants and factors into bundles of social elements. It needs to engage patients on their distinct determining factors of health and wellness. The specific factors would serve as the reference base for the quality of medical services rendered by the treating physician. If intended to place a patient at the center of public health, then by no means excluding the treating physician serves the system any good. The quality of service is determined by delivering mutually acceptable medical care by an objective assessment of the physician and the patient’s subjective perception by addressing individual determinants one person at a time. Value is the derivative of the quality delivered’ hence the accurate merit-based reimbursement model. Time has come once in for all to put double standards aside and revisit the definitions of quality, value, patient engagement within the context of personalized healthcare.

“The time has come for patients to take control of their healthcare system and demand transparency on all aspects from start to finish.”
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