Population Health from Above or Below

The innovation gurus have declared population health to be a key factor in health outcomes. As usual there are those who plan to help others while helping themselves. Can Big Data approaches make a difference? Are there other approaches? Do we trust consultants and corporations from afar to help diagnose and treat community wide health problems? Is there another approach that does not involve distant, different, and shipping scarce dollars elsewhere?

Those who truly want to improve the health of populations might want to consider approaches local in focus, lower in cost, and of no benefit to anyone outside of the community not to mention decades of previous development. 

Community Oriented Primary Care and Asset Based Management are approaches that have been around for over 50 years. The history of COPC is quite revealing as Sidney Kark tried to go to South Africa to address trauma - but found what was needed was sanitation and public health. Such problems are common when those far away attempt to address local care needs without really understanding the people or the who what when where and how of engaging people for change.

Advantages of local population determined approaches include 
  • Engagement specific to local priorities and preferences 
  • Full utilization of local resources plus needs assessments for the development of more
  • Local organization of health care efforts rather than disintegration as in current health care
  • Specific data development and utilization for specific local application (not shotgun approaches of too much collected with little used and even less relevant)
  • Development of interventions specific to desire to change
  • Skipping decades of mistakes, local resources, local desire to change, and other specifics that big data from above cannot hope to address. 
Local approaches are not one size fits all as in top down approaches. The proper approach is one size developed by one community fits one community.
One former proponent of primary care medical home eventually saw the light as there was little that a distant and different part time consultant and coach could do. What really matters is often the culture, the organization, the understanding - all local.
Local also might avoid the major folly of the US health care design - more layers of administration and management added in ways that accomplish less for ever higher cost.

Why not try the opposite of top down or more local dollars shipped elsewhere for nebulous reasons.

Family medicine represents the worst and best. Many family physicians have participated in local approaches and some teach these approaches. But the family medicine leadership fully embraces the latest innovations including those that are a poor fit for most family physicians. FM leaders like to talk about leading change, but do not embrace the local led change that family medicine has to offer. FM like many others are still waiting for solutions from above rather than facilitating local care. It is maddening for FM to ignore the decades of experiences of local family physicians while jumping for the latest innovation.

FM leaders want to promote primary care in Health is Primary. Many hours from many people go to promotional pieces. There is much ado but no focus on the way to do what is promoted. For example point 4 of 6 points in Health Is Primary is "Integrate public and mental health into the Patient Centered Medical Home (PCMH) and add care managers, health coaches and population health professionals to the primary care team." Of course there is nothing in any of the six major points about increasing payment so that family practices can do any of this, particularly the solo and small group half of family medicine going away by payment design and made worse with higher cost of delivery.

This is another one of those Americans can always be counted upon to do the right thing areas (Churchill quote) and more will be tried expensively and ineffectively until Americans do the right thing or exhaust the US treasury sending money to corporations to try everything else.

Primary care can be recovered and should be recovered,
but cannot be recovered when moving the wrong directions


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