How 3 Programs Address Chronic Disease and Population Health


Write for the harvard business reviewRyan Howard and Michael Englesbe from University of Michigan explain how programs in Michigan, North Carolina and England are leveraging specialist care visits to screen for chronic diseases and other basic health conditions – programs that can serve as models for health systems Across the country.

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Meet the needs of the population through screening programs

According to Howard and Englesbe, millions of American patients see specialists who focus on a single health condition rather than chronic conditions that could have a significant impact on health and life expectancy.

“Today, a patient in the United States and other developed countries may see an array of specialists, undergo various procedures, but never talk to a doctor about basic health behaviors such as smoking, diet, exercise or chronic diseases such as diabetes, obesity and stress, they write.

It’s a missed opportunity, write Howard and Englesbe, because these “discreet episodes of care with specialists” can be leveraged to “move the needle on our nation’s most pressing population health needs” – and, in fact, some health care systems have already implemented programs to meet this demand.

For example, the Michigan Surgical Home and Optimization Program (MSHOP) on Michigan Medicine and the Preoperative Anesthesia and Surgical Screening (PASS) program at Duke Health are interdisciplinary programs that address longitudinal health as patients receive specialized care, such as surgery.

Under these programs, patients undergoing any type of operation also benefit from screening for chronic conditions, including diabetes, obesity, smoking, malnutrition, physical inactivity, frailty and stress. . Then, patients with chronic conditions are referred to providers who can help them establish longitudinal care for long-term management.

In particular, Michigan Medicine has created a multidisciplinary clinic that tracks the progress of surgical patients as they begin treatment for their chronic health conditions – an approach that has so far increased the number of referrals for the management of long-term health and helped patients make significant health improvements that persist long after their operations.

Likewise, the UK National Health Service implemented the Making Every Contact Count (MECC) initiative to help patients make behavioral changes, such as quitting smoking and increasing physical activity, to improve their overall health. Under this initiative, patients receiving any medical service, from a routine eye exam to a minor operation, are screened for chronic health conditions and offered brief interventions and referral for treatment.

Additionally, MECC trains caregivers at all levels, including waiting room staff, physician assistants, and physicians, “to identify and engage patients in these brief interventions around health behavior change. “, write Howard and Englesbe.

Impact of these programs on the health of the population

Overall, these programs can help reduce the cost of care, improve chronic medical conditions, and help patients identify and implement critical lifestyle changes, such as quitting smoking.

“Considering that 50 million surgical procedures are performed each year in the United States, such an approach is a powerful way to improve population health within current care delivery pathways,” write Howard and Englesbe.

In fact, there is a long-established body of evidence that suggests these types of programs effectively address core health issues within the US healthcare system.

Over the past 20 years, research has shown that major life events, including surgery, emergency room visits and receiving a new diagnosis can serve as “teachable moments”, write- they. “These are events that motivate individuals to make changes to their health that they had not previously considered or been unable to make.”

For example, while less than 10% of smokers successfully quit each year, more than 50% of smokers who undergo surgery for smoking-related illnesses successfully quit after surgery. Even patients who undergo operations that are unrelated to smoking are more likely to quit smoking.

“As surgeons, we see this phenomenon time and time again: Patients told they need surgery speak of a new motivation to do everything in their power to ensure the best possible outcome. Currently , however, few health systems have processes in place to transform this motivation into ongoing motivational actions,” they write.

However, they write, “even within the fee-for-service structure still dominant in the United States, there are ways to align the delivery of specialty care with efforts to meet the most salient points of the population”.

While health care reform in the United States will likely continue to be a slow process, Howard and Englesbe argue that “the creative integration of the kinds of efforts we have described into the health care system we have – rather than waiting for the healthcare system we want – may be our best bet for improving the health of our people. (Howard/Englesbe, harvard business review2/10)


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