Population Health Management

 

At Novartis, our mission is to reimagine medicine to improve and extend people’s lives. From innovative science and medicine, to research and delivery, it’s this purpose that drives us to advance healthcare every day.

However, we know that medicines are only one part of the solution. Medical care is estimated to account for only roughly 20% of a person’s health outcomes.1 The other 80% is made up of what is called ‘social determinants of health’. These are health-related behaviours, socioeconomic and environmental factors that play a part in the holistic health of an individual.

The COVID-19 pandemic exacerbated health inequalities in the UK.2 At Novartis, we believe that these inequalities must be addressed as we look to build back our health system and continue to deliver care in a post-COVID-19 world. This is where we believe that Population Health (PH) and Population Health Management (PHM) can play a crucial role.

Marie-Andree Gamache

 

”We’ve already seen that PHM measures carried out locally can be such an impactful tool in actively preventing community ill-health and addressing health inequalities. We have seen improved efficiencies through PHM measures, with patient outcomes improved more holistically and not just in terms of a specific medical diagnosis. Now is the time for us to combine efforts to push for widespread adoption of this patient-centric approach.”

Marie-Andrée Gamache, Country President and Managing Director, UK and Ireland, Novartis

What is PH and PHM?

PH is an approach that aims to improve physical and mental health outcomes, promote wellbeing, and reduce health inequalities across a whole population. This includes focusing on those wider determinants of health.

PHM is an approach that supports local healthcare partnerships to use data to develop models of proactive, instead of reactive, care. This allows them to understand local issues and begin to tailor care and solutions to their greatest unmet healthcare needs. These partnerships may involve different parts of the system, including the NHS, local authorities, other government organisations, academia, charities, and industry.
 

Population Health Management

 

The promise of Population Health Management in England: From theory to implementation

PHM is a way of understanding current health and care needs and predicting what people will need in the future. Through well-executed infrastructure, insights, interventions and impacts, we can tailor better care for individuals, design more sustainable health and care services, and make better use of public resources.
 

Execution of PHM

 

To explore the impact that PHM can have in improving the overall health of our population, we commissioned The London School of Economics and Political Science (LSE) to conduct research into the current state of PHM, including challenges faced, and recommendations for the future. A scoping review, supplemented by interviews with key PHM stakeholders in England, was used to inform this research.

Significant challenges faced in the implementation of PHM were revealed, which can be categorised as technical, mindset or regulatory in nature.
 

Challenges of PHM

 

In order to overcome these challenges, several policy recommendations were also outlined, relating to:3

  1. Investment in infrastructure
  2. Transparency and communication
  3. Evidence generation, appropriate metrics and skills
     

 

Policy Recommendations

Click here to read the full LSE report, including policy recommendations

Click here to view a supporting infographic, summarising the research outcomes

Presenting and further exploring the research findings, GP and Broadcaster, Dr Sarah Jarvis, led an expert panel in discussing why PHM is so important for our health ecosystem and how it can be effectively implemented through collaborative interventions. Watch the video below to hear what these expert stakeholders had to say about ‘the promise of PHM’.

  • Chair: Dr Sarah Jarvis – GP and Medical Broadcaster, Visiting Professor of General Practice, University of Huddersfield
  • Marie-Andrée Gamache – Country President and Managing Director, UK and Ireland, Novartis
  • Professor Bola Owolabi – Director of Health Inequalities, NHS England
  • Dr Panos Kanavos – Associate Professor of International Health Policy, The London School of Economics and Political Science
  • Dr Simone Yule – National Clinical Advisor for PHM, NHS England
  • Professor Aruna Garcea – GP Clinical Director, Leicester City and Universities Primary Care Network
     

 

“Our role sits in one word, which is partnership. It’s around setting up those collaborations.” – Marie-Andrée Gamache

“I don’t think it’s a question of whether we can afford to implement PHM...it’s a question of whether we can afford not to.” – Dr Sarah Jarvis

“There’s obviously a challenge in terms of linkages and connecting the dots between the different parts of the ecosystem.” – Professor Panos Kanavos

“Data is no good unless we can interpret that data and we can action it intelligently.” – Professor Aruna Garcea

“It’s really important that we get that rich mix of social, economic and cultural information that allows us then to understand that patient’s holistic needs.” – Dr Simone Yule

 

In Conversation with… The UK’s Population Health Management Experts

Our ‘In conversation with...’ series explored the multidisciplinary collaboration needed for successful delivery of PHM. Chaired by media medic and GP, Dr Sarah Jarvis MBE, Chinmay Bhatt (Managing Director, Novartis Pharmaceuticals UK, August 2020 – June 2022), sat alongside an array of PHM experts, including Bevleigh Evans (Head of Population Health Management for NHSE&I, January 2019 – August 2022), Dr Dan Alton (GP; National PHM Clinical Advisor, NHSE; PHM Clinical Lead Berkshire West), and Andi Orlowski (Director of the Health Economics Unit at Midlands and Lancashire Commissioning Support Unit and Senior Advisor to NHSE).

Over the course of five episodes, our panel of experts sought to bring the concept of PHM to life, through real-world insight. We delved into the details of this approach, from the importance of good, rich data, to the indispensable need for a collaborative and partnership-based approach, which sees local systems (including health, social care and public services) working together.

Watch the videos below to understand what we can tangibly do to overcome barriers and maximise opportunities, enabling us to meet the goals of the NHS Long Term Plan and improve healthcare outcomes for all.

In Conversation with…The UK’s Implementation Science Experts

Improving population health on a national scale requires the uptake of evidence-based practice (EBP) into routine clinical use, otherwise known as implementation science – “the scientific study of methods to promote the systematic uptake of research findings and other EBP into routine practice, and, hence, to improve the quality and effectiveness of health services.”4

Find out more about this collaborative, evidence-based approach to improving population health here.

Interested in learning more about PH and PHM? Find some useful links and resources below:

References:

  1. NHS England. Population Health and the Population Health Management Programmer. Available at: https://www.england.nhs.uk/integratedcare/what-is-integrated-care/phm/ (Last accessed January 2023).
  2. NHS England. Action required to tackle health inequalities in latest phase of COVID-19 response and recovery. Available at: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/what-are-healthcare-inequalities/action-required-to-tackle-health-inequalities-in-latest-phase-of-covid-19-response-and-recovery/ (Last accessed January 2023).
  3. Caitlin Main, Madeleine Haig and Panos Kanavos. ‘The Promise of Population Health Management in England: From Theory to Implementation’. 2022. London School of Economics. DOI: https://doi.org/10.21953/lse.dujyxzlb3ju  
  4. Eccles MP and Mittman BS. Welcome to implementation science. Implementation Science. 2006;1:1.

 

UK | January 2023 | 254444