Guardrails on the Road to Better Population Health
By: Patrick Jordan, MBA, MA | November 27, 2014
I recently took my family for a fall drive on the Blue Ridge Parkway through the mountains of North Carolina. The drive has something for everyone: soaring vistas for the leaf peepers, eerie tunnels for the kids, and hairpin turns that reacquaint fast drivers with Newton's laws of motion.
It was this last characteristic that generated the most discussion during my drive: why the whole length of the Parkway--all 469 miles of it--didn't have guardrails. They could reduce serious accidents. They could save lives. They could allow faster driving.
For all the benefits, guardrails would cost too much. It boils down to a benefit/cost analysis--benefits from the reduction in crashes and costs associated with installing the improvement. The ratio has to be compelling to get the guardrail.
A similar analysis takes place in deciding which treatments are covered by insurance. Calculating a dollar value for health makes for uncomfortable math. We have information aplenty on the costs of healthcare: the US spent $2.8 billion on healthcare in 2012, the government expects healthcare costs will be 19.9% of GDP by 2022, the cost of specialty drugs is increasing 15% annually and will make up nearly half of annual pharmacy spending by 2018. Given what we know about the costs of care, it would seem that the benefits from new treatments need to be convincing. A recent study conducted at Tufts University on specialty drugs provided a good example. While specialty drugs cost 15 times more than traditional medicines, they conferred much greater benefits in Quality-Adjusted Life Years (QALYs). In other words, the more expensive guardrails can be worth the cost.
The guardrails to health in the future will look very different from the past, if only because of our increasing responsibility for our own health. At the turn of the 20th century, disease and death were often related to the basics of hygiene, sanitation, nutrition, and workplace safety. Vaccinations, fluoridation, and occupational laws were put in place. In the second half of the century, attention focused on heart disease and cancer. We responded with heavy investments in the treatment of disease. Toward the end of the century, we sought to preempt diseases by identifying what caused them. We developed campaigns on the effects of smoking, diet, and physical activity. As our understanding of disease and wellness evolved, so too did the safeguards on health.
The road to better healthcare and patient outcomes in the future may have relatively little to do the traditional venues for care. A study by the University of Wisconsin Population Health Institute demonstrated that clinical care represented only 20% of health outcomes. The remaining determinants on health were based on social and economic factors (40%), health behaviors (30%), and environmental factors (10%). Traditional thinking would place these factors well off of the usual healthcare map. To develop guardrails here, we need to bring together pharmaceutical innovation, insights on health outcomes, and engagement with patients in their communities. Such guardrails would help contribute to a holistic perception of individual health, which would help to ensure that patients receive the right treatment, at the right time. And that would be something we could all be thankful for.