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Can Doctors Manage Populations?


Doctors are having a hard enough time taking care of one patient at a time. Expecting them to do much more is just another straw.


There appears to be a growing consensus around the notion of population health. Investors are betting on predictive analytics and big data. Payors are turning into information management platforms. Data infomediaries are clicking their little hearts out figuring out the trends. And, all the while, doctors and their patients are being poked and prodded to cooperate to improve outcomes and lower costs.

But, is expecting doctors, particularly primary care doctors and advanced practice practitioners, to do this a realistic expectation? Here are some things that should give the policy wonks pause:

1. Most patients are unwilling or unable to participate. The 20% accounting for 80% of the costs should be the target and one size does not fit all. In addition, we need to consider global populations, not just local.

2. Most doctors lack the skills, education, tools, or incentives to participate. They are trained to be sick-care technicians, not population health leaderpreneurs.

3. The gap between the data and the doctors is widening.

4. The gap is being filled exponentially every day with a fire hose of bits and bytes derived from the confluence of the Internet of Things and mobile devices.

5. Most health information resides outside of large, brick and mortar based integrated delivery networks.

6. Unstructured data is vastly larger than structured data.

7. There are not enough medical information data scientists with clinical backgrounds.

8. Data navigators have yet to assume their place or earn the trust of providers on the front lines. Do you have a health infomaticians making rounds with you today?

9. There are nagging, persistent digital health product development gaps, particularly when it comes to demonstrating clinical effectiveness.

10. The nimbleness, creativity, and innovation of many digital health startups seems to evaporate into corporate-land when they are acquired.

Doctors are hassled, harried, and angry, and placing on them the additional burden of population health management is piling on. The model needs to change to fit the new data ecosystem. In addition, we need to create new jobs and roles, like entry level data technicians, similar to pharmacy and anesthesia technicians, to help clinicians manage the information load.

Doctors are having a hard enough time taking care of one patient at a time. Expecting them to do much more is just another straw.

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