Population Health Management Midlands PHM Academy 21 st January 2020 NHS England and NHS Improvement
Population Health Management Welcome Karen Bradley NHS England and NHS Improvement
Starter for 10… We have four questions to get you thinking about implications of PHM… 1) You can answer ‘Yes’, ‘No’ or ‘Not sure’ 2) Indicate your answer using the coloured cards: Not Yes No No Sur Sure 3) Find someone with a dif iffer erent ent co colour loured ed card d to you…introduce yourself! 4) You will have 2 min minutes es to discuss the reason for your answers
Qu Questi stion on 1: 1: P PHM sh HM shou ould ld be be a at th t the ce centr ntre e of of al all ou l our S r STP TP ap appr proache oaches Yes? No? Not sure?
5 Ques Qu estion tion 2: 2: W We sh e shou ould ld be be lo look okin ing g at t po popu pula lation tion su sub-gr grou oups ps rathe rather r th than in indi divid vidual ual pathw pathways s or or se service vices Yes? No? Not sure?
Qu Ques estion tion 3: 3: Y You ou can an le lear arn mor n more abo e about ut th the needs ds of of a pop popula lation tion su sub-gr grou oup p by ta talk lking ing to th o them, tha m, than fr from om lo look oking ing at t th the data data Yes? No? Not sure?
7 Questi Qu stion on 4: 4: R Resou sources ces sh shou ould ld be be sk skewed ed fr from om dis disadv advan anta taged ged to mor o more e adv dvanta ntaged ged gr grou oups ps if if th that t le leads ds to o better be er overa rall ll average rage health/ lth/wellbe llbeing ing Yes? No? Not sure?
Population Health Management Programme Recap Fraser Battye NHS England and NHS Improvement
Where have we come from? Where are we now? Where are we going?
In March 2019, we asked your STP for… …to run a project: A ‘Core Team’… • Enthusiastic, energetic, appetite for • New - to run through from start to finish change • Focused - population group with scope • Senior enough so lessons from projects to improve outcomes can inform STP’s overall PHM approach • Requiring a cross-sector approach - not • Multi-disciplinary, (e.g.) analysts, a simple ‘service improvement’ clinicians, commissioners, local govt, • In need of analysis - incomplete data, voluntary sector, finance, etc. sources need drawing together, etc. • High level sponsor and project • STP priorities and value in bringing management in place organisations together
Defining a Analysis and Logic modelling population sub- engagement to and setting group (PSG) understand PSG outcomes Measuring what Using research matters; measuring evidence to design Systems thinking to learn changes Stakeholder Multi-disciplinary Culture of mapping and team working stewardship influencing
Introduction to PHM; the science of improvement Analysts Needs assessment; opportunity analysis Impact assessment; evaluation Population segmentation; risk prediction Actuarial modelling Core Team Problem structuring; communicating results
Where have we come from? Where are we now? Where are we going?
PHM: direction of travel From To Focus on individual services, pathways, Needs of populations / population ‘segments’ interventions… Systems of intelligence for population outcome Single sources of data; performance management improvement Individual organisational resources; competitive Collective, system resources; culture of stewardship culture HiPPOs and hunches Intelligence-driven decision making Cost; bio-medical; doing to patients Value; wider determinants; doing with populations
‘Relational’ ‘Technical’ Population Multi- segmentation disciplinary Leading in working systems Risk Outcome stratification definition / Where the measurement Valuing and Learning from real value Impactability prioritising the people we lies: analysis serve Actuarial move Logic analysis Librarian from Analyst-decision modelling skills maker Culture of analysis relationships stewardship to action Digital Evaluation infrastructure Influence, Project persuasion, Resource IG working story telling mapping
Where have we come from? Where are we now? Where are we going?
By the end of today, you will have: 1. Reviewed and assessed core concepts and approaches in adopting PHM 2. Understood what is now required to: a) complete your project; and, b) make PHM ‘business as usual’ in your STP/ICS 3. Share lessons and generate commitments for next steps 4. Meet someone from another STP team who could help you in future work Defined support needed from the Faculty between now – end March
Dates for diaries End of programme ‘celebrate and share’ Analysts’ Revolution 5 th March 19 th March
Population Health Management A Review of Approaches to PHM: What Have We Learned… and What Will We Use? 21 January 2020 NHS England and NHS Improvement
Approaches to Population Health Management 1. Creating a Culture of Stewardship 2. Defining Population Subgroups 3. Learning about (and from) Population Subgroups 4. Using Logic Models: Impact and How to Achieve It 5. Measuring what Matters 6. Influencing Stakeholders
Is your STP/ICS ready to embrace PHM? C=Dx x F> R V
Rating Approaches for Change in Mindset and Action ✓ How much has the PHM approach changed your mindset? ✓ How useful will the PHM approach be for your project? 1. Individually rate PHM approach on a 1 – 10 scale (1= lowest) 2. Team discussion to arrive at a consensus rating on 1-10 scale 3. Plenary discussion across teams citing specific examples 4. Option for teams to revise their consensus ratings on 1-10 scale
Approaches to Population Health Management 1. Crea 1. eati ting ng a C a Cul ultur ure e of of St Stewar ards dship hip 2. Defining Population Subgroups 3. Learning about (and from) Population Subgroups 4. Using Logic Models: Impact and How to Achieve It 5. Measuring what Matters 6. Influencing Stakeholders
Creating a Culture of Stewardship Effect ct Size BENEFIT BENEFIT - HARM HARM Resources POINT UNDERUSE OVERUSE OF OPTIMALITY
Creating a Culture of Stewardship: Balancing Population Value and Personal Value This Photo by Unknown Author is licensed under CC BY
A Culture of Stewardship: Technical and Relational Skills ‘Relational’ ‘Technical’ Population segmentation Multi-disciplinary Leading in working systems Risk stratification Outcome definition / measurement Valuing and Where the Learning from prioritising Impactability real value the people we analysis serve lies: move from Actuarial Analyst-decision Logic analysis analysis to Librarian Project maker relationships modelling action skills working Digital Evaluation Influence, infrastructure persuasion, story IG telling Resource mapping
Creating a Culture of Stewardship ✓ Balancing Population Value with Personal Value Mindset Usefulness ✓ Balancing Technical and Relational Skills Mindset Usefulness
Approaches to Population Health Management 1. Crea 1. eati ting ng a C a Cul ultur ure e of of St Stewar ards dship hip 2. Defi 2. fini ning ng Pop opul ulation tion Sub ubgr groups oups 3. Learning about (and from) Population Subgroups 4. Using Logic Models: Impact and How to Achieve It 5. Measuring what Matters 6. Influencing Stakeholders
Defining Population Subgroups Who are the popula pulatio tion: n: by sex, x, ag age, , life-sta stage ge, income ome, locatio ation? n? Demographics What at do they do: : how w much, h, when, en, wher ere, what t are the triggers? gers? Behaviour What at do they think: k: needs ds, feelin ings, gs, beliefs, s, values? ues? Attitudes Burden den of disea ease se: clinical l conditions ditions, wellness, ness, illness, ss, multi ti- Health status morbi rbidi dity, risk k of advers erse e event, nt, curr rrent ent / futur ure e healthcar thcare e costs ts
Defining Population Subgroups Geographically
Defining Population Subgroups: A Six-Step Approach 1. General statement about the population of interest 2. Establishing inclusion/exclusion criteria for the population of interest 3. How does this population subgroup fit with other subgroups in the STP/ICS? 4. What are the ambiguities around inclusion and exclusion in the subgroup? 5. What is the size of the population subgroup within the geographical area? 6. What resources are available for the care of this population subgroup?
Defining a Population Subgroup ✓ A Geographic Approach Mindset Usefulness ✓ A Six-Step Approach Mindset Usefulness
Approaches to Population Health Management 1. Crea 1. eati ting ng a C a Cul ultur ure e of of St Stewar ards dship hip 2. 2. Defi fini ning ng Pop opul ulation tion Sub ubgr groups oups 3. Lea 3. earning rning ab abou out t (an and d fr from om) ) Pop opul ulati tion on Sub ubgroups oups 4. Using Logic Models: Impact and How to Achieve It 5. Measuring what Matters 6. Influencing Stakeholders
Learning about and from Population Subgroups
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