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The Totalitarianism of Population Health Management

Medical Economics just published a piece giving advice on how to “succeed” at population health management.

The article is filled with pleasantries:

  • “Population health management is about going beyond the walls of the practice to improve patient health”
  • “It’s all about a stronger emphasis on preventative medicine and making sure these appointments happen”
  • “It’s key to keeping costs down.”
  • “If you do it right, there is less duplication in tests and less waste. You are keeping track of and coordinating a person’s healthcare.”

Some of the claims, however, may seem pretty bold: “Data analysis and social determinants become as important as mammograms and diabetic eye exams.”

Achieving the goals of population health, however, will require that doctors give up their independence.  “Joining a larger group may be necessary” because small practices don’t have the “sophisticated software tools” to achieve the goals of making entire populations healthy.

And all this goodness will not come without a small dose of coercion: “small practices eventually will be forced to incorporate population health [into their practice]”

David Nash, MD, one of the US gurus of population health, is quite sanguine about the prospects of his heavy-handed approach to medicine.  His final warning comes at the end of the article

You can run, but you can’t hide from it, [Nash] says. We are heading toward the total accountability for the outcome of care, and with no outcomes, there will be no income for doctors, and that is a sea change.

A demand for “total accountability,” by the way, is one way to define of healthcare totalitarianism.

If there’s a silver lining to all this it’s that population health is nonsense on stilts, a project that is doomed to fail.  If you want to understand why,  please watch this brief talk I gave recently at the annual meeting of AAPS.

You will find the incoherence of this brilliant theory amusing, but let’s be mindful that the people who push population health have extremely powerful means at their disposal.  They are wrecking healthcare and must be countered at every turn.

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