Population Health — For Cars

I have been thinking about population health for people.  Population health, in the fullest sense, requires integrating health, education, and social services to keep a defined population healthy, address their health challenges holistically, and assist them with the realities of being mortal.  It is a very ambitious idea.

Why do I think this is possible?  Are there any analogs where this has been accomplished?  It struck me that a Ford dealer or Subaru dealer is very good at population health – for cars.  I can visit my dealer with any problem and they have the full range of services needed to address it.

I do not have to schedule each element of the service.  There are undoubtedly, specialists for engines, transmissions, brakes, and so on.  However, I need not think about this.  The dealer holistically takes car of my car.  He or she decides which specialists are needed and how to sequence and coordinate their services.

When the range of services relevant to my problem have been completed, I am presented with a single bill that summarizes all the services performed, the price of each service, and the total price I am requested to pay.  If I question any service, including its price, I can get my question answered and concerns resolved before I depart.

Healthcare, obviously, does not work like this.  There are primary care clinicians that refer me to specialists who may further refer me to other specialists.  At each stop, I will complete a new patient record and sign various releases, waiving my rights to complain.  Each of these stops will result in one or more bills sent to me as well as my insurance company.  Most of the items listed on each bill will be meaningless to me.

This chain of services involves disparate organization’s whose objectives may be far from aligned. Success for each organization is typically defined as successful completion of the step for which their organization is responsible.  Success for patients, however, involves successful completion of all steps.  Quite often, assurance of overall success is left to the patients, who are usually unlikely to be capable of performing the task.

Car dealers are able to successfully deliver population health – for cars.  This happens because all the service providers are managed – not necessarily owned — by the same organization.  This organization takes full responsibility for care coordination.  If customers are not pleased with the service, they go to a different dealer or perhaps buy a different car.  This market-based arrangement works.  Healthcare, in contrast, it not really market-based and, consequently, successful delivery of population health will be a major challenge.

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