Population Health Management

Background to the working party:

The Health and Care Research Sub-committee launched a member-led working party in 2018 to support the development of population health management.  The National Health Service (NHS) in the UK is tackling the challenge of rising healthcare demand and constrained funding by implementing new models of care to develop integrated local healthcare systems for a defined population.  To underpin delivery of the improved outcomes, better care and value for money that are being sought, it is essential that healthcare systems develop a comprehensive understanding of the health characteristics of their population – for example, current patterns of care demand, forecasting future demand, and predicting the effects of interventions.  The actuarial skillset has much to offer in building and deploying such demographic, risk modelling and analytical capability, but there is currently limited awareness of this across the NHS.

Population Health Management considers the distribution of health outcomes within a population and how to impact these outcomes in the most optimal way for the group as a whole.  It is a wide field and so the working party initially focussed on the specific topic of impactability modelling.  The predictive risk stratification and segmentation models typically utilised in population health approaches have focused on identifying population groups that have a high risk of experiencing an adverse event, such as an unplanned hospital admission, or have a high-cost profile.

However, the success of risk stratification at the whole-population level depends not just on identifying those most at risk of an adverse event, but rather in identifying those who are most at risk and most likely to respond positively to a given intervention – i.e. to be ‘impactable’.  The combination of risk stratification, impactability modelling and actuarial variability analysis can not only help to target the most promising patients for medical management, but also support the improvement of resource allocation across a local health economy.

Key objectives:

The research and output of the working party has been planned in phases.  Initially, a range of topics related to impactability had been explored, including:

• definition of impactability modelling – (e.g. analysis which quantifies the extent to which a defined population cohort is predicted to respond to a given healthcare intervention under specified circumstances)
• exploring an understanding of different approaches to measuring and modelling impactability including the skills, tools and techniques needed to achieve each approach
• the advantages and disadvantages of various potential approaches (both data-driven and those based on empirical evidence)
• consideration of the interactions between impactability and population risk management
• issues of public perception, inequality and ethics.

Impactability Modelling Report (June 2020)

The Working Party published its first report in June 2020: “Impactability Modelling for Population Health Management: A review of current concepts and practices”.  Here is the press release:

Population Health Management aims to achieve the best mix of health outcomes across the diverse members of a population, given the mix of services available in the health and care system.  

In 2019, the UK’s National Health Service (NHS) identified PHM as a key component of its Long Term Plan.  The actuarial profession is well-placed to support the demographic, risk modelling and analytical capability required to successfully embed PHM, whilst being highly focused on the public interest and ethical issues that can arise from such techniques.

Now in June 2020, in the midst of a global health pandemic, PHM approaches are more important than ever as health systems across the world deal with Covid-19, both the disease itself and also the many consequences of the societal changes that are taking place in response.

The working party is exploring a range of facets around PHM where actuarial thinking can add value and this first report looks at impactability modelling, a key pillar of successful PHM implementation.  Impactability modelling covers a range of approaches that leverage data analysis and the application of statistical techniques to support PHM aims.  The report focuses on developing a common technical and practical understanding of the topic, including:

•     Defining impactability and impactability modelling

•     Practical challenges and considerations

•     Potential approaches and models

•     Ethics, patients and the Public
 

Read the full report

Impactability Modelling Framework with Pre-Diabetes Example Report (September 2021)

As we emerge from the shadow of Covid, there is evidence that more people are now at higher risk of developing type 2 diabetes compared to before the pandemic.

In our latest paper, we describe the components of a framework that can guide health data analysts in developing their own impactability modelling approaches for their at-risk populations.

These approaches can support health professionals in identifying people who may benefit from interventions such as the NHS Diabetes Prevention Programme.
 

Read the full report

Key outputs to date:

• IFoA Protection, Health and Care Conference 2019 Webinar – June 2019
• NHS Health and Care Innovation Expo 2019 presentation – September 2019
• Impactability Modelling for Population Health Management report - June 2020
• IFoA Protection, Health and Care Conference 2020 Webinar – July 2020
• IAA Health Section Impactability Modelling Webinar - December 2020
• Impactability Modelling Framework with Pre-Diabetes Example report - September 2021

Chair: Alpesh Shah

• Membership: 14
• Established: 2018