November 12, 2019
Darline K. El Reda teaches in the Master of Public Health program at the College of Human Medicine’s Division of Public Health Flint campus. She writes about the need for public health practitioners in our broken health care system.
El Reda is an applied public health practitioner who has worked both in the public and private sector and has published on a variety of topic areas, such as infectious disease outbreaks, maternal and child health, patient-centered medical homes, immunization, obesity and cancer. She focuses on supporting physicians and physician organizations in optimizing their practices for a successful transition from a fee-for-service to value-based care reimbursement model.
The cost of health care in the United States continues to increase year over year and most recent figures estimate that the total cost of health care, from public and private expenditures, as a percent of our gross domestic product, or GDP, is approximately 17%.
The U.S. is the highest in the world in terms of GDP spending on healthcare, but this spending has not correlated with a higher ranking in health quality or outcomes. For example, based on findings from the most recent, Global Burden of Disease Study, the U.S. has poorer rates of amenable mortality, as measured by the Healthcare Access Quality, or HAQ, Index. Amenable mortality is a measure of the rates of deaths considered preventable by “timely and effective care.” The U.S. ranks last among comparable countries on the HAQ index, with a score of 88.7.
I started my public health career working in local community settings, such as city, county and state health departments as an epidemiologist, given my interest in design, implementation and evaluation of public health interventions in local communities where needs often go unmet.
However, the spending trajectory in healthcare and the increasing chatter around population health in the delivery system influenced my decision to learn more about how reimbursement in health care works. To do this, I joined a commercial health insurance company.
I spent nearly eight years of my public health career focused on understanding current physician reimbursement structures, developing and testing alternative reimbursement models and championing the use of administrative claims data to assess variation in physician performance and incorporate this performance data into the design and evaluation of population health interventions.
To say I learned a lot during my time at a health insurance company would be an understatement. We have a lot of challenges ahead of us to transform our health care system from a responsive one that treats illness to an active one that is truly focused on “population health.”
To me, this means that our healthcare delivery system should be actively focused on doing the right things, for all the right patients, at the right time, in order to achieve optimal population health.
Our charge is to do this while the current fee-for-service structure still primarily rewards health care providers for delivering a “service” as opposed to providing an optimal health outcome. Failing is not an option—we have a system we cannot afford that isn’t making us healthier nor contributing to an increased life expectancy. Something must change.
Currently, this is the focus of my work. I am no longer working at an insurance company, but I continue to work with payers and health care providers to optimize physician practices so that they can become effective population health managers. This means changing practice workflows, optimizing the use of health care technology, i.e. electronic health records, payer data portals, practice management tools, as well as using data to inform practice operations, enabling and motivating patients to play an active role in managing their health and supporting physicians as they transition to a system where an increasing proportion of their reimbursement is based on outcomes.
I have come to strongly believe that this work desperately needs more public health practitioners.
Why? Because we understand behavioral change theory, we train in quantitative methods and we know how to design, implement and support population-level interventions. There isn’t enough of this expertise in the healthcare delivery system. Public health practitioners are needed to work side-by-side with clinical staff inside practices to support them in their collective efforts in transforming to population health managers.