The Physical Therapist's Guide to Population Health

At Strive Labs, we keep our ear to the ground to stay on top of trends in healthcare. In 2016, we’ve already noticed that many forward thinking physical therapists are discussing the importance of population health, so you're going to be hearing a lot about it this month.

Population health can be defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group." Central to this concept is the importance of reducing disparities among different population groups due to the Social Determinants of Health (SDOH). SDOH include all factors that potentially have an impact on the health of human populations. I love the image below, as it illustrates all of the factors that underlie “visible” health at the surface.

Source here.

While some of these factors are fairly fixed (genetic endowment for example), many of them can be altered through education and behavior changes. In fact, if we look at the graphic below, we could argue that physical therapists can affect at least 60% of the SDOH by providing access to quality care (20%), educating the population about healthy behaviors (30%), and advocating for environmental changes in our communities to make them safer for biking and walking (10%).

I fully agree with Mike Riley, Jr.’s statement that he’s “tired of waiting for people to fall off ladders before [we] can help them.” Mike spoke with passion in the past about impacting population health by meeting people where they spend the majority of their time – in the workplace.

Additionally, for those of you who know Mike Eisenhart, you have heard him beating the drum of population health for years. Mike discussed his reasons for believing that physical therapists are more than capable of being on the forefront of population health in this podcast with Up Doc Media, where he explained that “by leading the charge, physical therapists can become effective primary care clinicians in the management of the health of populations.”

In this article, Mike addressed the concept of how physical therapists can provide value in the larger picture of healthcare. He explained that when looking at population health:

“...Dollars and cents alone cannot define success in this context, and value created is about solving the biggest problem possible for the largest number of folks at a fair profit. We have to decide if success is primarily being measured by dollars and cents or if it’s being measured by impact. What’s especially interesting to me is that, for a short window (because of the sheer size and scale of the problem) it looks like PTs can win in both areas if we get organized and mobilized, but it has to happen soon……like yesterday.”

In the same article, Mike discussed some themes that illuminate the opportunity for physical therapists in population health (make sure you check out the UpDoc Media Blog for more awesome content this):

1. There are not many “healthy people” left.

Almost ALL Americans, including (as sad as it may be) the very young are either at “significant risk” of, or currently have at least one chronic disease. That is a few hundred million people who have room for improvement. Heart disease, the number one killer for both men and women claims +/- 600,000 lives per year, a statistic that is considered to be as much as 80% preventable.

2. The incentives to change outweigh the incentives to stay the same.

After decades of being a largely ignored, out of control spending and system-wide change have forced healthcare stakeholders to come up with a sustainable solution. Conceptually, this means we (all of us) must develop systems/environments/care-approaches that lower the risk (i.e. keep people healthier, longer) AND lower the amount of sick-care required all while improving the end-user’s experience.

3. Simple is not the same as easy.

No matter how many times we try to make it about a pill or supplement or gadget, research continues to tell us that a healthy lifestyle (i.e. cardiorespiratory fitness, consumption of primarily high quality foods, managing stress and keeping exposure to known toxicity like tobacco products) can essentially solve the problem.

4. A single “go-to” profession does not currently exist.

Healthy lifestyle is not easy to pull off in most American towns and cities. Not only does it require consistent effort to exercise, find/cook healthy foods, etc., it also requires significant education (“health literacy”) of how to avoid traps associated with tricky labeling, understand proper dosing schedule of lifestyle interventions (depending on any one person’s unique risk picture) and interpret reasonable progress to manage expectations and stay motivated to attain mastery. There is not a single profession that gets all of the components of a healthy lifestyle in school. Not dietetics (nutrition), not medicine (disease management), not psychology/social work (behavior change & coaching) and not physical therapy (movement & exercise). All of these professions should play a role since each core area is critical; but to ensure the best customer experience, where gaps in care are minimized and continuity is maximized, it is best for each to have enough knowledge in all of the other core subject areas.

With all of this in mind, to me the answer is simple — the greatest long-term value for ANY professional who works in healthcare is now more in facilitating HEALTH (best version of ourselves) than it’s ever been and equally now less in “care” (number of procedures a professional might squeeze out in a day) than it’s ever been.

And so, despite what appears to be a diminishing opportunity in “care”, there is a huge and growing opportunity in health, especially for professionals who can detect, communicate and ultimately lower risk.

And so, despite what will require a shift and perhaps even an outright pivot toward an updated way of “doing things” for many physical therapists (especially those who are locked into a “treatment pays the bills” mindset) the opportunity exists.

And so, as a profession we need to come together with an organized approach to filling the societal need, solving the problem and capitalizing on the opportunity.

And so, I have decided to DO something."

Mike’s passion led him to the idea of a cross country bike ride to bring positive attention to our great profession and the most passionate among us by celebrating our professional purpose — helping people to move better and more as we do something to transform society. (Read more about Free the Yoke here.)

As Mike says, “If you’re one of us - one of the professionals who believe the role of a health care provider extends far beyond the walls of the office, all the way into the community - we’re looking for you. Join us!”

Huge shout outs to UpDoc Media, Mike Riley, Jr., and Mike Eisenhart for lending their voices & their content to the population health issue.

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Ann Wendel

Physical Therapist, Writer, Speaker, Consultant, Kettlebell Lover. Director of Brand Marketing for @strive_labs and @APTAtweets Media Spokesperson.