Why We Need A Consumer-First Vision For Population Health Management

These two questions will get you to your vision for population health management. But answer them incorrectly and it may not go so well.

Co-Founder & President at Nudge

I want to start with a little thought experiment to see if we can’t approach the topic of population health management in a more refined, and dare I say, more “human” way...

I think if we're trying to boil PHM down to its principles, we should start with two simple questions:

Question 1:  What is the most important outcome of population health management?

Question 2:  Who is the most important decision-maker in healthcare?

I would love it if you would take a moment to jot down your knee-jerk reaction to both of these questions before we dive deeper.

Take a second...


Okay, let’s take a closer look at that first question.


#1. What is the most important outcome of population health management?

I’m sure you have an answer for this one. So, what does success look like in your opinion?

Well, depending on your individual perspective - the company you work for, what your role is, your collective experience within the healthcare system, etc. - you may actually come up with wildly different responses.

For example, you may have shot straight out with one of many organizational goals for payers, such as “reducing financial risk and cost across the population.”


Listen. We should never make light of the cost savings point of view because ballooning costs are one of the most important issues facing this generation of Americans. It may not seem like a very “human” concern, but ask any economist and I’m sure they’d be more than happy to fill you in on how rising healthcare costs impact your life.

(or see our post outlining the financial implications of engagement in Medicare Advantage)

The problem with this as a primary goal is not its validity or its importance. The problem is that it is payer-centric. More on why I think this is a problem after a few more examples.

Here is an example of a response to our question that perhaps feels a little more mission oriented, especially for “carer” personalities:

The goal is to provide more timely, personalized and effective healthcare!”

Yes! Great answer... but also not the answer we're looking for.


Precisely because this response is more ‘caretaker-centric’, which I also think is fundamentally the wrong perspective from which to approach our population health management goals.

Now, before I frustrate anyone any further by insisting their standpoint isn't the most important one, let me get to the point of all of this by addressing question number 2.


#2. Who is the most important decision-maker in healthcare?

If you have ever been in a sales role, then you can probably identify with the importance of getting in front of a decision-maker.

Every B2B sales person knows that if you don’t connect directly with the person who makes the buying decisions, then your sales process is most likely going to be pretty inefficient. So one of the most important initial goals of sales is to identify and engage the person who makes the buying decisions.

We should be framing our population health management goals in much the same way.

And with that in mind I know that anyone (with a behavioral science background especially) will agree with me that the most important decision-maker in the healthcare system is the consumer.

Obviously not because they are literally paying for the services, but because they are making the decisions about how to engage with the healthcare system.

Every consumer’s choice for how to engage (or not engage) with healthcare services is the catalyst behind the chain of events that leads to (1) more or less timely and personalized care being delivered, (2) how healthcare expenditures will be allocated, and ultimately (3) whether costs will rise or fall.

In other words, it’s high time the healthcare industry truly come to grips with the fact that...

...consumer choice is the root cause of healthcare efficiency and effectiveness.
— Phil Beene

With this as our foundational principle, our answer to question #2 is obviously that the healthcare consumer is the most important decision-maker in healthcare.

And finally, what does that mean for question #1?

If we accept the principle that everything starts with the healthcare consumer, then we have to shift our earlier organizational-centric goal of reducing risk and cost, and our practitioner-centric goal of delivering more timely and personalized care, and find the consumer-centric equivalent - the ignition that sets off the chain of events that leads to more personalized, timely and cost effective care.

So what is the most important outcome of population health management in a consumer-centric world?

In two words:  "behavior change".

If population health management wants to deliver on its triple aim promise, we have to become great at nurturing healthcare consumers to engage differently and make wiser decisions about their health.

But we must remember that it is each consumer’s choice in the end. And our journey starts with respecting their agency by putting their needs and desires at their center of everything that we do as professionals.

Consumer health engagement starts with finding what’s important to each individual consumer. More on what empowers us to effectively engage healthcare consumers in this episode of The Nudgecast, and more to come in our next post.