Case Scenario
Medical Model vs. Population Health Model
Introduction
The medical model and the population health model represent two different approaches to health services delivery. While the medical model excels in diagnosing and treating acute conditions, it often falls short in addressing preventive measures and broader health determinants. The population health model, on the other hand, emphasizes prevention and community-based interventions, aiming for long-term health improvement. For comprehensive healthcare delivery, a combination of both models can lead to better outcomes, ensuring individual patients receive timely and specialized care while also addressing the health needs of communities.
In addition, health insurance companies are moving away from paying hospitals for treatment episodes. Instead, health insurance companies are paying hospitals to address the health status of communities. However, the shift away from paying for volume to paying for keeping communities healthy is happening slowly. The majority of payments to hospitals and doctors are still based on the volume of patients they treat.
Scenario
Sarah Williams, the vice president of the cardiology service line at St. Jude’s General Hospital, wanted to change how the hospital practiced medicine. Sarah witnessed how the St. Jude’s cardiac care team’s diligent interventions saved countless lives, and their expertise was second to none.
Medical Model Strengths:
Excellent for diagnosing and treating acute and complex medical conditions.
Well-trained, specialized medical professionals have expertise in specific diseases or conditions.
Access to specialized care, advanced medical technology, and medical care innovation.
Emphasizes personalized treatments based on a patient’s specific medical history and condition.
Quick and efficient response to urgent health issues.
However, she couldn’t ignore St. Jude’s glaring deficiencies in preventing heart disease. Patients were returning with the same preventable cardiac conditions, and the hospital seemed caught in a cycle of reactive treatment.
Medical Model Limitations:
Focuses on individual treatment, often overlooking preventive measures.
Can be expensive, with a tendency to overuse medical interventions.
May not address social determinants of health that influence individual well-being.
Sarah’s epiphany came during a conference where a renowned public health expert spoke about the potential of the population health model. Sarah recognized the urgent need to transition toward a more comprehensive population health model. Determined to bring about change, Sarah wanted to focus more on prevention. Sarah wanted to combine the strengths of both the medical model and the population health model for a more holistic approach.
Sara understood that population health models are financed through value-based payments, which are different from the volume-based incentives associated with fee-for-service payments. All types of payers are moving towards value-based payments to incentivize health care organizations to control spending and improve quality. Under value-based financing arrangements, health care organizations accept responsibility for the total costs of caring for a population of patients. St. Jude’s General Hospital would receive predetermined payments regardless of the level of care provided to each individual patient. Therefore, St. Jude’s General Hospital would risk losing money if the costs of medical care exceed the pre-determined payments.
Population Health Model Strengths:
Emphasizes preventive care and health promotion.
Addresses the root causes of health issues, including social determinants of health, such as housing, food, education, transportation, and social connectedness.
Collaborative approach involving multiple stakeholders for a broader impact.
Various value-based payment models incentivize healthcare providers to focus on improving the health of their patient populations and communities, rather than solely providing individual treatments.
Sarah began by initiating dialogues among her team members, doctors, nurses, and even community representatives, about moving beyond medical interventions. She knew that she faced objections from some staff members who feared that the population health model might compromise the quality of interventional care.
Population Health Model Limitations:
Often relies on data analysis and technology to identify health trends and tailor interventions, so concerns exist about data accuracy, privacy, and the potential for technology-driven decisions to overshadow clinical judgment.
May erode the provider-patient relationship, impacting the quality of communication, trust, and rapport between healthcare professionals and individual patients.
Requires sustained efforts and time to achieve measurable results.
May face challenges in funding and resource allocation.
However, Sarah was willing to address their concerns. She emphasized that both models could coexist harmoniously and offer the best of both approaches.
