Deputizing Doctors

December 2, 2015

 
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Americans need to see “population health” for what it really is. Last week, a POLITICO panel discussed the term “population health,” which is key to Obamacare’s transformation away from the private practice of medicine -- and into the everyday lives of Americans – starting with Medicare.

 
It begins with the lump sum and bundled payments doctors will be paid by Medicare under the Affordable Care Act (ACA) to practice “population health” rather than individualized patient care.
 
Joshua Sharfstein, M.D., former Maryland Secretary of Health and now Associate Dean for Public Health Practice and Training at John Hopkins Bloomberg School of Public Health explained “population health” in two ways. Here’s the first:
 
I think of population health as the health of a community. That includes the people seeking care and the people not seeking care. … It’s their overall health. … If you go back to when the term “population health” was coined, it was coined to get at some of the non-clinical factors that underlie the health of communities, including access to safe food, access to safe communities, and prevention...
 
The Maryland health information exchange gave a lot of tools to doctors to know what was happening to their patients even if they weren’t seeing them.
 
This means tracking individuals. Dr. William Borden, M.D., a health policy professor, said algorithms can be used to look for patterns in the community from “patient-reported outcomes” shared through a clinic’s computerized medical record portal, FitBit data, home blood pressure monitors, and more.
 
But population health is so much more. After being asked to explain the difference between population health and public health, Dr. Sharfstein clarified:
 
I think population health is the way that health care systems are thinking about public health now. Generally speaking, when people use the term, public health, they’re thinking about public health departments. … Public health is sometimes seen as for public health people, but when the clinical system gets into public health, they’re talking about population health. I think it’s a very similar concept. It’s the term that people in health care use when they’re doing some of the things that people in public health do.”
 
Translated:  Doctors, clinics, hospitals and health plans are being deputized as government agents. To protect yourself from tracking and profiling, opt out of your state’s health information exchange, find a cash-based physician, and refuse to share FitBit data, answer clinic questionnaires, or use the clinic online portal into your medical record. Then demand state legislators enact informed patient consent requirements for all data-sharing.
 
In freedom,
 
Twila Brase, RN, PHN
President and Co-founder
 
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