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The UK and the US: Speaking the Same Basic Language on Population Health

October 30, 2013
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Tim Straughan of Leeds, England, clarifies why population health is a challenge under any healthcare system

It was fascinating to interview Tim Straughan late last month, and to reflect on differences and similarities between the challenges facing the United States and the United Kingdom, when it comes to broader healthcare system issues going into the future.

On the one hand, as well all know, the UK has its government-funded, government-managed and –provided National Health Service (though it also has some private practitioners), which employs most British physicians, and runs most of its hospitals (though in a less centralized way that is commonly understand in this country), while the U.S. has a complex mix of government and private-insurance reimbursement system that funds a mostly-private healthcare delivery system. But the broader reality is that the U.S. and the UK ultimately far more in common than they have that is contrasting, as Straughan noted in our interview.

Straughan, the director of health and innovation at Leeds and Partners, oversees a pioneering public-private collaborative that is attempting to transform care delivery and care management in Leeds, the third-largest city in England.

As Straughan told me after explaining that Leeds and Partners is a collaborative that encompasses all the health stakeholder groups in the Leeds area, including the city government, the healthcare entity that operates the hospitals and employs the physicians in the area, and the business community, “Our ambition is to be internationally renowned in leading on health and innovation. So that’s quite a big goal. And within that, we’ve set up the Leeds Innovation Health Hub, which is a collaboration of all the healthcare providers in Leeds, and all the commissioners. We have provider organizations, the hospitals and the GPs in primary care centers; and in addition, since April 1, we’ve had something called Clinical Commissioning Groups, and they essentially buy or commission services from those providers.”

And here’s the interesting part: once you take away the differences in the funding and organization of healthcare systems, Leeds and Partners faces what all the community-based alliances, collaborative, and health information exchanges in the U.S. face—the need to gather together and share data in ways that support clinicians at the point of care and at the point of care management. And, like the U.S., the UK faces considerable challenges in moving forward to make healthcare delivery, financing, and care management more modern and ready to serve an aging population beset by chronic illness and socioeconomic and cultural issues.

Indeed, as Straughan told me, “So while a lot happens in London at Whitehall [the British Parliament], the equivalent of a part of your HHS [Department of Health and Human Services] is in Leeds. So we’re working on a whole health ecosystem. We want to work together as one unit across the whole system, and think we can do things together and quite powerfully, with huge benefit,” he said, adding that “[W]e’re doing a whole number of projects, including the creation of what we’re calling the Leeds Care Record, which includes not only the hospital data, but also the GP [general practitioner] primary care data, and the social care data, and eventually the home care data. There are real benefits to gain. And by joining up those data sets, it’s not only fantastic for caregivers, but also in terms of the value in terms of population-based and research-based data.”

Sounds quite a lot like what’s happening in the U.S. with accountable care, population health management, and health information exchange, doesn’t it?

The fact is, population health management represents a gigantic set of opportunities and challenges, regardless of the healthcare system involved. For one thing, it’s not just the United States that is trying to work through how to bridge a Grand Canyon-sized divide between inpatient and outpatient care delivery and financing; indeed, national healthcare systems like those in France and Germany face perhaps an even deeper chasm between the two sides of care delivery, though they also lack the intense data fragmentation built into the overly complex U.S. system.

But the cold, hard reality of the mechanics of building any kind of population health management initiative is that those mechanics are inherently very difficult. And when you add into the mix the need to create health information exchange mechanisms in order to support population health management, that fact makes things even more complex and challenging.

What the folks in Leeds are doing—and, interestingly, they’ve partnered with a division of Alere, a U.S.-based company, to facilitate the data and information elements of this—speaks to the amazing opportunities, and the daunting challenges—facing all of the advanced, industrialized nations of the world as they move forward at a time of the widespread aging of populations and explosion in chronic illness, to make population health a reality.

So it should be at the same time both heartening and sobering to hear about British challenges to population health. And encouraging, too, since we can definitely learn from one another in all this. So despite dialectical differences, in healthcare as in culture, one finds we are speaking the same essential language on both sides of “The Pond.” That fact will be good to keep in mind going forward into the global healthcare future.