Most Healthcare Programs Are Focusing on the Wrong Populations

It’s been a crazy busy day. In fact, make that a crazy busy month. I can barely keep up as I prepare for HIMSS, finish planning for the Healthcare IT Marketing and PR Conference (early bird registration ends tomorrow), and work on all of the other balls I have in the air. Luckily, all of these things and many more are really great things.

With that excuse out of the way, I wanted to do a really simple blog post today asking an interesting question. I can’t remember where I heard this idea, but I wanted to get your ideas. Here’s the question:

Are most healthcare programs focusing on the wrong populations?

That’s a pretty broad question that could have a lot of different answers depending on which program we’re talking about. However, I think it’s a discussion worth having.

Are the current healthcare programs just making the healthy healthier? Are we transgressing the populations that could most use healthcare? Are we designing applications and devices that could be really beneficial, but they’re not being adopted by those who could benefit from them most?

I’d love to hear your thoughts.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Even if we focus on the required populations, we are actually focusing on the most commonly reviewed healthcare activities. Historically, we have removed some of the most needy groups from our reviews by failing to engage in much more than what is required. The most underrepresented groups receiving care are known to be highest risk, yet we still fail to differentiate them from a typical HEDIS or PIP like review. The people with rare diseases, those who refuse to go to a physician on a regular basis, those on orphan medications, are never fully monitored, except by entry of their name into a disease registry staff or by special needs npo programs like the PTSD, MS, epilepsy, autism, childhood leukemia, or hemophilia foundations.

    Ignoring these special needs group was done mostly for convenience during the earliest managed care years. But now that technology has improved, we have no reason NOT TO BEGIN monitoring these ignored special needs groups and making them a part of our regular review of our healthcare program. The larger quality of care programs devoted to very common conditions or diagnoses like diabetes, asthma, child care needs, meet the needs of a significant number of patients, often with an average to slightly better than average impact over the years. But to implement programs that are focused on smaller populations, people with conditions that significantly impact their quality of life, we have the ability to produce a much more satisfying outcome. It is easier to significantly change 100 lives, than to try to modify 20,000 or more people in the region who are smokers or have an array of chronic diseases in need of ongoing managed care. Somewhere there has to be a healthy balance between these two ways of managing population health.

    EMR/EHR makes it possible to monitor your entire population health, for thousands to tens of thousands of conditions and various age groups. So why not do it?

  • John,

    I agree with you on two counts: It’s discussion worth having and it’s a very broad question!

    As a starting point, I think it’s important to distinguish what kind of healthcare programs you’re referring to. At Dossia, we find ourselves having very different conversations along these lines depending on the organization. Hospitals and ACOs, for example, are looking at this differently than say, a self-insured employer or health plan.

    One thing we’ve noticed is that as populations get stratified for risk, more and more organizations want to focus primarily on the segment likely to drive the highest utilization and cost, typically between 10% to 20% of the population. The low or moderate risk segment gets short shrift, when every segment should be engaged in ways that make sense given their health profile. Healthier individuals should be encouraged to stay on top of preventive care. Those at moderate risk of chronic disease should be nudged or coached or incentivized to make lifestyle changes that reduce their risk. And of course the high-risk segment needs a more focused and sustained level of engagement and support.

    As Brian rightly points out, a good population health management system should enable us to clearly identify, track and manage all of these segments. A sound and scalable PHM strategy is one that doesn’t address one segment at the expense of the other.

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