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Population health systems: doing beyond integrated care

Integrated care has become a key focus of health service reform in England in recent years, as a response to fragmentation within the NHS and social care system. Yet efforts to integrate care services have rarely extended into a concern for the broader health of local populations and the impact of the wider determinants of health. This is a missed opportunity.

This paper aims to challenge those involved in integrated care and public health to ‘join up the dots’, seeing integrated care as part of a broader shift away from fragmentation towards an approach focused on improving population health. Using examples from organisations and systems in other countries that are making this shift, the authors argue that improving population health is not just the responsibility of health and social care services or of public health professionals – it requires co-ordinated efforts across population health systems.

International case studies

The paper looks at examples from different parts of the world where systems are emerging that are focusing on improving population health. Read about the case studies in more detail:

  • Kaiser Permanente, United States

  • Nuka System of Care, Alaska

  • Gesundes Kinzigtal, Germany

  • Counties Manukau, New Zealand

  • Jönköping County Council, Sweden

Key messages

The international examples described in the paper share certain similarities in their approach.

  • At the macro level, they use a population-level lens to plan programmes and interventions across a range of different services and sectors. Key features include: population-level data (to understand need across populations and track health outcomes); population-based budgets (either real or virtual) to align financial incentives with improving population health; and involvement of a range of partners and services to deliver improvements.

  • At the meso level, they have developed different strategies for different population segments, according to needs and level of health risk. Key features include: population segmentation and risk stratification; strategies targeted at different population segments; and developing ‘systems within systems’ with relevant organisations, services and stakeholders.

  • At the micro level, they deliver various interventions (including housing support, education programmes, employment advice and smoking cessation services) to improve the health of individuals. Key features include: integrated health records to co-ordinate services; scaled-up primary care systems; close working across organisations and systems to offer a wide range of interventions; and close working with individuals to support and empower them to manage their own health.

Policy implications

In England, making the shift from integrated care to population health requires NHS organisations to work much more closely with local authorities, third sector organisations and the private sector, as well as patients and the public. It requires alignment at all levels, from central government to localities and neighbourhoods.

At a minimum, developing a population health systems perspective requires greater pooling of data and budgets; population segmentation; place-based leadership drawing on skills from different agencies and sectors based on a shared vision and strategy; shared goals based on analysis of local needs and evidence-based interventions; effective community engagement; and incentives to encourage joint working.