Emergency medicine meets public health through ‘precision population health’

Philip Levy, M.D., MPH, made an alarming observation as an emergency physician: 45-year-olds were dying of end-stage heart disease. His public health instincts oriented him to a population health population problem. For several years as associate professor of Emergency Medicine at Wayne State University and practicing physician, Dr. Levy has been focused on strategies for addressing heart disease in adults. By mapping blood pressure in census tracts, Dr. Levy has observed that “virtually the entire City of Detroit is dealing with an epidemic of uncontrollable heart disease.” He and other health professionals discussed a data-centered approach to this problem at the 2019 Detroit Regional Chamber Policy Conference.

Public health is seldom a topic for the business-oriented conference. If addressed, it’s usually in the context of health care costs. In this case, “early vascular aging,” as Dr. Levy characterized, is something that the business community should be concerned with. He announced that Wayne State University and community partners — including Microsoft Corp. —  have embarked on a data-driven approach to impact this problem through “precision population health.” The Detroit-based initiative essentially uses neighborhood-level health data with demographic information to establish and implement custom interventions to address the social determinants of health. This initiative will be in three phases:

• Phase 1, July 2019-2020: Establish a shared data repository with information derived from health records, as well as demographic, government, and community non-profit databases. This data will be layered with social determinant data such as household income, crime statistics, and access to fresh food.
• Phase 2, March 2020-March 2021: Establish a pilot project in one or more neighborhoods to evaluate current interventions and identify gaps that are impacting health outcomes.
• Phase 3, March 2021 onward: Identify and address the determinants of health and the stressors impacting health equity and wellness in urban environments.

Renee Branch Canady, Ph.D., president of the Michigan Public Health Institute, added that the funding model for public health doesn’t align with the enormity of the need to intervene in population health scenarios like heart disease. “There’s a limited pool (of funding) for all of us. How do we partner and align?” She included health systems with public health agencies.

Laura Appel, the chief innovation officer of the Michigan Health and Hospital Association, affirmed the commitment of health systems to community health improvement, citing their members’ partnerships with community health centers. However, she indicated there was a limit to which hospitals could be involved in public health initiatives.

Timothy Lawther, MPH, deputy director of the Detroit Health Department, noted that precision population health is similar to precision public: providing the right intervention for the right people at the right time. The advantage today is that population health practitioners have data they haven’t had before to make strategic decisions. “Connecting the data with the individual person…is very different for public health.” He underscored the importance of credible community engagement. “There’s a lot of talk about (community) engagement. Nothing changes. We need to develop the capacity of community members so they can interpret the data.”

David Brooks, director of the Wayne County Department of Health, Veterans, and Community Wellness Services and moderator of the panel, affirmed the county’s partnership in this initiative.

Dennis Archambault is vice president, Public Affairs, for Authority Health.