The vision of the Roundtable on Population Health Improvement, said David Kindig, Professor Emeritus of Population Health Sciences and Emeritus Vice Chancellor for Health Sciences at the University of Wisconsin School of Medicine, is of a strong, healthful, and productive society that cultivates human capital and equal opportunity. This vision, he said in his introduction to the workshop on how modeling can inform strategies to improve population health, derives from the recognition that such outcomes as improved life expectancy, quality of life, and health for all are shaped by interdependent social, economic, environmental, genetic, behavioral, and health care factors and will require robust national and community-based policies and dependable resources to achieve. Given the many factors that influence population health, it can be challenging to develop strategies that will most effectively improve the health of targeted populations.
Recognizing the difficulty in addressing this challenge, the Institute of Medicine (IOM) in its 2012 report For the Public’s Health: Investing in a Healthier Future (IOM, 2012) made a consensus recommendation calling for the Department of Health and Human Services (HHS) to coordinate the development and evaluation of and to advance the use of predictive
1The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.
and system-based simulation models in order to understand the health consequences of the underlying determinants of health and to also use modeling to assess intended and unintended outcomes associated with policy, funding, investment, and resource options. Prompted in part by this recommendation and by the interest of its members, the roundtable formed an ad hoc committee to plan and convene a workshop exploring the potential uses of simulation and other types of modeling for the purpose of selecting and refining potential strategies, ranging from interventions to investments, to improve the health of communities and the nation’s health. In this context modeling refers to a formal representation of ideas for the purpose of problem solving. Depending on the problem to be solved, different modeling techniques, such as statistical approaches or more complex computational models, can be used to represent those ideas. For the purposes of this workshop, “a model is an idealized representation—an abstract and simplified description—of a real world situation that is to be studied and/or analyzed” (Gass and Fu, 2013). The workshop’s discussions focused primarily on mathematical models.
The resulting workshop, held on April 9, 2015, in Washington, DC, included a combination of invited talks and interactive discussions with all workshop attendees. The day-long workshop included dialogue between modelers from a range of disciplines and model users, with a focus on finding practical ways to move modeling forward in population health at the local, state, and federal levels, including strategies to build modeling capacity (see Box 1-1 for the full statement of task). The objectives of the workshop objectives included
- identifying how modeling could inform population health decision makers’ strategies and decision making based on lessons learned from models that have been, or have not been, used successfully;
- identifying opportunities and barriers to incorporating models into decision making; and
- identifying data needs and opportunities to leverage existing data and to collect new data for modeling.
In his introductory remarks to the workshop, IOM President Victor Dzau commented on the importance of having multiple sectors work together to create the right environment to improve health. He noted that the audience at the workshop included members of many fields, such as education, philanthropy, health care, and private industry, among others, and that there is a need for all of these sectors to work together to make healthier communities and a healthier population. Given the many impacts on health and the multiple stakeholders involved, policy
decisions hold uncertainty. Dzau said that modeling can be used as a tool to support population health decisions by communicating uncertainty to those who make decisions that can affect public health and by helping to sort out the complexity. The public health field, though, is behind many others in its use of modeling to making informed policy decisions, Dzau said. The Environmental Protection Agency (EPA), for example, does not make any policy decisions without the use of modeling as an input, he said. He also pointed to the growing role that innovative technologies are playing in improving health care and said that he believes that such technologies have promise to be part of the solution in the population health arena as well. He stressed the need to consider all the tools available when making policy decisions.
Dzau also spoke about his ideas for the IOM to be a more dynamic organization. “We have always been right in the forefront, and we have always been there asking the questions and providing the right analysis, but I will say it is time that we also broaden further along the horizon and touch on many different disciplines,” he said. In particular, he said he wants to the see the IOM have more impact. As an example, he discussed an IOM report released in 2015, Dying in America (IOM, 2015). This report addressed many of the most important aspects of end-of-life decisions in an objective and comprehensive manner, but what was perhaps just as important, Dzau said, is that it has triggered a series of meetings with stakeholders such as Congress, the American Medical Association, the
American Association of Medical Colleges, nursing associations, and others that have focused on the message that it is time to change the way the nation deals with the end of life. It was his hope, he said, that this workshop would also trigger a broader conversation with those stakeholders that need to take action to improve public health.
The workshop (see Appendix A for the agenda) was organized by an independent ad hoc planning committee in accordance with the procedures of the National Academies of Sciences, Engineering, and Medicine. The planning committee consisted of Ana Diez Roux, Dean of the Drexel University School of Public Health; Marthe Gold, Visiting Scholar at the New York Academy of Medicine and Professor Emerita of Community Health and Social Medicine at the City College of New York; David Mendez, Associate Professor of Health Management and Policy in the Department of Health Management and Policy at the University of Michigan School of Public Health; Bobby Milstein, Director of ReThink Health; Pasky Pascual, an environmental scientist, lawyer, and former Director of the Council for Regulatory Environmental Modeling at EPA; Louise Russell, Distinguished Professor at the Institute for Health, Health Care Policy and Aging Research and the Department of Economics at Rutgers University; Steven Teutsch, former Chief Science Officer at the Los Angeles County Public Health; and Steven Woolf, Director of the Virginia Commonwealth University Center on Society and Health. Teutsch served as the planning committee chair.
This publication summarizes the presentations and discussions that occurred throughout the workshop, highlighting the key lessons presented and the resulting discussions among the workshop participants. Chapter 2 provides an overview of the role that modeling can play in improving population health. Chapter 3 presents three case studies that illustrated different kinds of models, how they have been used, and their effectiveness, or lack thereof, in informing decisions. Chapter 4 describes the type of information that policy makers would like to get from models and recounts the discussions that four breakout groups, each representing different stakeholders, had on this topic. Chapter 5 identifies some of the barriers and opportunities for using models to inform population health interventions and policies, and Chapter 6 discusses how the Centers for Medicare & Medicaid Services plans to use modeling to inform its population health initiatives as well as some of the lessons that the field has learned from efforts to use modeling to assess the impact of population health initiatives. Chapter 7 recounts the roundtable’s discussion on
future directions and capacity building and provides a summary of some of the key ideas presented at the workshop.
In accordance with the policies of the IOM, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. The workshop summary has been prepared by workshop rapporteurs Joe Alper and Amy Geller as a factual summary of what occurred at the workshop.
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