Optum facilitates systems and hospitals in incorporating a population health management approach, ensuring that the system is driven by population need rather than first-come, first-served.

Let’s consider the elective waiting list. Optum has worked across 36 integrated care systems nationally and supported analysis of waitlists in the majority over the course of the last year. Result? People are queued according to the order they arrived – not exactly a lightbulb moment.

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However, the data analysis also shows that people with select characteristics – eg, those who are from deprived backgrounds, have multiple co-morbidities, are frail, have learning disabilities, those who are waiting for more complex procedures, or who missed scheduled outpatient appointments – are more likely to have an adverse event while waiting. Is it wrong, then, to prioritise their treatment? Should we suggest that for some, the culturally heretical “jumping of the queue” is the right thing to do? Perhaps a different view might imagine reorganising the queue from the outset through proactive targeting of those most in immediate need.

I am a mother with two young children and in December I awoke to a 40+ temperature unable to swallow. I believed I had Strep – it had been going around school. I weakly called the GP at 8am, desperately hoping one of my busy signals would turn to a ring. I was in a queue the order of which was determined by the rapidity at which I can move my thumb to redial. And this time, it worked. Fourteen minutes later I was through and received a call back within a very reasonable three hours; I was issued a prescription for my needed antibiotic treatment and on my way to recovery.

I’m sympathetic toward my GP. The surgery has 6,800 patients, three doctors and two locums. That’s a list size of over 2,200 patients per doctor. With ratios like this – or more – everywhere in the country, why do surgeries rely on patients to self-select appointments? Nearly 25 per cent of the UK population has a long-term condition requiring ongoing treatment and on any given day urgent needs (like Strep) require capacity to rapidly diagnose and treat. Yet many surgeries, like mine, don’t distinguish their service and simply allow whoever calls first to get the first appointment.

At Optum, we recognise that there is a balance to strike between the urgent and important. That change is not going to happen by “doing more” on top of the day job; indeed, the day job itself must transform. And change can be hard, it feels risky when the promise is “first, do no harm”.

The solution

The solution can be broken into two parts. First, use data to evidence the status quo because harm already exists. Second, try something different. Identify a group of people with commonalities (a “segment” or “cohort”) that at best has unmet need, or frankly is experiencing harm in the current state. Next, predict the positive impact you want to have, use the day job to get to work and evaluate the impact. This is a population health approach.

The national agenda points to having an ICS-wide intelligence platform with a fully linked, longitudinal dataset (including primary, secondary, mental health, social care and community data) to enable population segmentation, risk stratification and population health management by April. In partnership with Optum, this can be achieved in a manner of weeks.

We can harness the full power of a system by using a linked dataset – by system I mean specialised services, effectively and efficiently working together toward a common goal. Previously disparate organisations can come together to achieve better health outcomes, opening access to untapped resources. The linked data enables new and better insight into individuals’ health and living situations to deliver higher value care, evaluate impact and sustain the change. Optum supports systems and hospitals to take a population health management approach so that the system is led by population need, not by first-come, first-served.

Deputy chief executive of Lincolnshire Integrated Care Board, Matt Gaunt, has realised some of the early benefits a linked dataset can provide. Through our Lincolnshire ICS and Optum partnership, we have worked alongside the CSU and wrapped around existing infrastructure to ensure capability development with analysts, managers, and clinicians. Within three months in Lincolnshire, we achieved +80 per cent of the population’s linked data (in six months, it was 90 per cent), ready and usable for population health analytics: segmentation, risk stratification and identification of cohorts at greater risk owing to deprivation, co-morbidities, those on multiple waitlists, first generation immigrants, and so on.

As an immigrant myself, I confess that I do love the British queue. To me, it represents a cultural commitment to fairness. And in the wonderfully, radically inclusive health system that has operated here for the past 75 years, we could certainly do worse than first-come, first served… But we could do so much better.

This article was prepared by Alexis Bradshaw in a personal capacity. The views, thoughts and opinions expressed by the author of this piece belong to the author and do not purport to represent the views, thoughts and opinions of Optum.