Harvard Business Review

In an HBR essay published February 10, 2022, a case is made for planting population health change in the current fee-for-service- dominated U.S. health care system.

The authors of the piece are Ryan Howard, MD, a general surgery resident at the University of Michigan and Michael Englesbe, MD, is the Cyrenus G. Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery and director of the Blue Cross Blue Shield of Michigan Collaborative Quality Initiatives Portfolio.


“In many countries, when patients see specialists such as surgeons, the physician focuses on the primary health issue and does not screen the patient for chronic conditions or unhealthy behaviors. This is a missed opportunity.”

Howard and Englesbe in HBR

Howard and Englesbe offer clear and pragmatic optimism on how to tackle population health outcomes in the current system we have (versus the system we want).

“Hospitals already have the tools to manage chronic diseases, but patients are rarely connected to these resources at the time of an operation. Screening and referral to treatment for chronic health conditions not only improves immediate postoperative outcomes they also allow patients engaging with the health care system in a narrow, specialized manner to establish meaningful, long-term health maintenance. There are innovative models already doing precisely this.”

They mention two recently-launched statewide population health initiatives funded by Blue Cross Blue Shield of Michigan—the Michigan Social Health Interventions to Eliminate Disparities (M-Shield) and HBOM that adopt that model.