In 2004, W. Chan Kim and Renée Mauborgne wrote the seminal book Blue Ocean Strategy. In short, a blue ocean strategy is an analytical framework for creating and capturing unexplored markets.1
This concept of a blue ocean strategy is certainly relevant to radiology. Throughout our history, we have built upon our successful foundations through new techniques, more modalities, expanded applications, and advanced innovation. We have thrived by continuing to explore the limits of medical imaging for the benefit of patient care.
Certainly, population health and its multiple extensions fit into the concept of a blue ocean for radiology. While population health has become commonplace in other subsets of medicine, particularly primary care, it is just now becoming more popular in our specialty — as it should. Given our expertise in scale, population health applications and processes are prime to be adapted to and expanded by radiology practices.2
Even the term “population health” itself is used in different contexts. In 2003, it was proposed that the definition of population health be “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”3 The overarching concept of population health is to approach healthcare from a group or population perspective and serve as complementary to the individual approach that has been the basis for much of our history.
Radiology is already solidly embedded in several programs based in population health. Perhaps the most pervasive is breast imaging. Advocating for broad-based screening programs to impact the morbidity and mortality of breast cancer has long been a rallying call for radiology. The overwhelming majority of experts recognize the benefits of population screening for breast cancer. Mammography programs established and promoted by radiology have saved the lives of countless patients.
Similarly, lung cancer screening (LCS) has the potential to intervene in the malignancy cycle earlier to decrease mortality from the deadly disease. Although several factors have delayed widespread adoption, the College — through its partnerships across organized medicine — is determined to expand this lifesaving tool for those at risk.
In addition to breast imaging and low-dose CT for LCS is CT colonography. Shown to be as effective as optical colonoscopy in detecting significant polyps and early colon cancer, this application is another example of population health where radiology can be a major provider to benefit a large demographic. The ACR continues to advocate for Medicare reimbursement of this vital service.
Radiology is already solidly embedded in several programs based in population health. Perhaps the most pervasive is breast imaging. Advocating for broad-based screening programs to impact the morbidity and mortality of breast cancer has long been a rallying call for radiology.
Other modalities and applications are at our fingertips, such as US for abdominal aortic aneurysms, fast scans for whole-body MRI, cardiac CT for calcium scoring, and dual-energy X-ray absorptiometry for bone density measurement. There is no doubt that unleashing the imagination of our research community will result in new and innovative applications. Many applications can be applied to the data that we already acquire. For example, in a 2021 paper in RadioGraphics, Perry J. Pickhardt, MD, professor of radiology and chief of gastrointestinal imaging at the University of Wisconsin, eloquently demonstrated the utility of opportunistic screening during abdominal CT.4
Population health may be a relatively new concept in radiology but the intersections with well-established initiatives are clear. Several centers (such as Michigan Medicine, Beth Israel Deaconess Medical Center, and Stanford University) are already leading the way.5
Within the ACR, virtually all of our specialty and operational commissions identify with the call to apply their skillsets towards population-based care. The Population Health Management Committee, chaired by Syed F. Zaidi, MD, MBA, falls under the direction of the ACR’s Commission on Patient- and Family-Centered Care and is led by its chair Arun Krishnaraj, MD, MPH — along with contributions from others throughout the College. A robust population health resource center has already been established.
By launching the Radiology Health Equity Coalition, our community has committed to addressing uneven outcomes for different demographics. Although concepts such as Imaging 3.0® and patient- and family-centered care have typically been associated with a personalized focus, they are expanding to consider population-wide impact. Through the work of the ACR Data Science Institute®, we will be able to provide more screening information that radiologists can leverage to bring more services to our communities. As a strong component of our new strategic plan, look for more population health information and research to be coming from other areas of the ACR, such as the Harvey L. Neiman Health Policy Institute® and Quality and Safety.
Expanding our focus to population health will also support our practices. We will be reach out to a broader patient base and offer new and important services. Operationalizing our models for scale and screening not only makes business sense but is the right thing to do. Population health models within radiology have become exemplars in the transitions from volume- to value-based payment models.6 We look forward to population health being promoted and enhanced by other radiology societies, academic centers, and practices. Together, we can make a difference and have radiology recognized as not only a follower but a leader in population health.