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Peter Goldbach, M.D.


Population health programs offer great promise for improving health while reducing costs. Success, however, requires participant engagement. As programs mature, organizations are learning that the most difficult members to engage are those who are neither sick nor well: It’s the people in between. Data show that the “silent middle” drives approximately 53 percent of an organization’s health care costs. As members of this group rarely interact with their providers, reaching them can be a challenge. However, ignoring them isn’t an option.

The silent middle

Traditional disease management programs target high-cost, high-risk patients. This is “low-hanging fruit” in terms of cost savings, but such patients represent only 5 percent to 10 percent of your population. Wellness programs benefit a larger cohort but don’t offer substantial savings.

Roughly 68 percent of most populations, however, are neither sick nor well. They’re in the middle. Many in this segment are quietly developing yet-to-be-diagnosed chronic conditions. Engaging with them is emerging as the holy grail in population health. Three strategies can help.