A few of you wrote asking where you could purchase my red baseball hats—the ones embroidered with the words, “Make American Healthcare Great Again.” Stay tuned.

I drove past a Mini Cooper dealership today and learned that not all Minis are created equal. Minis come in different sizes—small, medium, and large; one for the papa bear, one for momma bear, and so on.

Then I pulled into a Starbucks. And my mind put Minis together with Starbucks and led me to think about how fans of Starbucks might order a Mini. Tall. Grande. Venti.

“I’ll have a Grande with mocha leather seats.”

I settled for an iced coffee. While I was looking at all of the ice cubes in my drink, my mind immediately jumped to the fact the a Chicago woman, who has apparently missed way too many Mensa meetings, is suing Starbucks for five million dollars because she used string theory and discovered that adding ice to her iced coffee used up some of the space where the coffee would have been had she ordered an iced coffee with no ice. Perhaps I could join the lawsuit.

Part of me wishes she had tried to order a caff, half-calf, decaf Venti, latte with skim soy milk. Her head would have exploded.

Let’s discuss population management. We’ll get to population health management in a minute. Population management and The Wall. It occurred to me that one way to solve this problem, and to pay for it, would be to make the wall a tourist attraction. Like the Great Wall of China. Did you know The Great Wall is the 26^th most visited site in the world, and that is it visible from outer space? I am betting that The Donald would not settle for just building a wall. His too would have to be visible from space. And can you imagine his reaction if his wall was only the 27^th most visited site in the world?

Maybe he could manage the populations on both sides of the wall. Build Trump Casinos right into the wall, have a two-drink minimum and sell my red baseball hats to help pay for the wall.

So, that is how my mind works. Red hats to Minis to Starbucks to the wall and back to the red hats. The circle of life in Paul’s world.

Now to population health management. No wall required.

The most important requirement to being able to effectively execute population health management is knowing something about the health of the population. I do not mean that in a frivolous way. How do we define the term “population”, and what do we mean by the term “health?” (I cannot remember whether the quotation mark goes before or after the question mark; hopefully, that will not undermine this post.)

Does population refer to the people within a provider’s radius of service? Or does it just refer to their patients?

If population refers to people who simply live in a provider’s area, who are not currently under the care of that provider, people whose health history is not stored in the provider’s EMR, can we agree that the provider knows nothing about the health of those people? If the population refers to patients whose health data is stored in the EMR, what does the provider actually know about the health of those people? Knowing someone had his or her gall bladder removed three years ago tells the provider nothing about the health of that person today. Having the person’s gall bladder data also tells the provider nothing about whether that individual might have been dealing with hypertension or depression.

If those statements are even partially correct, does spending money analyzing big data through analytics make sense? To analyze big data you have to have big data. Having a lot of data is not the same as having big data.

The same questions can and should be raised about payers. How much to they really know about the health of their members? (To me, the term members seems a tad too convivial.) A payer’s knowledge about an individual’s health is limited to what they can ascertain from the claims that individual files. Just because millions of their members are not filing claims does not mean those members are healthy; it may just mean that neither the member nor the payer knows anything about that member’s health.

What about retail pharmacies? What do they know about the total health of their customers who have taken or who are taking medication? Do they know if the medication made the person better, or if the medication is helping the person manage their illness? Or, do they only know that the person refilled their script?

Is the healthcare community actually trying to manage big data while only having very little data on a person-by-person basis? Is it possible to execute population health effectively when the current health of most of the individuals in the population is unknown? Knowing how someone was is not the same as knowing how someone is. Can you name a single healthcare organization that has a current, accurate, and complete picture of your health?

Population health management has its own wall. Millions of people in the population collect data about their health. They do it with smart apps and by using wearable devices. And they do it every day. They will do it again tomorrow, and the day after tomorrow.

And what do they do with that data? Pretty much nothing. They may look at it.

So here is the big question. Has collecting and storing that data improved anyone’s health? The part that is needed to turn a single person’s data into relevant health information is to have someone who understands how the disparate pieces of data fit together assess it. And that is the wall. The population health wall stands between what is possible to know about a person’s current health and what is known about that person’s health.

People, people in the population whose health and wellness the healthcare community is charged with managing, cannot find an organization capable of managing their health and wellness proactively. The data is there. Big data. And the amount of big data gets bigger every day.

If the big data falls in the woods, and nobody is there to assess it, does it make a sound? It could if someone was there to hear it.

Population health management. And the wall.

The circle of life.