10 facts you need to know about population health

AHA News

Led by a range of Medicare pilot programs emanating from the “Patient Protection and Affordable Care Act” (ACA), providers are being held responsible for the health status of a defined population instead of just those who see a clinician or go to a hospital. This step up to population- level health involves identifying the people in a community who need attention and giving it to them.

Trustee magazine interviewed experts on population health as well as health system executives that took a population-based and community-focused approach a number of years ago. Their advice and observations are distilled into a list of 10 things trustees should know about population health.

1. This is not voluntary. Accountability for the health status of a population is where we’re headed.

Hospitals already are on the hook to prevent discharged patients with certain diagnoses from having to be readmitted within 30 days, notes David Nash, M.D., dean of the Jefferson School of Population Health in Philadelphia. “That’s all about practicing effective population health to prevent a readmission,” he says. The ACA’s experiments in accountable care organizations and other value-based, outcome-oriented
models of health improvement are pilots now, but suggest the paths the government will take.

2. Trustees have to think outside the four walls of the institution.

In the new era, hospitals and physician offices become way stations in the larger health management of “covered lives,” which will take the place of “patients” as the main focus of a health system’s activities.

“That calls for all kinds of services not currently offered: for example, maybe it’s of value for a hospital to support a local senior center – put some physicians and nurses, case managers into that center to decrease unnecessary admissions, reduce readmissions,” Nash says.

3. Promoting the good health of the community has to become more than a nice mission statement; trustees need a keen understanding of how to do it.

Nash says a first step may be the outward moves required to extend the hospital’s reach past its usual terminus of responsibility at discharge: a nurse call center to contact people recently discharged, a case manager to visit patients at home and make sure they return for follow-up appointments.

Good health also involves helping clinicians do more for patients than current care settings can accomplish, says Donald Caruso, M.D., medical director at Cheshire Medical Center/Dartmouth-Hitchcock in Keene, NH. “The biggest battle that I’ve had is on the ground, in the exam room, getting people to change lifestyle and do the things that actually impact their health outcomes,” he says.

4. Boards have to re-engineer their strategic priorities from the ground up to make population health a central theme, reallocate resources and commit to the changes.

“Boards are going to have to think about how we go upstream,” says AHA Chairman-elect Benjamin Chu, M.D., group president of Kaiser Permanente’s Southern California Region and Hawaii. It goes to the heart of what a nonprofit hospital should do to demonstrate community benefit. Typically, profits are plowed into medical education and expanding services, he says, “but a portion maybe should be devoted to thinking about what would make a bigger impact on communities overall.”

5. The ability to identify and track target populations, then analyze preventive and interventional needs, is the foundation of population health.

“You can only have an impact on the health of a larger community over time if you have good information about their char...

Topic: Advocacy and Public Policy

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