Population Health The 21st century’s opportunity to finally achieve health

for all . . . no matter where we . . .

What’s Population HealthDefined different ways by scholarsSame elements – looks at outcomes achieved in the health

of populations and the role social determinants play in affecting those outcomes

Dr. David Kindig of University of Wisconsin Population Health Institute coined phrase

Population Health is the steadfast coordination and integration of all clinical and social services that assist each and every patient in becoming well and/or staying well. Health care providers – hospitals, doctors, laboratory service providers, diagnostic and treatment centers, nutritionists, and social/human service providers of all types – work together to provide coordinated health care that is mindful of the environmental influences affecting patients.

Starts with Knowing Community Needs

Policy DriversSTATE FEDERALCommunity Service Plans

(CSP) and Community Health Improvement Plans (CHIP)

CHNAs pre-requisuites in new, voluntary public health department accreditation process

Many states/local health departments required CHNA prior to ACA

Affordable Care Act (ACA)Community Health Needs

Assessment (CHNA) for hospitals

Conducted every three years Adopt strategies to meet

identified needs Retain tax-exempt status $50,000 fine at stake

Policy and Payment ImplicationsPolicy and Payment Implications

Put Policy to PracticeNew payment structures that emphasize “accountable

communities”Accountable Care OrganizationsBundled payment arrangementsPatient-centered Medical HomesState Medicaid reforms and transformation

Patient satisfaction and transparencyHCAHPS’ influencePatient satisfaction key at every point of contact

County Health Rankings and Road Map

August 28, 2015 Finger Lakes Health Systems Agency 8A collaboration of Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute

Chronic Disease Burden Aligns with population health-based approachAbout 117 million Americans suffer from one or more

chronic health conditions (CDC)Chronic disease treatment costs

$7900 for every American with a chronic disease As a nation, we spend 86% of our healthcare dollars on

treatment of chronic diseases (CDC)Care for the chronic disease sufferer does not end

upon hospital discharge or when patient leaves physician office

WHY?

AccountabilityTo the patient – to ensure all supports in placeTo our medical and social service colleagues – so their

hard work along the care continuum continuesTo ourselves as providers – that the most effective

and evidence-based care is delivered most cost-effectively at the right time, in the right place, and at the right level

To society – so that healthcare costs are kept within reasonable limits and the U.S. improves its health ranking

Population Health Presents Strategic OpportunityInnovative partnerships and care settings

Retail clinicsMedical malls

Virtual healthcareMobile appsRemote appointments

Less quantifiable marketshareNot counting beds, but counting healthy lives

Team-based careSeamless and coordinatedEmerging healthcare positions