Health Center 101 Resources: Population Health

Population Specific Approaches to SDOH: Elderly, LGBT, Migrant Workers and Public Housing Residents (2018). Resource Type: Archived Webinar. Description: Individuals within certain special and vulnerable populations experience health inequalities and therefore are at a higher risk of late detection, inadequate management and treatment of diabetes. Improved access to certain non-clinical enabling services and a comprehensive social history is essential to understanding the needs of these often overlooked individuals, and developing interventions that address those needs. More Details...

Improving the Health Outcomes of Both Patients AND Populations (2019). Resource Type: Archived Webinar. Description: This national webinar focuses on empowering health centers to initiate a population health strategy at their organization. More Details...

Using your EHR for Population Health Management: A Cross-reference Tool (2017). Resource Type: Publication. Description: Health centers are interested in implementing population health management (PHM), but often lack the resources to purchase specialized PHM software suites to implement in conjunction with their EHR. We assessed the functionality of certified EHRs to assist health centers in utilizing native EHR capabilities to perform PHM functions. More Details...

The Value Proposition for Population Health Management for Health Centers: Calculating ROI on your PHM investment (2017). Resource Type: Publication. Description: Measuring return on investment ROI and the value of population health management is an emerging concern for health centers.  Calculating ROI on HIT investment is complex, and few health centers have experience in this endeavor.  The definition of value varies by type and size of provider, patient population, and other factors, and may be unique to an organization.  This white paper discusses principles and approaches to measure the value proposition for population health management for health centers.  Although few examples exist, we present the results of one health center’s measurement of the value of PHM. Measuring return on investment ROI and the value of population health management is an emerging concern for health centers.  Calculating ROI on HIT investment is complex, and few health centers have experience in this endeavor.  The definition of value varies by type and size of provider, patient population, and other factors, and may be unique to an organization.  This white paper discusses principles and approaches to measure the value proposition for population health management for health centers.  Although few examples exist, we present the results of one health center’s measurement of the value of PHM. Download the white paper below. More Details...

Population Health Management, Social Determinants of Health and How These Fit: The relationship between population health management and social determinants of health (2016). Resource Type: Publication. Description: This is a 21-slide module presenting an introduction to the concept of and relationship between population health management and social determinants of health beginning with current definitions, a brief history of along with the evolution of the field. This is a 21-slide module presenting an introduction to the concept of and relationship between population health management and social determinants of health beginning with current definitions, a brief history of along with the evolution of the field. A comprehensive model for the relationship among the social determinants of health and outcomes of population health is also included. More Details...

Data for Population Health Management: Measuring Population Health & Emerging Directions in Population Health (2016). Resource Type: Publication. Description: This is an 18-slide module describes the role and importance of data to population health management. This is an 18-slide module describes the role and importance of data to population health management. This includes the various sources for data that inform population health management, an introduction to population health analytics; and recommended frameworks for collecting data and measuring impacts and outcomes of population health. The module concludes with a brief discussion of areas of future research and development in population health management. More Details...

Current Population Health Management in Health Centers: The Case for Implementing Population Health Management and Addressing the Social Determinants of Health (2016). Resource Type: Publication. Description: This is a 27-slide module on population health management in the Federally Qualified Health Centers (FQHCs). The module provides several examples of current initiatives that support PHM and SDM as well as the use of these concept in supporting health equity in navigating the Affordable Care Act (ACA). This is a 27-slide module on population health management in the Federally Qualified Health Centers (FQHCs). The module provides several examples of current initiatives that support population health management and social determinants of health as well as the use of these concept in supporting health equity in navigating the Affordable Care Act (ACA). The module also serves to specifically outline the rationale of PHM in areas of cost efficiency, quality improvement and patient care including value-based reimbursement and risk contracts, targeting care and resources to improve outcomes, and patient engagement and care management.   More Details...

A Roadmap for Implementing Population Health Management: The implementation of population health management and social determinants of health in healthcare centers (2016). Resource Type: Publication. Description: This is a 22-slide module on the implementation of population health management and social determinants of health in healthcare centers using the framework of the Institute for Healthcare Improvement (IHI) for health equity. This is a 22-slide module on the implementation of population health management and social determinants of health in healthcare centers using the framework of the Institute for Healthcare Improvement (IHI) for health equity. This outline provides a foundation that begins with electronic health records (EHR) and its progression to PHM. A step by step road map to implementation is outlined including adjusting organizational culture, conducting a vendor assessment, population stratification, work processes, patient registries, piloting and measuring implementation, and improvement. More Details...