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Population Health Prevails at Two Institutions


Population health—a movement to improve the health of an entire population—is a growing trend driven by the U.S. government. Many health systems are already on board, as healthcare shifts from a fee-for-service system to a value-based system.

One group of Premier Health hospitals and health systems has been collaborating since 2011 to build capabilities to become clinically integrated care networks that are accountable for the health of defined populations within their communities, according to Joseph Damore, vice president of population health management for the Charlotte, N.C-based company.

Damore says Premier has developed a comprehensive framework for the activities and capabilities necessary for successful population health management. Building blocks include:

  • Patient-centered foundation (greater patient engagement and involvement in clinical decisions);
  • Health home (a primary care medical home);
  • High-value network (a set of providers who deliver quality care at an efficient price and whose performance is measured in the areas of cost, quality, and satisfaction);
  • Payer partnership (care delivery network providers working with payers to create aligned financial incentives consistent with providing high-value care);
  • Population health data management (collecting, analyzing, and reporting data covering all of the care the network’s patient population receives); and
  • Network leadership (systematic governance and administration) focused on improving health, managing and coordinating care, and managing per capita cost.

“We’re also working with health systems on initiatives to establish patient-centered foundations and medical homes and create clinically integrated networks, providing our members with a direct roadmap to follow to successfully transition to this new value-based model,” Damore says.

At Jackson Memorial Hospital, one of the nation’s largest safety net hospitals, managing population health is ingrained in staff from day one. Nonetheless, Joshua D. Lenchus, DO, RPh, FACP, SFHM, president of Jackson Health System Medical Staff, says there are opportunities for improvement.

“A more team-based, collaborative approach is being piloted on some floors of our hospital, with specific physician groups,” he says. “Armed with the knowledge of these interventions, we can work on bolstering the pearls and rectifying the pitfalls as we move forward.

“One of our biggest obstacles to success is our patients’ general socioeconomic status.”

A current initiative at Jackson includes piloting a physician-led, multidisciplinary approach to address some of the health determinants. Furthermore, the health system is building additional satellite community clinics and urgent care centers, as it attempts to address disease earlier in the process. Additionally, there is a renewed emphasis on reinforcing the primary care infrastructure to facilitate patient appointment needs, Dr. Lenchus says. TH

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