Population Health 101: What Is It And Why Should We Care?

posted by Rashi Venkataraman

on August 23, 2017

“Population health” has taken on different meanings over the years. It can include everything from health outcomes, to nonmedical social determinants, like access to healthy food, and even public policy, according to researchers David Kindig and Greg Stoddart.

But what does that really mean? At its core, population health aims to keep patients healthy and out of the hospital, thereby preventing unnecessary tests and treatment and reducing costs.

Health plans were early adopters of population health principles. On a regular basis, plans strategically mine clinical and financial information to help patients achieve better health outcomes, lower their health care costs, and take an active role in improving their overall health and wellness.

As an example, here’s how it might work for patients who have chronic conditions like diabetes, heart disease, or hypertension. Through chronic disease management programs, interdisciplinary care teams work with patients and their families to develop and help patients adhere to treatment plans, including preventative measures like keeping their blood pressure or blood sugar levels under control. Health plans are adept at aggregating and analyzing claims and clinical data to identify patients’ health at risk, and give providers actionable information to tailor interventions to their needs. By incentivizing providers to keep patients healthy, health outcomes improve and costs decrease across the system and across patient populations.

Plans with successful population health strategies do the following:

  • Invest in a robust analytic infrastructure platform and dedicated teams to customize health care for their membership.
  • Transition away from a single disease-focused program to a “whole person” approach that is more holistic, effectively addressing all of a member’s conditions.
  • Leverage provider and consumer incentives, tools, and resources to encourage healthy behaviors and improved health outcomes.
  • Develop innovative community-based solutions for addressing the social determinants of health to help people get the ongoing support they may need for housing, transportation, and education.

Health plans and providers focused on improving population health recognize that a patient’s zip code could have a greater impact on their health than their genetic code. Social determinants, such as where someone was born or where they work, can play a role in a patient’s overall wellness and health. Addressing these factors requires a multifaceted, multi-stakeholder approach to coordinate the health care and social services people need.

Approaches to improving population health continue to evolve. Plans are implementing population health strategies tailored to different regions of the country, the specific needs of their members, and the availability of resources. AHIP looks forward to collaborating with our member health plans and other industry stakeholders to highlight innovations, share best practices, and demonstrate improvements in population health.

Rashi Venkataraman is Executive Director for Prevention & Population Health with AHIP’s Clinical Affairs Team.

To learn more about how plans can address the social factors influencing health, please read AHIP’s Issue Brief Beyond the Boundaries of Health Care: Addressing Social Issues.”