The Current Landscape of Population Health in Essential Hospitals & Academic Medical Centers Bianca Perez, PhD | Director of Research America’s Essential Hospitals Marilyn Szekendi, PhD, RN | Director, Quality Research University HealthSystem Consortium Kalahn Taylor-Clark, PhD, MPH Senior Advisor, Center for Health Policy, Research and Ethics George Mason University
MEET THE PROJECT TEAM Bianca Perez, PHD Kalahn Taylor-Clark, PHD, MPH Marilyn Szekendi, PHD, RN Director of Research Senior Advisor Director, Quality Research America’s Essential Hospitals Center for Health Policy, Research & Ethics University HealthSystem Consortium (UHC) George Mason University Katherine Susman Jocelyn Vaughn Research Associate Project Manager, Quality Research America’s Essential Hospitals University HealthSystem Consortium (UHC) 2
PROGRAM PRESENTERS Theresa De La Haya, RN Katherine Diaz Senior Vice President, Director of Health Care Services Community Health & Clinical Prevention Programs University Health System University Health System Debra Gussin, MSW, MPA Tanikka Price Esq. Associate Administrator, Community Health Educator, Moms2B Ambulatory and Allied Care Services The Ohio State University Wexner Medical Center Harborview Medical Center 3
OBJECTIVES • Present a conceptual framework of population healthcare and population health • Describe the results of an analysis of 121 programs at essential hospitals and academic medical centers • Learn about three hospital-led programs that are leading the way in population health 4
POPULATION HEALTH DEFINITIONS 5
CONCEPTUAL FRAMEWORK: POPULATION HEALTHCARE + POPULATION HEALTH → CULTURE OF HEALTH POPULATION HEALTH POPULATION HEALTHCARE WHO are we targeting? WHO are we targeting? • People within a geographic area • Patients in a hospital system who may or may not be seeking (targeted or broad-based) healthcare services HOW are we intervening? (targeted or broad-based) • Practicing upstream healthcare HOW are we intervening? within the delivery system • Practicing upstream healthcare by • Focus on secondary and tertiary collaborating with prevention community/social resources WHAT are we measuring? • Focus on primary prevention • Health and wellness outcomes, WHAT are we measuring? measured at the hospital level • Health and wellness outcomes, measured at the community- and/or county-level 6
CONCEPTUAL FRAMEWORK: POPULATION HEALTHCARE + POPULATION HEALTH → CULTURE OF HEALTH POPULATION HEALTH POPULATION HEALTHCARE WHO are we targeting? WHO are we targeting? • People within a geographic area • Patients in a hospital system who may or may not be seeking (targeted or broad-based) healthcare services HOW are we intervening? (targeted or broad-based) • Practicing upstream healthcare HOW are we intervening? within the delivery system • Practicing upstream healthcare by • Focus on secondary and tertiary collaborating with prevention community/social resources WHAT are we measuring? • Focus on primary prevention • Health and wellness outcomes, WHAT are we measuring? measured at the hospital level • Health and wellness outcomes, measured at the community- and/or county-level 7
CONCEPTUAL FRAMEWORK: POPULATION HEALTHCARE + POPULATION HEALTH → CULTURE OF HEALTH POPULATION HEALTH POPULATION HEALTHCARE WHO are we targeting? WHO are we targeting? • People within a geographic area • Patients in a hospital system who may or may not be seeking (targeted or broad-based) healthcare services HOW are we intervening? (targeted or broad-based) • Practicing upstream healthcare HOW are we intervening? within the delivery system • Practicing upstream healthcare by • Focus on secondary and tertiary collaborating with prevention community/social resources WHAT are we measuring? • Focus on primary prevention • Health and wellness outcomes, WHAT are we measuring? measured at the hospital level • Health and wellness outcomes, measured at the community- and/or county-level 8
CONCEPTUAL FRAMEWORK: POPULATION HEALTHCARE + POPULATION HEALTH → CULTURE OF HEALTH POPULATION HEALTH POPULATION HEALTHCARE WHO are we targeting? WHO are we targeting? • People within a geographic area • Patients in a hospital system who may or may not be seeking (targeted or broad-based) healthcare services HOW are we intervening? (targeted or broad-based) • Practicing upstream healthcare HOW are we intervening? within the delivery system • Practicing upstream healthcare by • Focus on secondary and tertiary collaborating with prevention community/social resources WHAT are we measuring? • Focus on primary prevention • Health and wellness outcomes, WHAT are we measuring? measured at the hospital level • Health and wellness outcomes, measured at the community- and/or county-level 9
METHODS • America’s Essential Hospitals’ Gage Awards and UHC Annual Conference submissions from 2012-2014 were included • 121 programs were included in this analysis, 55 from America’s Essential Hospitals and 66 from UHC • A sample of UHC Annual Conference abstract submissions was identified using the following search terms: - ACO - Accountable care organization - Medical home - Care coordination with community partners - Social determinants of health - Upstream factors - Community - Population 10
METHODS: CRITERIA FOR INCLUSION UHC (AMC) America’s Essential Hospitals (EH) Total Annual Gage Award Total Annual Conference Submissions (2012-2014) Abstracts (2012-2014) n = 66 n = 2,147 Abstracts Yielded Not Related to from Key Word Population Health Search Management n = 558 n = 6 Not Related to Population Health Management Indirectly Related to n = 472 Population Health Management n = 5 Indirectly Related to Population Health Management n = 20 Describe Population Health Management Describe Population Health n = 55 Management n = 66 11
RESULTS POPULATION HEALTH SUBMISSIONS (2012 – 2014) Population (Who) EH AMC (n=55) (n=66) Total geographic population 20%** 5% Targeted geographic population 24% 23% Total patients (i.e., all hospital patients) 7% 5% Targeted patients (e.g., hospital patients with specific condition) 49% 68%** Intervention (How) EH AMC Leverages community partners/resources 64% 67% Addresses upstream factors/social determinants 91% 79% Focus on preventive care 58%** 33% Chronic disease care (e.g., care transitions) 55% 88%** Measurement/Outcomes (What) EH AMC Community-level health outcomes (e.g., obesity rate in community) 27%** 2% Hospital-level outcomes (e.g., readmission rate) 56% 79%** Process outcomes (e.g., rate of screening) 84% 73% 12
BROAD DIVERSITY IN COMMUNITY PARTNERSHIPS EH AMC Type of Community Partnership/Resource (n=35) (n = 44) Federal, state and local agencies 49%** 14% Faith-based organizations 23%** 0% Schools 20%** 0% Acute care facilities (e.g., health system, local community hospitals) 17% 9% Volunteers 11% 7% Media 11% 0% Payors/HMOs/MCOs 9% 9% Philanthropic organizations/Community Benefit Grant 9% 4% Research/advocacy/education organizations 9% 2% Homeless prevention services 3% 2% Grassroots organizations 6% 0% SNFs, VNAs, Assisted Living/Adult Daycare 3% 16% FQHCs and clinics for underserved/homeless 3% 9% Food banks 3% 0% Home health agencies 0% 14%** Solutions based organizations 0% 7% ≤5% of both groups: Community -based care transitions programs, Support groups, Jails/prisons, Retailer, Independent physician practices, Emergency Medical Services, Legal assistance program, Private PCMH 13
Specific Services and Interventions to Address Social Determinants EH AMC (n = 50) (n=52) **Sig. at .95 level of sig. Health Care Support 64% Patient/caregiver education 42% 44% Care coordination/navigation of health system 79%** 30% General psychosocial or behavioral support 25% 20% Medication reconciliation 21% 12% Access to medication, equipment (e.g., breast pumps), and services (e.g., 25% veterans benefits) 8% Substance abuse treatment 2% 2% Feeding assistance 2% Social and Community-based Resources in Support of Community Living 14% Cultural/linguistic support 0% 8% Transportation 15% 6% Housing/environmental assessments 6% 8% Food assistance 6% Education, Economic, and Job Support 14% Economic assistance (e.g., assistance with utility bills) 6% 4% Vocational training/job assistance 4% Social Support 6% Legal assistance 2% 4% Recreational support 0% 8% Food assistance 6% 0% Spiritual support 4%
CURRENT PROGRAMS LEAN TOWARD FOCUS ON SECONDARY PREVENTION EH AMC (n=33) (n=22) Primary Prevention 48% Health education/lifestyle management 14% 3% Exercise/rehabilitation 0% 0% Dental care 5% Secondary Prevention 45% Screening or vaccination 18% 15% Intensive primary care services 50% 12% Smoking cessation 9% 6% Avoidance of infection/medication complications 14% 15
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