Population Health PDF

Population Health Mohamed Eldeeb CPHQ,CPHRM,LSSBB,TQM,SCRUM Master ,TOT , Team STEPPS master training, TEMOS approved consultant  Population health management PH can be defined as the health outcome of group of ind...

Population Health Mohamed Eldeeb CPHQ,CPHRM,LSSBB,TQM,SCRUM Master ,TOT , Team STEPPS master training, TEMOS approved consultant  Population health management PH can be defined as the health outcome of group of individual this population can be geographic region or other group with special characteristic In USA 80 millions chronic disease patient Total income impacted of chronic disease is 4 trillion in 2016 Individual health Public health Population health One on one individual health service Community based prevention Look for effective point to intervene Utilizing intervention targeting through the public population ( high risk group) health system or through social intervention. Is the art of prevention 3 Ps: Focus on social, cultural, environment Promotion and physical condition affecting prevention population Protection  Social determination act one from the important issues can affect population health Challenges of social determination: 1. Lack of assessment Model 2. Screening tool not linked with evidences 3. Lack of resources to collect information The Association of American Medical Colleagues AAMC describe 10 requirements of a comprehensive PHM 1. Data infrastructure 2. Community engagement 3. Team based care 4. Panel Management 5. Patient risk stratification 6. Care management 7. Complex care management 8. Self management support 9. Addressing social determination of health 10. Ensuring health equity The Key part of the population health journey is to understand the needs of the patient, engaging the right partners and design effective system: Using as asset based approach IHI provide a three part data review process: 1. Review available data 2. Understand experience of their team 3. Understand experience of their patient To ensure the the application of PHM the National committee of Quality assurance NCQA has 4 recommendation: 1. Improve leadership buy in 2. Practitioner leadership 3. Goal setting and alignment 4. Create and communicate the PHM strategies Pathway of population health: 1. Health and wellbeing develop over the time 2. Social determination drive health and wellbeing 3. Equity of care 4. Address demographic data 5. Health require partnership Simply we can conclude the target : 1. Improve health wellbeing 2. Improve health equity  Shifting from reimbursement to healthcare: Value based Health care Value based Reimbursement Focus: This is a broader concept that emphasizes Focus: This specifically refers to how healthcare providers providing high-quality, efficient healthcare services while are paid for their services reducing costs Key characteristics: Payment tied to outcomes: Providers Key principles: are rewarded based on the quality of care they deliver 1. Quality over quantity: Prioritizes outcomes over the and the health outcomes achieved number of services provided Risk-sharing: Providers may share financial risk with 2. Coordination of care: Ensures seamless care across payers, such as insurers different providers and settings Bundled payments: Payments are made for a group of 3. Patient engagement: Involves patients in decision- related services, rather than individual procedures making and care planning. 4. Population health: Focuses on the health of entire communities, not just individuals.  Importance of continuity of PHM: Strategy: Components: 1. Needs assessment (physical, social, psychological) 1. Leadership role 2. Health promotion ( Primary prevention, behavior 2. Patient involvement modification, 3. Care coordination 3. Coordination of care)  Quadrable aim: We agreed before that we have triple aim but with VBHC shifted to Quadrable 1. Affordable service 2. High Quality 3. Good outcome 4. Staff well being How to promote Quadrable aim: 1. Identify population 2. Design care model 3. Partner for success 4. Derive appropriate utilization 5. Continuously improvement Care transition: Moving one patient from one health care provider to another American care management Association ACMA set standard should be followed to ensure the effective transfer: