At a national level, high performing health systems stand on a foundation of high performing primary care.  Without that foundation we would expect care to be expensive, quality to be variable, and the experience of care to be fragmented and often frustrating. Our payment policies in the U.S. consistently shortchange the work of primary care and we are all suffering the consequences. Even in instances where some of us may be lucky enough to have a high functioning primary care practice (great access, someone who knows us as a person and not just a disease, who coordinates any care we […]

Population health, and the payment arrangements it supports, cannot be done successfully without incorporating social risk. Adoption of value-based payment The decade since the passage of the 2010 Affordable Care Act (ACA), has witnessed a gradual increase of providers being reimbursed via some form of quality-linked payment. A few have even transitioned to advanced forms of population-based payment and large-scale practice transformation. These value-based payment (VBP) models, such as advanced alternative payment models (APMs), hold providers financially accountable for the quality and cost of care delivered to patients. Currently about 40 percent of Centers for Medicare & Medicaid (CMS) payments […]

Sophia Tripoli, director of health care innovation, Families USA

Population health is central for health care providers and payers striving to improve quality of care and lower costs. Population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” In other words, focusing on a group of individuals versus one individual. The groups are often made up of a specific geography, such as global or local communities, but can be groups like employers, ethnic groups, disabled persons or any other defined group. The health care outcomes of such groups are of relevance to policymakers in both the public […]

I have started to hear the phrase “social determinants of health” being interspersed with the phrase “health equity.”  Although the two phrases are related, there are some fundamental differences in their definitions. Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.1 These factors are both individual (such as my own propensity for eating potato chips) as well as communal (no pharmacy within walking distance of my apartment). Health equity refers to the concept that health […]

The value of community health workers (CHWs) is finally being recognized here in the U.S. This cadre works to approximate and glue together the pieces of our fragmented health care system, with the potential for an extraordinary impact, or rather return-on-investment. The CHW has a diverse daily task list. They might check a patient’s blood pressure, connect the patient to a local transportation resource or promote adherence to a complicated human immunodeficiency virus (HIV) or tuberculosis medication regimen.  While their educational backgrounds vary, the most critical commonality among community health workers is this: they know their communities.  In the mid-2000s, […]

Iliana Gilman, Principal, Health Management Associates

A 15 percent increase in value is a compelling reason for business and industry to consider investing in the health of communities. Another? How to reverse the trend of new hires being less healthy than retirees. To improve healthcare costs by improving the way we deliver care has led to an increased appreciation of non-medical factors that drive outcomes.  For example: New York State’s Value-Based Payment program requires delivery system contractors to implement at least one intervention aimed at improving social determinants of health (SDOH) and contract with at least one community based organization (CBO). Dr. Nico Pronk, President of […]

Nico Pronk, PhD, MA, FACSM, FAWHP, President, HealthPartners Institute and Chief Science Officer, HealthPartners