Population Health Management

Catalog description

This course is designed to provide students with a contextual understanding of the reasons for a renewed focus on population health as a clinical care-delivery model. An overview of the current state of the health of the U.S. population will set the stage for a brief examination of the Affordable Care Act. New care delivery models, such as Accountable Care Organizations, that are promoted in the ACA are discussed. The course provides an overview of the role Centers for Medicare and Medicaid Services (CMS), state governments, and payers play in creating new healthcare financing models that incentivize a shift from episodic to value-based care. Exploration of changes in reimbursements, the importance of quality measures, and implementation of evidence-based guidelines will be presented. With this foundation, the course focus turns to examine the many elements of population health management as a concept of broader public health goals. These elements include patient attribution models and risk identification and stratification into sub-populations, as well as care coordination - a key strategy in meeting the health needs of a population across the continuum of care. The specific intervention strategies of chronic condition management and transitions of care are described. The primary care setting, which is the focal point of population health management, is explored. The transformation of this care provider to a patient-centered medical home is described along with the evolution of interdisciplinary care teams, the use of extenders such as medical assistants, and the shifted emphasis to prevention and health promotion. The emphasis on the role of the patient in population health, the need for improvements in health literacy, consideration of the social determinants of health, and the need for health education are discussed. An overview of various technology and data analytical tools and processes used to support population health management care delivery models is provided. Discussion of the importance of using data to track, trend, and measure population health interventions will continue in the technology section of the course. The course will conclude with examinations of the multiple challenges and barriers that health care organizations, payers, and patients experience with value-based care and population health care delivery models. Lastly, a look forward at trends in policy and regulations, application of comparative effectiveness research, and the pervasiveness of `big data' will allow students to explore the future of health care delivery transformation.