Safety Net Hospitals Aim for Road Map to Population Health

The first steps are to define what population health means to safety net hospitals. Any national strategy toward population health would likely be more nuanced than a purely medical initiative to tackle a particular disease.

The nation's safety net hospitals are building a road map for population health.

Backed by a $350,000 grant from the Robert Wood Johnson Foundation, America's Essential Hospitals will survey its 275 member hospitals in 35 states about the programs they're using to improve population health for their service areas. The aim of the Moving to Action for Hospitals and Population Health project is to identify effective population health strategies that can be adopted nationally.  

One of the first questions the survey hopes to answer about population health is what exactly everyone means when they use the term "population health."

"If you ask 100 people you will get 100 different definitions," says Kalpana Ramiah, drPH, director of research for AEH. "We are excited because now we can think about what population health means to our membership, who care for the nation's most vulnerable populations, including those with complex healthcare diseases and racial and ethnic minorities. What does it mean to our member hospitals and how should they be engaged with population health?"

Ramiah says many safety net hospitals are already working locally on specific issues related to population health, such as food insecurity and adequate housing, but those efforts are often isolated and there aren't enough opportunities to share and build on success stories.

"Where do you start is a good question," she says. "That is why we are doing the survey and interviews to figure out what that population means for our membership."

The Essential Hospitals Institute, the research arm of AEH, also plans to conduct a literature review; interview patients, caregivers, community members, and other groups to understand their perspectives on the value of population health; and convene a stakeholders' summit that will include clinicians, researchers, policymakers, community-based organizations, and others.

The Institute will use its findings and summit proceedings to develop a population health road map to share with member hospitals and partners. From there, it will transition to a multiyear project to promote broader use of population health programs nationally.

David Engler, PhD, director of the Essential Hospitals Institute, says the concept of population health has been around for a while, but it's somewhat broad.  

"Our members are struggling with where to start," he says. "We have heard from them about needed assistance, and that is what this program does. It develops a road map for our members to use for hospitals nationwide to use."

Population Health? Slash Health Disparities First

Engler says the link between social determinants such as poverty and population health have been established. "There is also a clear trend toward the notion that socio-demographic factors in a population matter," he says.

"Therefore, improving water supplies, improving education, housing, improving a variety of environmental factors will have a positive impact on health, will create a reduction overtime of morbidity and mortality, and will create a better use and efficiency of healthcare resources."

Any strategy toward population health would likely be more nuanced and holistic than a purely medical initiative to tackle a particular disease such as diabetes.

"Rather than attacking diabetes from the notion of only controlling A1C, the medical model of control," Engler says, "it's the notion of controlling diabetes through better food, nutrition at home the workplace and school, exercise programs that are known to impact diabetic care. It's also about better awareness. One third of folks in hospitals today have diabetes and don't know it. It is getting that knowledge base to folks to reduce the burden of diseases. It's more of a multifactorial approach rather than a clinical one-off approach to healthcare."

Engler hopes to have a road map in place as population health moves away from hospital-centric care and toward multiple community-based sites with outpatient services and wellness centers.

Seeking Value? Add Nonmedical Workers

"In five years the hospital-centric approach to healthcare will change, and it will be more and more distributed among a community of healthcare providers and wellness providers," he says.

"It is the notion that there are a lot of community resources that can be brought to bear, that hospitals don't have to do it alone, that partnerships will pay off, and that there are folks in the community that have a good role in this."