General
Term for the application of management strategies to improve healthcare delivery for populations, emphasizing achieving the highest quality at the lowest cost
Population Health Management
Term for the framework for optimizing health system performance
What is an accountable care organization (ACO)?
a collaboration of healthcare professionals— including doctors, hospitals, and other providers— that works to provide coordinated, high- quality care to Medicare patients
What is hot-spotting?
Hot spotting is a PHM practice that seeks to identify populations that are accessing the healthcare system excessively.
Term for “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health status?”
What is the difference between population health and population health management?
Population health has a broad focus on the determinants of health for a population, PHM looks at healthcare delivery for populations with the highest quality and lowest cost
What do the Triple Aim and Population Health Management have in common?
Both emphasize collaborative efforts and work to improve health experience for populations across various dimensions
What does the success of an ACO depend on?
Its systematic effort to keep the patient population as healthy as possible and to mitigate chronic disease
What is health coaching?
A PHM approach that involves engaging the people to modify their behaviors and address their health risks
What is the name of a population health management model that changes the way that primary care is delivered, based on the principles or physician-led practice, whole-person orientation, integrated and coordinated care, focus on quality and safety, and access?
Patient-Centered Medical Home
What is the difference between public health and primary care?
Primary care focuses on treating patients via medical services
Public health focuses on disease prevention and health promotion and emphasizes community efforts
List the three dimensions of the IHI Triple Aim
Improving patient experience
Improving health of populations
Reducing cost per capital
How are ACOs able to shift from the traditional acute care environment to focusing on preventative care?
The ACO must coordinate care across a range of healthcare settings.
What are health exchanges?
A marketplace that helps individuals, families, and small businesses view, compare, and purchase health insurance plans that meet government standards.
List some of the advantages of using telemedicine.
Improved access for both patients and providers, lower cost of healthcare delivery, quality of care equal to care on-site, saves time for patients
How does a population health management approach integrate public health and primary care?
It requires these systems to integrate their work with the aim of ensuring a healthy population, overcoming challenges and learning from each other
List four indicators that the IOM has developed for health systems to use in tracking their management of the health of populations
Life expectancy
Addictive behavior
Access to care
Preventative services
How can an ACO avoid unnecessary hospitalizations, prevent emergency department visits, reduce the need for expensive tests and procedures, and bring about better patient outcomes?
Through effective Population Health Management, thus why it is important that they work together
Why is there a need for cold-spotting?
By seeing where there are lack of access to health care, the population can effectively address the needs of the community to build an environment for healthy living
The PCHM model applies a proactive, team-based approach to care that focuses on prevention, early intervention, and close partnerships with patients. What is the core focus of the PCHM model?
Population Health Management - model requires patient to be viewed not only as an individual, but also as a part of a population
What are 4 core principles to include in integrating primary care and public health?
The common goal of improving population health
A focus on identifying & addressing community’s needs
Leadership commitment to bridging groups
Analyzing data in a collaborative manner with stakeholders
What are 6 considerations the IOM must take in selecting indicators?
Importance for health
Likelihood to contribute to progress
Understandability
Technical integrity
Potential to have broader system impact
Utility at multiple levels
Why must ACOs proactively reach out to patients who need preventative and chronic care?
Because while most of today’s healthcare is episodic, PHM is continuous.
What is the purpose of health exchanges?
To not only aim to increase the number of people who have health coverage, but also to provide the opportunity to educate the population about health issues.
List the five key principles of a patient-centered medical home.
Physician-led practice: Patients have access to personal physicians who lead their care team
Whole-person orientation: Comprehensive care provided including acute care, chronic care, preventive services, etc.
Integrated and coordinated care: ensure patients receive services they need in the medical neighborhood in an appropriate way
Focus on quality and safety: use of the quality improvement process and evidence-based medicine
Access: enhancing access to care