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Population Health a Strong Focus of VITAL2016

This year’s annual meeting, VITAL2016, focused heavily on an emerging issue for health care and hospital systems: population health.

Hospital-driven population health initiatives target the social determinants of health for individuals and communities. Those social determinants can include housing instability, food insecurity, employment and income, the built environment  the physical aspects of an area, such as buildings, homes, infrastructure, and open spaces  and many more.

The common thread of population health that ran through many VITAL206 sessions, including in the Innovation and Adaptation, Clinical Leadership, and Executive Leadership program tracks, reflected the priority America’s Essential Hospitals has put on sharing strategies to meet patient’s social needs.

Innovation and Adaptation

In this track, attendees heard how Cook County Health & Hospital System (CCHHS), in Chicago, has reduced food insecurity. In a session titled Food as Medicine: Food Insecurity and Health Care, CCHHS Policy Director Kathy Chan shared lessons from the health systems’ innovative work, including

  • a two-question screening tool to identify food-insecure patients;
  • a partnership with a regional food bank;
  • connecting patients with food assistance programs and other benefits; and
  • a culinary and nutritional education pilot program.

In a session titled Beyond Medical Care: Improving Value via Population Health, speakers from Erlanger Health System, in Chattanooga, Tenn., and Jersey City Medical Center – RWJBarnabas Health, in Jersey City, N.J., spoke about how their population health practices grew from their mission to care for the most vulnerable. This session covered the role of socioeconomic barriers, how to establish coalitions, best practices in patient engagement, the use of risk stratification, and the impact of population health initiatives in rural settings.

In a third session in this track, titled Addressing the Non-Medical Needs of Patients, speakers from the Medical University of South Carolina, in Charleston, shared successes from Coastal Connections, a volunteer-run program for patients’ non-medical needs. Attendees learned about how the program connects patients with university students who can help with specific needs, as well as the successes of forming partnerships with community organizations and helping hundreds of patients throughout South Carolina.

Clinical Leadership

In Addressing Patients’ Social Needs: A New Standard of Care, Susan Kansagra, MD, assistant vice president of population health at NYC Health + Hospitals, in New York, led attendees through a discussion of the evidence for addressing patients’ social needs and how this relates to a national shift toward value-based care. Further, Kansagra shared her insights from NYC Health + Hospitals, which is pursuing and piloting specific strategies in this area.

Executive Leadership

A session titled Working in Partnership for a Healthier Community highlighted the West Baltimore Primary Care Access Collaborative, a partnership between Bon Secours Baltimore Health System and 15 community partners. Attendees learned about the initiative’s strategies to reduce health disparities, improve health care access, reduce costs, and expand the primary care/community health workforce within the Baltimore community. Specific strategies included hiring community health workers, reducing inappropriate emergency department use, supporting a pipeline to health careers through scholarships, and offering fitness and nutrition classes.

Overall, these sessions created a stream of population health discussions throughout VITAL2016. Population health also was the focus of numerous posters presented during the conference, and two association members received Gage Awards for their work in population health.

America’s Essential Hospitals and its research and quality arm, Essential Hospitals Institute, continue to compile resources and information on population health.


About the Author

Janelle Schrag is a senior program analyst with America's Essential Hospitals.

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