Population health management discussion

Population health envisions sustaining all members of the community at their highest possible level of functioning, both for their individual happiness and for the collective community benefit. Achieving the vision helps the community as a whole with lower healthcare costs and a larger, stronger workforce. Success in population health is measured by residents’ ability to lead a productive life, their life expectance, the incidence of preventable diseases and premature death, and disease prevention indicators such as immunization rates and the ability or support services.

The purpose of healthcare organization participating in population health management is to use the healthcare organization as a vehicle to improve the health status of its community. Many leading not-for-profit healthcare organizations are committed to population health management. Population health management is different from excellence in care, moving from process to outcome as a corporate focus. the Affordable Care Act encourages the healthcare organizations to do so. It rewards eliminating unnecessary admissions. it requires a community benefit review every three years as part of the IRS Form 990 Schedule H Community Benefit Calculations in order to retain tax exemption for the not-for-profit status.

Aligned to ULO(s)
ULO1: Differentiate between population health and population health management (CLO 4,5)

ULO2: Distinguish between the roles of the diverse partners in implementation of population health management (CLO 4,5)

ULO3: Map out plans to control the leading health conditions in the United States in general and health facilities specifically (CLO 4,5)

ULO4: Create a community health promotion program to help your facility improve their community catchment health (CLO 4,5)


You are the Director of Population Health Department of a not-for-profit healthcare system. Your department has recently conducted the Community Needs Assessment, which indicated high incidence of diabetes in the community and high frequency of outpatient doctor visits and hospital readmissions among individuals with diabetes. In grouping of disease and prevention forecasts by prevention level and service program, the report indicated that diabetes falls under the secondary prevention level (early-stage identification and elimination of disease); and examples of prevention activities include screening and dietary management.

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