Hospitals traditionally have focused on caring for individuals and personalizing care for each patient admitted to their facilities. Community health initiatives coordinated by hospitals and health systems, such as mobile vans, health screenings and educational offerings, typically are delivered apart from an overall strategy or impact analysis. Moving to a value-based system focused on reducing costs and improving quality, hospitals and health systems need to be more proactive and strategic in reaching out to patient populations beyond the hospital's walls — to manage and improve population health.

By asking the right questions and helping to establish partnerships with other sectors of the health care system, trustees can support the hospital's role in managing the health of patient populations to improve outcomes.

Questions to Ask

Thinking beyond the hospital's four walls is a "transformation for most hospital boards," says David Nash, M.D., dean of the Jefferson School of Population Health in Philadelphia and co-author of Population Health: Creating a Culture of Wellness (2010). A board member of Main Line Health in suburban Philadelphia, Nash suggests that hospital trustees start asking these questions:

  • What is our post-discharge process like?
  • How accurately are we able to track patients once they leave the hospital?
  • What is our readmission rate?
  • What is our unexpected readmission rate?
  • What are the data requirements and IT infrastructure we'll need beyond the four walls of our hospital?

Besides building infrastructure, other challenges include credentialing the appropriate providers, such as case managers and disease managers, and evaluating the populations served, Nash says. "Hospital boards will have to ask more comprehensive questions: Given the obesity rate and population we serve, what is the real impact to reduce hypertension and stroke?"

The same kinds of questions need to be asked of all the preventive areas that involve boards. "In the end, it involves education, education, education," Nash says. "I think this adds to the burden that most boards have."

Partnerships that Work

Population health resides at the intersection of three health care mechanisms: improving quality and safety, increasing care coordination and expanding preventive services. Achieving all of these goals demands greater accountability and collaboration from all parties within the health care system.

Hospital leaders point to a variety of collaborations that may help to improve population health. A 2011 survey conducted by SchellingPoint LLC and the American Hospital Association Committee on Performance Improvement asked hospital and health system CEOs with which entities they would most likely collaborate to advance population health initiatives. An overwhelming majority — 98 percent — cited the desire to work with physicians and other clinical providers. But a majority also indicated the need to explore partnerships with other clinical sites; community, public health and governmental agencies; and payers.

A new Hospitals in Pursuit of Excellence guide, "Managing Population Health: The Role of the Hospital," describes strategies and partnership opportunities to improve population health. It includes 13 case examples of different collaborations across the health care system, highlighting the partnerships' benefits despite financial challenges. Many hospitals already have been pursuing population health management to some degree, and those that have not yet done so have the tools to start. To access a free copy of the guide, go to www.hpoe.org/resources/hpoehretaha-guides/805.

Jill Seidman, M.P.H. (jseidman@aha.org), is program manager and Cynthia Hedges Greising (cgreising@aha.org) is communications specialist, both at the Health Research & Educational Trust, Chicago.