Class 1

Question 1

Population Health

Answer 1

A “cohesive, integrated, and comprehensive approach to healthcare that considers the distribution of health outcomes within a population, the health determinants that influence distribution of care, and the policies and interventions that are impacted by those determinants

Question 2

Health determinants

Answer 2

The range of personal, social, economic, and environmental factors that influence health status

Question 3

Health Outcomes

Answer 3

The change in the health status of an individual or population. Example: Increase/decrease in mortality/morbidity

Question 4

Distribution of Health Outcomes

Answer 4

The differences in health status or in the distribution of health determinants between different population groups

Question 5

Goal of Population Health Management

Answer 5

To improve health outcomes of a group of individuals, including the distribution of such outcomes within the group

Question 6

Why population health?

Answer 6

U.S. health outcomes are poor despite spending the most of all industrialized countries (16.4% of GDP in 2012) on health care.

Question 7

Current system in US healthcare is not producing desirable results

Answer 7

• High Cost
• Suboptimal quality of care
• Americans not receiving needed care or treatment
• Disparities exist

Question 8

Population Health (vs Public Health)

Answer 8

A comprehensive framework for assessing and improving the health and well-being of a defined population. Focuses on specific cohort of individuals with relevant commonalities; includes, but not limited to geographical communities and people enrolled in health care organizations or health plans.
*Public Health is the entire population, whereas population health is a subset of the population.

Question 9

Public Health (vs Population Health)

Answer 9

Organized measures by societal (i.e. government) bodies to prevent disease promote health and prolong life among entire populations Often includes public policies and large scale programs on health wellness promotion such as the NYS prevention agenda.
*Public Health is the entire population, whereas population health is a subset of the population.

Question 10

Components of PHM

Answer 10

1. Care management
2. Quality/perf improvement
3. Health IT
4. Finance

Question 11

Medical care vs. environmental factors

Answer 11

Just 10% of health outcomes are attributable to medical care, while 70% are tied to social and environmental factors

Question 12

Clinically Integrated Network

Answer 12

A jointly governed group of providers including independent physicians, physician groups, employed physicians, and hospitals or health systems that work together

Question 13

CINs work together to

Answer 13

1. Develop mechanisms to monitor and improve the utilization, cost and quality of healthcare services provided
2. Develop and implement protocols and best practices
3. Furnish higher quality, more efficient care than could be achieved by working independently
4. Pool infrastructure and human and financial resources savings or financial
5. Jointly contract with commercial and government payers and employers on a shared savings or financial risk basis

Question 14

Regulations and Initiatives Promoting Population Health

Answer 14

1. DSRIP
2. MACRA
3. NYS Health Home Program
4. Bundled Payment for Care Improvement Initiative

Question 15

DSRIP

Answer 15

25% reduction in avoidable hospital use over five years

Question 16

Medicare Access and CHIP Reauthorization Act (MACRA)

Answer 16

Establishes a new way of how care is being delivered to Medicare beneficiaries through changing the reimbursement system, focusing on quality, value, and accountability

Question 17

NYS Health Home Program

Answer 17

A NYS Medicaid care management service model for members who have complex chronic conditions. All of the member’s caregivers communicate with one another so that all of a patient’s needs are addressed in a comprehensive manner

Question 18

Bundle Payments for Care Improvement (BPCI) Initiative

Answer 18

CMS Medicare initiative which bundles payments for multiple services beneficiaries receive during an episode of care. A payment arrangement that includes financial and performance accountability for an entire episode of care.

Question 19

Design thinking

Answer 19

• Learn from People
• Find Patterns
• Design Principles
• Make Tangible
• Iterate Relentlessly