1. Population Health Strategies in Rural Hospitals Pam Halverson, Regional Vice President, Clinic Operations, UnityPoint Clinic and Executive Sponsor for the Trinity Pioneer ACO and Edith Parker, Professor and Head, Community and Behavioral Health

2. Definitions of “Population Health” “the health outcomes of a group of individuals, including the distribution of such outcomes within the group, and we argue that the field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two. Kindig and Stoddart, 2003

3. What Does It Take to Improve Population Health?

4. 1. Think Ecologically About Determinants and Interventions Policy Community Organization/Institution Interpersonal/Family/Friends Individual/”Patient” What are the determinants of disease at these levels? What are possible interventions and partners at these levels?

5. Int Patient Policy Making Entities Community Factors and Organizations Work/School Clinicians/Clinics Family/Friends/Neighbors Patient –Centered Ecological Framework for Childhood Asthma

6. 2. Collect Data Beyond the Clinic and Focusing on the Population Longitudinal Assessments that Identify current status and measure change Assessments that include the social determinants of health as well as outcomes.

7. 3. Prevention, Prevention, Prevention Focus on Primary as Well as Secondary and Tertiary Prevention Remember Universal, Selected and Indicated Strategies for Prevention

8. Targeting Prevention- Strategies Universal (everyone) Selected (those with known risk) Indicated (health problem already experienced)

9. 4. There Are Examples of Evidence- Based Interventions to Change Health Behaviors Examples exist for all levels of the Ecological Framework Some are clinic focused but others happen outside of the clinic, and use selected or targeted approaches. Community Preventive Services Task Force: http://www.thecommunityguide.org/index.html

10. It takes a community…. Importance of coalitions, collaboratives, harnessing all sectors – Partnering with Health Departments, Community Agencies on Health Assessments – Organizations partnering to address Social Determinants and Thinking Out of the Box: -Farmer’s Markets at FQHCs