HCI3 Exam 1 - Population Health

population health

an approach to study and improve health outcomes of a specific group of people

payers

people who have public or private health insurance or uninsured

health system

hospitalized patients, ambulatory care patients, etc.

community

people who live in an area, have certain risk factors, or diagnosed with certain conditions

primary prevention

preventing the disease before it occurs in healthy people through education

secondary prevention

detecting the disease early through screening

tertiary prevention

managing disease(s) to reduce morbidity, mortality, and to maintain quality of life

population health management (PHM)

model to save money at the population level by keeping patients as healthy as possible and avoiding preventable expenditures; optimize preventative services, identify high-risk patients, and improve disease management strategies

patient education/engagement, medication optimization/management, interdisciplinary team collaboration, addressing health disparities, data analysis/improvement, and technology/care model innovation

pharmacists' services in population health include

clinical pharmacist interventions (CPI)

pharmacist-initiated actions that directly result in patient management or drug therapy changes

value-based care (VBC)

focuses on quality care, provider performance, and the patient experience

value proposition

clear statement that explains the benefits a company offers to its customers and answers "why should a customer choose your product over others?"

quality measures

quantifiable standards developed to measure the quality of healthcare provided

hospital level quality indicators

support internal quality improvement, monitoring, and assessment of ADEs related to patient safety and reflect inpatient quality of care

geographic level quality indicators

identify and evaluate access to outpatient care and provides insight into the health of the community and community-based healthcare systems

area level quality indicators

used as a "screening tool" flagging potential healthcare access problems or population health concerns in a defined area; often work with public health agencies, states, healthcare systems, and organizations to improve healthcare quality

healthcare effectiveness data and information set (HEDIS)

standardized performance measurement of health plans icluding commercial, Medicare, and Medicaid; maintained by the NCQA

effectiveness of care, access of care, experience of care, utilization and risk-adjusted utilization, health plan descriptive information, and measures collected using electronic clinical data systems

six core domains of HEDIS measures

prevention measure

proportion of eligible members who received preventative services such as childhood immunization status, flu vaccinations, breast cancer screening, and controlling high BP

treatment measure

proportion of eligible members who received recommended care for certain conditions such as pharmacotherapy management of COPD exacerbation, pharmacotherapy for opioid use disorder, or osteoporosis testing and management in older women

CMS star ratings

rate the qualitiy of Medicare Advantage and Medicare Prescription drug plans (part C and/or part D) on a scale of 1-5; determine rebate amounts

outcomes, intermediate outcomes, patient experience, access, and process

five broad categories of CMS star ratings

outcomes

reflect improvements in a beneficiary's health and are central to assessing quality of care

intermediate outcomes

reflect actions taken that can assist in improving a beneficiary's health status

patient experience

reflect beneficiary's perspectives of the care they received

access

reflect processes and issues that could create barriers to receiving needed care

process

capture the healthcare services provided to the beneficiaries which can assist in maintaining, monitoring, and improving their health status