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Resource Overview

Population Health Management (PHM) is an evolving concept encompassing a suite of emerging technologies to aggregate, analyze and use data to improve clinical and financial outcomes.  PHM tools enable health centers to identify, monitor and target care to patients within a population. Resources in this section provide a conceptual foundation to help health center staff deepen their understanding of PHM and how the social determinants of health can be used to improve outcomes.

PHM and SDH Concepts and Overview Resources
Event date: 1/13/2022 2:00 PM - 3:00 PM Export event
Dashboarding Social Needs Data: Support Population Health and Advance Equitable Care through Visual Display of Social Determinants of Health
Jodie Albert

Dashboarding Social Needs Data: Support Population Health and Advance Equitable Care through Visual Display of Social Determinants of Health

HITEQ Highlights Webinar

As health centers work towards providing more patient-centered and equitable care, they are increasingly adopting standardized social needs screening tools, such as PRAPARE and others, to systematically identify the challenges patients face in managing and improving their health, such as food and housing insecurity, transportation barriers, or safety concerns.  This information can be used to make impactful care planning and programmatic changes that lead to improvements in health outcomes, resource utilization, and reimbursement.  Data dashboards help analyze social determinants of health information in visual displays that deepen insights and trigger action towards addressing patient’s social needs, improving population health, and reducing inequities in care.

This webinar provided a foundational overview of social determinants of health dashboard design and presents case studies from health centers leading the way on use of social determinants of health data dashboards to build community partnerships, improve linkages to services outside the four walls of the clinic, and demonstrate the value-based impact of social needs services in improving the health, well-being, and quality of life of communities served.  One health center shared their experience building dashboards and using them in their clinic.

 

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Acknowledgements

This resource collection was cultivated and developed by the HITEQ team with valuable contributions from the National Association of Community Health centers (NACHC) as well as HITEQ's Advisory Committee and many health centers who have graciously shared their experiences with HITEQ.

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Quadruple Aim

A Conceptual Framework

Improving the U.S. health care system requires four aims: improving the experience of care, improving the health of populations, reducing per capita costs and improving care team well-being. HITEQ Center resources seek to provide content and direction aligned with the goals of the Quadruple Aim

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