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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
Population Health Learning Network (PHLN) Toolkit

Population Health Learning Network (PHLN) Toolkit

Tools and Resources to Align Population Health Management Strategies Toward Value-Based Care and Payment

This toolkit is a compilation of tools and resources shared over the course of the Center for Care Innovation's Population Health Learning Network (PHLN) which convened 25 safety net primary care organizations over the course of two years to learn, share, build, and refine care models and implement strategies to strengthen and advance their population health management (PHM) efforts. It was designed to improve the health and well-being of more than 1.2 million Californians across this two-year program. The tools and resources that Center for Care Innovations has shared herein are intended to support other safety net clinis with PHM improvement efforts.

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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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The Quadruple Aim
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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