Models for Population
Health Improvement by Health
Care Systems and Partners

Tensions and Promise on the Path Upstream

PROCEEDINGS OF A WORKSHOP

Melissa Maitin-Shepard, Rapporteur

Roundtable on Population Health Improvement

Board on Population Health and Public Health Practice

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

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This activity was supported by contracts between the National Academy of Sciences and the Association of American Medical Colleges, Blue Cross and Blue Shield of North Carolina, The California Endowment, Dartmouth-Hitchcock, Geisinger, Kaiser Permanente, The Kresge Foundation, Nemours, The Rippel Foundation/ReThink Health, Robert Wood Johnson Foundation, U.S. Department of Health and Human Services’ Program Support Center, and Wake Forest Baptist Health. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-26532-4
International Standard Book Number-10: 0-309-26532-0
Digital Object Identifier: https://doi.org/10.17226/26059

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Copyright 2022 by the National Academy of Sciences. All rights reserved.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Models for population health improvement by health care systems and partners: Tensions and promise on the path upstream: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26059.

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PLANNING COMMITTEE ON HEALTH CARE SYSTEM APPROACHES TO POPULATION HEALTH: TENSIONS AND PROGRESS¹

MARC N. GOUREVITCH (Chair), Chair, Department of Population Health, New York University Langone Health

PHILIP M. ALBERTI, Senior Director, Health Equity Research and Policy, Association of American Medical Colleges

SALLY A. KRAFT, Vice President of Population Health, Dartmouth-Hitchcock Medical Center

SANNE MAGNAN, Senior Fellow, HealthPartners Institute

RAHUL RAJKUMAR, Senior Vice President and Chief Medical Officer, Blue Cross and Blue Shield of North Carolina

LOURDES J. RODRÍGUEZ, Senior Program Officer, St. David’s Foundation

Health and Medicine Division Staff

ALINA BACIU, Roundtable Director

CARLA ALVARADO, Program Officer (until January 2021)

BRITTANY DAVENPORT, Senior Program Assistant (until December 2019)

HARIKA DYER, Senior Program Assistant (from April 2020)

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¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop Series rests with the workshop rapporteur and the institution.

ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT¹

SANNE MAGNAN (Co-Chair), Senior Fellow, HealthPartners Institute; Adjunct Assistant Professor, Division of Medicine, University of Minnesota

JOSHUA M. SHARFSTEIN (Co-Chair), Associate Dean for Public Health Practice and Training, Johns Hopkins Bloomberg School of Public Health

PHILIP M. ALBERTI, Senior Director, Health Equity Research and Policy, Association of American Medical Colleges

JOHN AUERBACH, Executive Director, Trust for America’s Health

CATHY BAASE, Chair, Board of Directors, Michigan Health Improvement Alliance; Consultant for Health Strategy, The Dow Chemical Company

RAYMOND BAXTER, President and Chief Executive Officer, Blue Shield of California Foundation

DEBBIE I. CHANG, Senior Vice President, Policy and Prevention, Nemours

MARC N. GOUREVITCH, Professor and Chair, Department of Population Health, New York University Langone Health

GARTH GRAHAM, President, Aetna Foundation

GARY R. GUNDERSON, Vice President, Faith Health, School of Divinity, Wake Forest University

WAYNE JONAS, Executive Director, Integrative Health Programs, H&S Ventures, Samueli Foundation

ROBERT M. KAPLAN, Professor, Center for Advanced Study in the Behavioral Sciences, Stanford University

DAVID A. KINDIG, Professor Emeritus of Population Health Sciences, Emeritus Vice Chancellor for Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison

MICHELLE LARKIN, Associate Vice President, Associate Chief of Staff, Robert Wood Johnson Foundation

PHYLLIS D. MEADOWS, Senior Fellow, Health Program, The Kresge Foundation

BOBBY MILSTEIN, Director, ReThink Health

JOSÉ T. MONTERO, Director, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention

KAREN MURPHY, Executive Vice President and Chief Innovation

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¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.

Officer, Founding Director, Steele Institute for Healthcare Innovation, Geisinger

RAHUL RAJKUMAR, Senior Vice President and Chief Medical Officer, Blue Cross and Blue Shield of North Carolina

LOURDES J. RODRÍGUEZ, Director, Center for Place-Based Initiatives, Dell Medical School; Associate Professor, Department of Population Health, The University of Texas at Austin

PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation

MYLYNN TUFTE, State Health Officer, North Dakota Department of Health

HANH CAO YU, Chief Learning Officer, The California Endowment

Health and Medicine Division Staff

ALINA BACIU, Roundtable Director

CARLA ALVARADO, Program Officer

BRITTANY DAVENPORT, Senior Program Assistant (until December 2019)

HARIKA DYER, Senior Program Assistant (from April 2020)

Consultant

MELISSA MAITIN-SHEPARD, Rapporteur

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Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by GEORGE J. ISHAM, HealthPartners Institute. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.

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Contents

ACRONYMS AND ABBREVIATIONS

1 INTRODUCTION

Workshop Objectives

Organization of the Workshop and Proceedings

A Metaphor for Framing the Workshop

2 OVERVIEW OF THE LANDSCAPE: TENSIONS AND PROMISE

Activities in the Health Care Sector to Improve Social Care and Strengthen Social Resources

Opportunities for Health: Addressing Social Determinants of Health

Audience Discussion

3 HOW LEADERSHIP AND ORGANIZATIONAL STRUCTURE CAN ADDRESS HEALTH-RELATED SOCIAL NEEDS AND ADVANCE HEALTH EQUITY

Redesigning a Health System to Create Well Communities

Enterprise-Wide Infrastructure to Advance Health Equity

Audience Discussion

4 DOWNSTREAM: ADDRESSING PATIENTS’ HEALTH-RELATED SOCIAL NEEDS

Rush System for Health: A Case Study for Health Equity

Many Voices: One West Side

Audience Discussion

5 MIDSTREAM: ACCOUNTABLE HEALTH COMMUNITIES AND PARTNERSHIPS WITH HUMAN SERVICES ORGANIZATIONS

The Denver Regional Accountable Health Community

Partnerships with Area Agencies on Aging and Other Community-Based Organizations

Audience Discussion

6 UPSTREAM: CHANGING ENVIRONMENTS, CHANGING POLICY

Policy and Environmental Changes to Improve Health in Klamath County, Oregon

Changing the Environment to Promote Health Outside the Four Walls of the MD Anderson Cancer Center

Audience Discussion

7 SMALL-GROUP INTERACTIVE EXERCISE: UP/MID/DOWNSTREAM PARADIGMS IN ADVANCING POPULATION HEALTH AND HEALTH EQUITY

Instructions

Report Back

8 FINAL REFLECTIONS

APPENDIXES

A References

B Workshop Agenda

C Biographical Sketches of Presenters and Moderators

D Small-Group Exercise: Up/Mid/Downstream Paradigms in Advancing Population Health and Health Equity

Acronyms and Abbreviations