How we achieve population health in our communities and within our organization

I was welcomed to the Providence family. Over that time, we have solidified our organizational focus on population health. We have put together a team charged with shifting our entire business model to lead the way toward improving health outcomes, access and affordability for everyone.

Many of our caregivers (all employees) had questions about this new, and sometimes complex, undertaking. Below are some of the answers I shared to their most frequent questions. 


Rhonda Medows, M.D., executive vice president
Population Health

What is population health?

Population health is about caring for whole populations (groups of people) to improve the health and well-being of everyone, regardless of payer and care setting. It focuses on addressing health patterns within a specific group of people to prevent illness, promote wellness, as well as take care of people when they are sick.

Who makes up a population?

Everyone. Groups are made up of individuals and every individual counts. A population may be defined by geography, health status, payer, literacy and other social factors that tie together a specific group of people.

While care teams will continue to take care of individual patients, population health introduces an additional concept of care where we track and measure group, or population, outcomes. This approach helps us know if we are making a difference in the communities we serve.

When will we shift to population health?

Population health is taking place now across the entire organization. We are aligning with national health care changes designed to dramatically improve the U.S. health system. The entire health care industry is moving away from fee-for-service to performance-based, connected care that improves health outcomes for everyone. National payment changes for our Medicare (elderly) populations are rapid and will have an impact on our whole organization. And, strategic discussions for state-funded Medicaid (low-income) populations and commercial (private insurance) payers are following suit.

How can we achieve success in population health?

By ensuring everyone knows they play a role
Working together as an aligned team – from our clinicians to our shared services caregivers – enables our organization to shift from delivering “health care” to supporting “health.” 

Clinical caregivers play the key role of providing care across the full spectrum – from birth to end of life. We must cultivate alignment between all of our care teams to provide value-based, connected care across each person’s lifespan.

Our health plan also play a role. When we pay for care, we have a vested interest and the ability to improve care coordination, health outcomes and keep costs down. We will be able to break the constraints of fee-for-service payment models, and be better aligned with our clinics and hospitals to invest in preventative care and quality.

By knowing our populations
To actively improve health outcomes, we are assessing population needs based on geography, health status, payer, literacy and other social factors that determine health (income, education, housing). We are developing innovative solutions to provide better access to appropriate services (care setting, resources, tools) to our defined populations that will empower people to manage their health and well-being. And, at the right time, right place and at the right cost.

By improving health outcomes
We are cultivating proactive clinical and administrative interventions aimed at decreasing episodic, fragmented care. We are already investing in systems to support population health care management and care coordination that focuses on prevention and wellness.

By lowering cost
Today, much of how our organization is paid is based on individual health care encounters we have with patients. Government payers (like Medicare) and commercial insurers are increasingly paying us for quality care and our ability to manage the total cost of care a person receives. Our Mission already encourages us to provide best-in- class care that is affordable and accessible to everyone.