Medical home must-dos for population health management

The growing population health movement has led insurers and providers to patient-centered medical homes (PCMH), accountable care organizations and other integrated care models to improve the outcomes and reduce the costs for patient populations.

But throwing around buzzwords like medical homes isn't enough to better manage population health. In this special report, FierceHealthPayer spoke with healthcare leaders from hospitals and insurance companies to identify essential ingredients for successful population health management. 

In trying to better align payment and care for patient populations, healthcare organizations need to take a public health approach and truly look at the entire population and their needs.
"Everybody needs clean air to breathe, everyone needs clean water to drink," Jeff Harness (pictured left), director of integrated care and population health at Cooley Dickinson Health Care, Northampton, Mass., told FierceHealthPayer in an exclusive interview. Cooley Dickinson is working toward PCMH status for all of its primary care practices.

Connected to its medical home goals is Cooley Dickinson's integrated care management program for chronically ill patients. That program includes a social worker so patients who have serious social issues--unstable housing, inability to afford utility bills--have someone to help them find resources they're eligible for and figure out other ways to get their needs met, Harness said.