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
Current Population Health Management in Health Centers
HITEQ Center

Current Population Health Management in Health Centers

The Case for Implementing Population Health Management and Addressing the Social Determinants of Health

This is a 27-slide module on population health management in the Federally Qualified Health Centers (FQHCs). The module provides several examples of current initiatives that support population health management and social determinants of health as well as the use of these concept in supporting health equity in navigating the Affordable Care Act (ACA).

The module also serves to specifically outline the rationale of PHM in areas of cost efficiency, quality improvement and patient care including value-based reimbursement and risk contracts, targeting care and resources to improve outcomes, and patient engagement and care management.  

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Intended AudienceHealth Center Leadership, Health Center QI staff; Health Center IT Staff

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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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