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Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
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Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
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Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
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Page 69
Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
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Page 70
Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
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Page 71
Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
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Page 72
Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
×
Page 73
Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
×
Page 74
Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
×
Page 75
Suggested Citation:"Appendix C: Biographical Sketches of Presenters and Moderators." National Academies of Sciences, Engineering, and Medicine. 2021. 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. doi: 10.17226/26059.
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Page 76

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Appendix C Biographical Sketches of Presenters and Moderators1 Philip Alberti, Ph.D.,*† is the senior director for health equity research and policy at the Association of American Medical Colleges (AAMC). Dr. Alberti supports the efforts of academic medical centers to build an evi- dence base for effective programs, protocols, and partnerships aimed at ameliorating inequalities in health and health care through research. Dr. Alberti is responsible for working with AAMC’s constituents to elevate the status of community-partnered and health equity–related research efforts, identifying emerging funding sources and policy implications for such projects, and disseminating findings to achieve the broadest possible impact. Prior to joining AAMC in 2012, Dr. Alberti led research, evalua- tion, and planning efforts for a Bureau within the New York City Depart- ment of Health and Mental Hygiene that works to promote health equity between disadvantaged and advantaged neighborhoods. Dr. Alberti holds a Ph.D. in sociomedical sciences from the Columbia University Mailman School of Public Health and was a National Institute of Mental Health fellow in the Psychiatric Epidemiology Training program. Benjamin Carter, M.B.A., is the executive vice president, the chief finan- cial officer, and the treasurer at Trinity Health. He has extensive knowl- edge of the organization, having led all aspects of the finance, treasury, risk management, revenue excellence, and payer strategies areas across the system. Additionally, he maintains operational responsibilities for 1 * denotes planning committee member; † denotes roundtable member. 67 PREPUBLICATION COPY—Uncorrected Proofs

68 MODELS FOR POPULATION HEALTH IMPROVEMENT several ministries and has ongoing responsibility for integrating new ministries into the system. Prior to joining Trinity Health, Mr. Carter served as the executive vice president and the chief operating officer of the Detroit Medical Center (DMC), where he was responsible for the operations of the regional sys- tem’s eight hospitals and related outpatient facilities. During his tenure there, he was instrumental in DMC’s financial turnaround, which resulted in 6 consecutive years of profitability. He led key growth, cost reduction, and profit initiatives in multiple service lines. Prior to leading DMC operations, Mr. Carter spent nearly 17 years in executive-level positions at Oakwood Healthcare in Dearborn, Michigan. He started his career at Plante Moran in Southfield, Michigan, where he worked for 8 years. Throughout his career, Mr. Carter has served on many internal and external boards including Care Tech Solutions, Inc., DMC Care Express, Invest Michigan Advisory Board, Boys Hope Girls Hope of Detroit, and was appointed the co-chair of Governor Rick Snyder’s task force on Responsible Retirement Reform for Local Government. He is a member of the American Institute of Certified Public Accountants, the Michigan Association of Certified Public Accountants, and the Healthcare Financial Management Association. Mr. Carter is an alumnus of the University of Michigan in Ann Arbor, where he graduated magna cum laude with m ­ aster’s and bachelor’s degrees in business administration. Jennifer Cofer, M.P.H., is the director of the EndTobacco Program and Cancer Prevention Policy at the University of Texas MD Anderson Cancer Center. Employing more than 18 years of experience in public health and tobacco control, she collaborates with internal and external partners to promote tobacco control initiatives and evidence-based best practices in policy, prevention, and cessation. She is a member of the American Public Health Association and the current chair-elect of the Cancer Alliance of Texas. Ms. Cofer holds a bachelor’s in health education and an M.P.H., both from the University of Southern Mississippi. She has been a certified health education specialist for 20 years. A. J. Diamantopoulos is the accountable health communities man- ager for the Denver Regional Council of Governments Area Agency on Aging. He leads the team working with clinical and community pro- viders to demonstrate the critical link between better health outcomes and increased access to community-based services. Mr. Diamantopoulos ­ earned a master’s degree in health and health care policy from the U ­ niversity of Denver. PREPUBLICATION COPY—Uncorrected Proofs

APPENDIX C 69 Laura Gottlieb, M.D., M.P.H., is an associate professor of family and community medicine at the University of California, San Francisco (UCSF). A former National Health Services Scholar and safety-net ­ amily f physician with fellowship training in social determinants of health, Dr. Gottlieb now serves as the principal investigator on multiple quantita- tive and qualitative projects examining the integration of social and medical care services. These projects range from large randomized trials on specific interventions undertaken in clinical settings to ­ rojects that p explore the scope of this rapidly evolving field, including by character- izing the payment, technology, and workforce foundation for care inte- gration. She is the founding director of the Social Interventions Research and Evaluation Network, a national research acceleration and translation institute supported by Kaiser Permanente and the Robert Wood Johnson ­ Foundation (RWJF) that brings together researchers across the United States to synthesize, disseminate, and catalyze research at the inter­ section of social and medical care. Dr. Gottlieb is also the associate director of the RWJF National Program Office Evidence for Action grants program based at UCSF. She completed her M.D. at the Harvard Medical School and both her M.P.H. and residency training at the University of Washington. Dr. Gottlieb is affiliated with the UCSF Center for Health and Community. Marc Gourevitch, M.D., M.P.H.,† is the Muriel G. and George W. Singer Professor and the founding chair of the Department of Population Health at New York University (NYU) Langone Medical Center. The focus of Dr. Gourevitch’s work is on developing approaches that leverage both health care delivery and policy- and community-level interventions to advance the health of populations. Dr. Gourevitch leads initiatives in urban health metrics, is the co-director of the Community Engagement and Population Health Research Core of the Clinical and Translational Science Institute that bridges NYU Langone and New York City (NYC) Health+Hospitals, and leads NYU Langone’s participation in the NYC Clinical Data Research Network funded by the Patient-Centered Outcomes Research Institute. His research centers on improving health outcomes among drug users and other underserved populations, integrating pharmacologic treat- ments for opioid and alcohol dependence into primary care, and devel- oping strategies for bridging academic research with applied challenges faced by health care delivery systems and public sector initiatives. Dr. Gourevitch previously served as the founding director of NYU Langone’s Division of General Internal Medicine and led NYU Langone’s Centers for Disease Control and Prevention–funded Fellowship in Medicine and Public Health Research. A graduate of Harvard College and the Harvard Medical School, he trained in primary care/internal medicine at NYU and PREPUBLICATION COPY—Uncorrected Proofs

70 MODELS FOR POPULATION HEALTH IMPROVEMENT Bellevue Hospital and received his M.P.H. from the Columbia University Mailman School of Public Health. Ernest Hawk, M.D., M.P.H., is the vice president and the division head for cancer prevention and population sciences at the University of Texas MD Anderson Cancer Center and holds the T. Boone Pickens Distin- guished Chair for Early Prevention of Cancer. Additional responsibilities include leadership of the Duncan Family Institute for Cancer Prevention and Risk Assessment and co-leadership of MD Anderson’s Cancer Pre- vention and Control Platform, which advances community health promo- tion and cancer control through evidence-based public policy, public and professional education, and community-based service implementation and dissemination. A native of Detroit, Michigan, Dr. Hawk earned his bachelor’s degree and M.D. at Wayne State University and his M.P.H. at Johns Hopkins University. He completed an internal medicine internship and residency at Emory University, a medical oncology clinical fellowship at the Uni- versity of California, San Francisco, and a cancer prevention fellowship at the National Cancer Institute (NCI). Prior to his appointment at MD Anderson in December 2007, Dr. Hawk held several positions at NCI in Bethesda, Maryland. He most recently served as the director of the Office of Centers, Training and Resources, responsible for NCI’s cancer centers program, a major translational science program (i.e., the SPORE program), NCI’s extramural training enterprise, and its extramural disparities portfolio. His prior NCI posts included the chief and medical officer in the Gastrointestinal and Other Cancers Research Group, the medical officer in the Chemo­ revention Branch, and p the chair of the Translational Research Working Group. Dr. Hawk has been involved in a wide range of preclinical and clini- cal chemoprevention research, including developmental studies of non­ steroidal anti-inflammatory drugs, COX-2 inhibitors, and preventive agent combinations in high-risk cohorts. He earned numerous awards for his work, including the NCI Research Award for Distinguished Achieve- ment in Cancer Prevention, the Distinguished Alumnus Award, and the American Society of Clinical Oncology/American Cancer Society Award. Most recently, his interests have broadened to include improvement of minority and underserved populations’ participation in clinical research, and the integration of risk assessment, behavioral science, and preven- tive strategies developed through sequential clinical trials for applica- tion in clinical or public health settings. He has published more than 175 scientific articles and book chapters, edited 3 books, serves as the senior deputy editor for Cancer Prevention Research, and is on the editorial board of Cancer Medicine. PREPUBLICATION COPY—Uncorrected Proofs

APPENDIX C 71 Jessie Hecocta is an enrolled member of the Klamath Tribes and is cur- rently the relationship manager for the Blue Zones Project. Ms. Hecocta’s education and passion for well-being has led her to become a team mem- ber of Blue Zones Project-Healthy Klamath. Ms. Hecocta has been driving the adoption of comprehensive well-being practices within a wide range of organizations for the Blue Zones Project since its launch in 2015. Ms. Hecocta’s favorite principle from the Blue Zones Project is Right Outlook, which encompasses both downshifting and purpose; “taking the time to find your sense of purpose or best self takes quiet, reflection, and internal searching.” Darlene Oliver Hightower, J.D., is responsible for the implementation and evaluation of community programs aimed to improve the health of individuals in the Rush University Medical Center’s (Rush’s) commu- nity areas. She oversees the Office of Community Engagement, which includes three school-based health clinics; Rush University community outreach programs, community benefit reporting, and Rush’s cradle-to- career health care pipeline programs. Ms. Hightower is also a member of the senior leadership team for West Side United, a cross-sector, collective impact collaborative aimed at improving health and economic vitality on the West Side of Chicago. Prior to joining Rush, Ms. Hightower was the national vice president of programs for Public Allies, Inc. She is a Chicago Community Trust Leadership Fellow, a University of Chicago Civic Leadership Academy Fellow, and an Administrative Law Judge for the Chicago Department of Human Relations. Ms. Hightower attended Bradley University (graduating with high honors) and received her law degree from Georgetown University Law Center in Washington, DC. Ayesha Jaco is a philanthropist, an educator, a choreographer, and the co-founder of M.U.R.A.L. (formerly the Lupe Fiasco Foundation). She has partnered with many Chicago-based organizations to provide com- prehensive social services, substance abuse prevention, food equity, and study abroad and artistic programming for more than 18,500 inner-city youth and their families. In 2008, Ms. Jaco founded the youth dance com- pany Move Me Soul and has provided more than 1,000 Chicago teens and young adults with professional dance training and life skill development. Currently, Ms. Jaco is a faculty member at the Northeastern Illinois University Jacob Carruthers Center for Inner-City Studies. She was fea- tured in Hype Magazine South Africa for her artistic prowess and youth work and she was recently awarded the Power 25 Chicago Award by Walker’s Legacy for her commitment to excellent leadership, commu- nity achievements, and philanthropic contributions. Ms. Jaco holds a B.S. in dance and mass communication from Illinois State University and a PREPUBLICATION COPY—Uncorrected Proofs

72 MODELS FOR POPULATION HEALTH IMPROVEMENT m ­ aster of arts management (arts in youth and community development) from Columbia College Chicago. Sally Kraft, M.D., M.P.H.,* is the vice president of population health at Dartmouth-Hitchcock, where she leads a multidisciplinary team dedi- cated to improving the health of populations and communities across the region served by Dartmouth-Hitchcock faculty and affiliates. She has worked with the High Value Healthcare Collaborative on disseminating evidence-based practices in health systems across the United States. Dr. Kraft served as the medical director of quality, safety, and innovation at the University of Wisconsin Health system from 2007 to 2014, where she led system-wide initiatives to redesign ambulatory care. She received her M.D. and M.P.H. from the University of Michigan, completed a resi- dency in internal medicine at the Santa Clara Valley Medical Center, and fellowships in pulmonary and critical care medicine at Stanford Univer- sity. She has practiced pulmonary and critical care medicine in Stanford, C ­ alifornia, and Madison, Wisconsin. Jennifer Little, M.P.H., was born and raised in Fort Collins, Colorado. She earned a bachelor’s degree in human development and family studies­ with a focus on healthy aging from Colorado State University. She then went on to earn her M.P.H. from Oregon State University. Ms. Little started her public health career as a tobacco prevention and education coordinator for Klamath County Public Health. She then worked for a nonprofit hospital system, Sky Lakes Medical Center, and helped develop a population health management program that utilized community health workers. Ms. Little then returned to Klamath County Public Health as the director. Ms. Little has a passion for public service and serves as the chair of the Community Advisory Council, the chair of the Blue Zones Project Built Environment Committee, and sits on the board of the Klamath Basin Senior Citizens’ Center. Sanne Magnan, M.D., Ph.D.,*† is the co-chair of the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine. She is the former president (2006–2007) and the chief executive officer (2011–2016) of the Institute for Clinical Sys- tems Improvement. In 2007, she was appointed the commissioner of the ­ innesota Department of Health by Minnesota Governor Tim Pawlenty. M She served from 2007 to 2010 and had significant responsibility for the implementation of Minnesota’s 2008 health reform legislation, includ- ing the Statewide Health Improvement Program, standardized quality reporting, development of provider peer grouping, certification process for health care homes, and baskets of care. PREPUBLICATION COPY—Uncorrected Proofs

APPENDIX C 73 Dr. Magnan was a staff physician at the Tuberculosis Clinic at St. Paul–Ramsey County Department of Public Health (2002–2015). She was a member of the Population-based Payment Model Workgroup of the Healthcare Payment Learning and Action Network (2015–2016) and a member of the Centers for Medicare & Medicaid Services’ Multi-sector Collaboration Measure Development Technical Expert Panel (2016). She is on Epic’s Population Health Steering Board and on Healthy People 2030 Engagement Subcommittee. She served on the board of MN Community Measurement and the board of NorthPoint Health & Wellness Center, a federally qualified health center and part of Hennepin Health. Her previous experience also includes the vice president and the medical director of Consumer Health at Blue Cross and Blue Shield of Minnesota. Currently, she is a senior f ­ ellow with HealthPartners Institute and an adjunct assistant professor of medicine at the University of Minnesota. Dr. Magnan holds an M.D. and a Ph.D. in medicinal chemistry from the University of Minnesota and is a board-certified internist. Benjamin Money, M.P.H., joined the Department of Health and Human Services in 2019 as the deputy secretary for health services. Mr. Money previously served as the president and the chief executive officer of the North Carolina Community Health Center Association (NCCHCA), serv- ing the 41 community health centers in the state. He led NCCHCA during a 10-year period of unprecedented growth in organizations, clinical sites, and patients served. In this role, Mr. Money was a member of the boards of the North Carolina (NC) Institute of Medicine, the NC Health Care Quality Alliance, the NC Health Information Exchange Advisory Board, the NC Safety-net Advisory Council, the Care Share Health Alliance, and the public health practice advisory committees for both the East Carolina Brody School of Medicine and the Gillings School of Global Public Health at the University of North Carolina (UNC) at Chapel Hill. Mr. Money’s 36-year career in health care began in community mental health and includes 11 years in local public health and 18 years with com- munity health centers. He holds a master’s degree in public health nutri- tion from UNC at Chapel Hill and he brings deep knowledge of health and North Carolina coupled with rich and varied leadership experience, passion, and vision. Rahul Rajkumar, M.D., J.D.,*† is the senior vice president and the chief medical officer at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Dr. Rajkumar came to Blue Cross NC after serving as the chief medical officer and the senior vice president for CareFirst BlueCross BlueShield. At CareFirst he developed and led programs addressing costs PREPUBLICATION COPY—Uncorrected Proofs

74 MODELS FOR POPULATION HEALTH IMPROVEMENT and health care improvement. These include initiatives related to model physician practices known as patient-centered medical homes, behavioral health, telemedicine, and substance abuse treatment. Before joining CareFirst, Dr. Rajkumar served for 4 years as the deputy ­ director of the Center for Medicare & Medicaid Innovation. He led federal efforts to promote value-based payments for physicians and hospitals, resulting in signing tens of thousands of agreements with providers worth billions of dollars. He also oversaw programs promoting primary care, the initial federal pilots for accountable care organizations, bundled pay- ments for health care procedures, and patient safety initiatives. Dr. Rajkumar has a bachelor’s degree in history, a law degree, and a medical degree, all from Yale University. During his work at CareFirst and the federal government, he has worked as an attending physician at the Veterans Affairs Hospital in Washington, DC. Lourdes Rodriguez, Dr.P.H.,*† serves as the director of Community-Driven ­ Initiatives at the Dell Medical School at The University of Texas at ­ ustin. A She works on community-engaged research and practice projects that build on ideas elicited from community colleagues. Previously, she served as a program officer at the New York State Health Foundation. From 2004–2012, she was a faculty member of the Columbia University M ­ ailman School of Public Health. Dr. Rodriguez received a B.S. in indus- trial biotechnology from the University of Puerto Rico at Mayagüez, an M.P.H. from the University of Connecticut, and a Dr.P.H. from Columbia University. Marisa Scala-Foley, M.S., is the director of the Aging and Disability Business Institute at the National Association of Area Agencies on Aging, which provides community-based organizations with the tools and resources to successfully adapt to a changing health care environment, enhance their organizational capacity, and capitalize on emerging oppor- tunities to diversify funding. Recently, she served as the director of the Office of Integrated Care Innovations in the Center for Integrated Programs at the Administration for Community Living, where she managed the agency’s efforts to build the capacity of state and community-based organizations for delivery sys- tem reform. Before that, she helped found and lead the Center for Benefits Access at the National Council on Aging. Ms. Scala-Foley has worked her entire career in the field of aging on issues related to health care and long-term services and supports. She holds a master’s degree in gerontological studies from Miami University (Ohio) and a bachelor’s degree in sociology/gerontology from the College of the Holy Cross in Worcester, Massachusetts. PREPUBLICATION COPY—Uncorrected Proofs

APPENDIX C 75 Joshua Sharfstein, M.D.,† is the vice dean for public health practice and community engagement and a professor of the practice in health policy and management at the Johns Hopkins Bloomberg School of ­ ublic Health. He is also the director of the Bloomberg American P Health Initiative. Previously, Dr. Sharfstein served as the secretary of the M ­ aryland Department of Health and Mental Hygiene, as the principal deputy commissioner of the Food and Drug Administration, and as the health ­commissioner of Baltimore City. In these positions, he pursued creative solutions to longstanding challenges, including drug overdose deaths, infant mortality, unsafe consumer products, and school failure. He is an elected member of the National Academy of Medicine and the National Academy of Public Administration. Consuelo H. Wilkins, M.D., MSCl, is the executive director of the Meharry-Vanderbilt Alliance and an associate professor of medicine at both the Vanderbilt University Medical Center (VUMC) and the Meharry Medical College. As the director of the Engagement Core of the All of Us Research Program (a component of the Precision Medicine Initiative), Dr. Wilkins oversees initiatives that meaningfully engage research partici- pants in the governance, oversight, implementation, and dissemination of the program. She has pioneered methods of stakeholder engagement that involve community members and patients in all stages of biomedical and health research. Dr. Wilkins is currently a principal investigator of two National Insti- tutes of Health–funded centers: (1) the Vanderbilt-Miami-Meharry Center of Excellence in Precision Medicine and Population Health, which focuses on decreasing disparities among African Americans and Latinos using precision medicine, and (2) the Vanderbilt Recruitment Innovation Center, a national center dedicated to enhancing recruitment and retention in clin- ical trials. She is widely recognized for her work in stakeholder and com- munity engagement and has pioneered methods of stakeholder engage- ment that involve community members and patients in research across the translational spectrum. One approach is the Community Engagement Studio—a model of engagement that can be used to elicit project-specific input from patients and communities at any stage of clinical or transla- tional research. Prior to joining the faculty at VUMC in 2012, Dr. Wilkins was an asso- ciate professor in the Department of Medicine, the Division of Geriatrics, with secondary appointments in psychiatry and surgery (public health sciences) at the Washington University School of Medicine in St. Louis, Missouri. She served as the founding director of the Center for Com- munity Health and Partnerships in the Institute for Public Health, the co-director of the Center for Community-Engaged Research in the Clinical ­ PREPUBLICATION COPY—Uncorrected Proofs

76 MODELS FOR POPULATION HEALTH IMPROVEMENT and Translational Science Awards Program, and the director of “Our Community, Our Health,” a collaborative program with St. Louis Uni- versity to disseminate culturally relevant health information and facilitate community–academic partnerships to address health disparities. Dr. Wilkins serves on numerous boards and committees such as the National Academies of Sciences, Engineering, and Medicine’s Commit- tee on the Return of Individual-Specific Research Results Generated in Research, the American Association of Medical Colleges Journal Over- sight Committee for Academic Medicine Laboratories, the Safety Net Consortium of Middle Tennessee, and the AcademyHealth Translation and Dissemination Institute Advisory Committee. Dr. Wilkins is an invited speaker around the country and a mentor to many junior faculty and health professions students. PREPUBLICATION COPY—Uncorrected Proofs

Next: Appendix D: Small-Group Exercise: Up/Mid/Downstream Paradigms in Advancing Population Health and Health Equity »
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The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on September 19, 2019 titled Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream. The term upstream refers to the higher levels of action to improve health. Medical services act downstream (i.e., at the patient level) in improving population health, while such activities as screening and referring to social and human services (e.g., for housing, food assistance) are situated midstream, and the work of changing laws, policies, and regulations (e.g., toward affordable housing, expanding healthy food access) to improve the community conditions for health represents upstream action.

The workshop explored the growing attention on population health, from health care delivery and health insurance organizations to the social determinants of health and their individual-level manifestation as health-related social needs, such as patients' needs. The workshop showcased collaborative population health improvement efforts, each of which included one or more health systems. This publication summarizes the presentations and discussions from the workshop.

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