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Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream: Proceedings of a Workshop (2021)

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

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Suggested Citation:"Appendix D: Small-Group Exercise: Up/Mid/Downstream Paradigms in Advancing Population Health and Health Equity." 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 77
Suggested Citation:"Appendix D: Small-Group Exercise: Up/Mid/Downstream Paradigms in Advancing Population Health and Health Equity." 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 78
Suggested Citation:"Appendix D: Small-Group Exercise: Up/Mid/Downstream Paradigms in Advancing Population Health and Health Equity." 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 79
Suggested Citation:"Appendix D: Small-Group Exercise: Up/Mid/Downstream Paradigms in Advancing Population Health and Health Equity." 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 80

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Appendix D Small-Group Exercise: Up/Mid/Downstream Paradigms in Advancing Population Health and Health Equity 77 PREPUBLICATION COPY—Uncorrected Proofs

Up/mid/downstream paradigms in advancing population health & health equity 78 Locus of Action Prevention Approach Tactics Healthcare sector Sector-level and Infrastructure (adapted from (adapted from (adapted from Castrucci & engagement cross-sector and system Auerbach, “3 Alderwick & Auerbach) Mission-centrality, engagement needs buckets of Gottlieb, Milbank capabilities, control (adapted prevention”) 2019) from Kindig & Isham) UPSTREAM Total Improving SDoH at Shaping laws, policies, Mission-aligned; population or population (area) regulations & Limited capabilities; community- level through investments (public & Low control; wide collaboration w/ private sector) that Action through prevention other create community partnership sectors/services conditions supporting Cross- P cutting health for all people H u E e b d H Workforce? a l Community and Health-related social u o Prevention l i Org. services social service needs screening in c u structures? t c MIDSTREAM extend into partnerships to clinical settings; a s target care to CHW initiatives; h Org. policies? community t i (e.g., CHW- or identified needs of Closed-loop referrals w/ c H i n Data & home-based) specific patients CBOs a e o g technology r a n e l Metrics t Others? h Traditional Mission-central; clinical Social needs- Clinical preventive Many capabilities; informed care High control PREPUBLICATION COPY—Uncorrected Proofs preventive services services DOWNSTREAM ***WORKING DRAFT – prepared by Marc Gourevitch with assistance from Alina Baciu to inform discussion at the September 19 workshop Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream

WORKSHEET FOR THE PRACTICAL EXERCISE Toward Co-Creating Shared Language to Understand and Advance Population Health and Health Equity (1) Identify a rapporteur and a note-taker; annotate the large format version of the diagram, to report group feedback and leave behind for NASEM staff; Keep the handout for your reference, and to continue the conversation after today. (2) Reflect on the presentations and discussion of the day, and the tensions and promise of upstream approaches to advance population health. Considering the Cross Cutting Needs: Workforce, Organizational Structures & Policies, Data & Technology, Metrics and any other considerations, review the diagram and answer the following questions. (3) For comments from the web, email abaciu@nas.edu. What information does the diagram seem designed to convey? How does this diagram help describe the role of my organization & work? What are its possible uses? How can I use this in my organization, my work? What changes are needed to make it more useful for specific audiences? How can I adapt this to describe in my organization, my work? PREPUBLICATION COPY—Uncorrected Proofs References: Castrucci, B, and J Auerbach. 2019. Meeting Individual Social Needs Falls Short of Addressing Social Determinants of Health. Health Affairs Blog. Kindig, DA, and G Isham. 2014. Population Health Improvement: A Community Health Business Model That Engages Partners in All Sectors. Frontiers of Health Services Management. Auerbach, J. 2016. The 3 Buckets of Prevention. Journal of Public Health Management and Practice. Alderwick, H, and LM Gottlieb. 2019. Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems. Milbank Quarterly. 79

PREPUBLICATION COPY—Uncorrected Proofs

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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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