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INTRODUCTION

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Illustration by George Folz, © 2019 Board of Regents of the University of Wisconsin System

BACKGROUND

Population health aims to improve the health of an entire population and reduce health inequities between population groups.1 This includes policies and interventions that impact the underlying social causes of health conditions, as well as the study of health outcome distributions within a group. Well-known public health activities, including the promotion of preventive health measures (e.g., hand washing, immunizations, use of bicycle helmets) are population health initiatives. Population health, in other words, is a broad framework that encompasses efforts to leverage governmental, business, non-profit, and community-based entities to improve health.2

The Let’s Move! campaign initiated by former First Lady of the United States Michelle Obama took a population health approach to the problem of childhood obesity.3 Campaign officials were successful in making changes across industries, economic sectors and Congress, passing the Healthy, Hunger-Free Kids Act. Schools offered healthier meals. Only snacks and beverages meeting the new nutrition standards could be marketed and sold at schools, meaning there were more fruits and vegetables available. Large chain restaurants reduced portion sizes and replaced french fries with fruits and vegetables in kids’ meals. Combined, all of these changes impacted the availability, quality, and marketing of food products to children and their families, while simultaneously encouraging greater exercise. Childhood obesity rates declined in the last decade, and many credit Let’s Move! as an important contributing factor.4

Based in Oakland, California, Kaiser Permanente provides an example of a health system that has embraced population health. Broadly speaking, a health system is a healthcare organization that includes at least one hospital and one physician group that work in tandem to provide comprehensive care to a defined patient population. Many health systems are comprised of hospitals, clinics, and pharmacies owned and operated by a single entity. These can be for-profit or non-profit organizations, as well as governmental health systems such as the Veterans Health Administration or academic health systems that have an association with a university. Kaiser Permanente is a non-profit health system combined with a managed care organization that serves approximately 9 million members across nine states.5 The managed care component, as in other health systems, focuses on cost-effective solutions to the provision of care.6 Examples of managed care solutions include requiring patients to only see providers within an approved network or allowing out-of-network visits with a higher co-payment.

Kaiser Permanente’s model incentivizes population health management with high quality affordable care provided to its members, individuals, and employer groups. One such approach was initiated in response to high rates of homelessness observed in service areas.7 Recognizing that stable housing is essential to good health, Kaiser Permanente began housing initiatives to address the issue of housing insecurity. This included investing in apartment buildings to support ...

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