Population Health

Improving the health of an entire population requires a shift in thinking and looking at the delivery of care beyond the four walls of a clinic or hospital. IHC aligns payers and providers for value-based purchasing, equips providers and healthcare systems for service delivery transformation, and engages community organizations to sustain healthy behaviors.

Integrated Delivery Network Development

Integrated delivery networks (IDN) are comprised of physicians working with hospitals to form a healthcare ecosystem. They build on successes and leverage community resources and meaningful strategic partnerships to improve access, quality of care, and cost-savings. The goal is value-based integrated care through strategic partnerships, coordinated care processes, collection of data, and electronic systems to track services and provide a comprehensive view of consumer health. IHC works to advance these networks.  

We have dedicated leadership, program directors, physicians, nurses, and data analysts with credentials and expertise in healthcare, education, data and information technology, and quality and performance improvement to make this happen.

 How We Can Help
  • Environmental scans, and evaluating and assessing organizations and populations to determine baseline and foundational capabilities
  • Facilitate community involvement in the accountable communities of health concept
  • Education and training and virtual communication sessions
  • Resources and tools for fiscal and program management
  • Convene organizations to examine and determine health transformation direction
  • Assist clinicians and community-based organizations with designing and implementing closed-loop referrals between health and social service agencies
  • Support cross-sector electronic client referral systems that connects end-users with community organizations
  • Data for rapid cycle improvement

Addressing Social Determinants of Health

Social determinants of health (SDOH) are major drivers of healthcare costs and outcomes. Evidence indicates that 40% of health outcomes are related to SDOH and 30% of deaths are attributed to social factors. The SDOH implications are compounded for high-need, high-cost (HNHC) populations that need preventive health services and coordinated care to improve their health, lifestyle and minimize personal costs.  

We have a dedicated team with credentials and expertise in healthcare, education, data and information technology, performance improvement, pharmacy and social services that work together to address SDOH factors and barriers limiting positive health outcomes.

 How We Can Help
  • Facilitate statewide SDOH resource campaigns
  • Equip providers to submit monthly SDOH data
  • Encourage hospitals to utilize community-based social needs solutions
  • Support implementation of electronic/health information technology to transfer SDOH referrals data and closed-loop reporting
  • Redesign of a statewide web-based information and referral service
  • Baseline environmental scan assessing existing community social services capacity and accessible public directory of social services
  • Facilitate hospital and community planning meetings to determine client social services referrals
  • Live and virtual SDOH education and training
  • Evidence-based health equity and literacy education, training, and virtual communication sessions
  • Development and execution of Statewide Strategies specific to SDOH
  • Partner with organizations that have key investment in SDOH solutions
  • Design and implement closed-loop referral processes for community-based organizations Support cross-sector electronic SDOH referral systems to connect end-users with community organizations
  • Initiate community-based population health strategies with health systems to include social services agencies

Human-Centered Care Design

At the center of healthcare transformation is the patient.  As healthcare continues to shift from volume to value, the way care is delivered must change. Human-centered design is an approach to interactive systems development that aims to make systems usable and useful by focusing on the users, their needs and requirements, and by applying human factors, usability, knowledge, and techniques. Human-centered design enhances effectiveness and efficiency, improves human well-being, user satisfaction, and sustainability.

We employ a diverse team of expertise to support human-centered approaches at all levels.  Our team engages directly with personnel from direct care to the C-suite and beyond to design and foster organizational cultures of person-centered safety and engagement.

 How We Can Help
  • Person-centered care design into the application of all clinical and community-based interventions
  • Human-centered design approaches in root cause analysis and performance improvement strategies, including experience/journey mapping and overlay
  • Utilize assessment tools to measure patient activation and facilitate targeted personalized interventions to enable positive behaviors and buy-in
  • Strategies and best practices for inclusive, intentional interactions and care experiences throughout systems of care
  • Assist providers, administrators, and systems apply human-centered design approaches to strategic planning and performance improvement
  • Implement meaningful approaches to patient engagement and activation shown to improve outcomes, satisfaction, and joy in practice
  • Use the full spectrum of person and family engagement strategies to bring patients, caregivers, and consumers on board as equal players in care
  • Develop and implement protocols and procedures that establish person-centered design and engagement as the standard operating practice 
  • Create value statements demonstrating return on investment for person and family engagement and human-centered design implementation
  • Articulate relationship and role of human-centered care and design as a core value within a Culture of Patient Safety and the mission and vision of healthcare systems
  • Technical assistance and training on human-centered care design approaches, methods, and strategies from initiation to systematic application
  • Align person-centered engagement and design principles with patient safety and value-based care goals including quality and outcomes

Community Coalition Development

The health and well-being of populations are dependent on many factors, one being a strong community coalition. Community coalitions built on diverse, collaborative partnerships with a shared vision positively impact the populations they support. 

Our Population Health Division is comprised of teams equipped to support your efforts in healthcare transformation and community coalition development. Our experienced leaders focus support work around community integration, SDOH, and human-centered design while using research and analytics to ensure alignment between clinical and community efforts.

 How We Can Help
  • Promote a culture of transparency to allow continuous improvements and outcome effectiveness in community coalition work to accelerate necessary change
  • Work collaboratively with clinical and community organizations to encourage joint development and implementation of community health needs assessments to achieve targeted health outcomes
  • Support person and family engagement statewide strategies through awareness and education to enhance participation
  • Lead professional development opportunities at the local and state level
  • Increase efficiency and effectiveness of collaborative efforts empowering meaningful patient-centered change
  • Examine critical community partnerships and opportunities for alignment at national, state, and local levels to maximize impact and sustainability
  • Expand provider engagement for community-level integration
  • Measure, analyze, and report outcomes for clinical-community effectiveness and cost efficiency

Population-Based Community-Applied Interventions

Integrated clinical and community efforts maximizes outcomes and the impact on communities on a large scale. Combined community initiatives and population health strategies effectively promote engagement and increase access to care. Evaluating the uniqueness of each community while incorporating assets and challenges can help determine a roadmap for success in population-based community-applied interventions.

Our diverse team has a proven track record of improving outcomes to support community population health needs. IHC leadership, program directors, support staff, and data analytics team have extensive experience in both clinical quality improvement and public health application.

 How We Can Help
  • Incorporate continuous quality improvements into optimized referral systems for integration of community and clinical care
  • Utilize relevant data to guide necessary improvements and transformation
  • Perform cost of care analysis to ensure quality care can be achieved at a lower cost
  • Tailored technical assistance, on-site and virtual consultation, and professional development opportunities
  • Convene key leaders in Iowa from providers, payers, government, and community organizations to advance sustainable healthcare tools and resource sharing
  • Adapt with economic variabilities and address SDOH needs to align communities to better serve their populations
  • Develop recommendations relative to visioning and innovation, data sharing and use, and healthy communities
  • Determine interdependencies between population management and shared accountability
  • Align population-based community-applied interventions within the Accountable Communities of Health model and guide data-driven strategies to successful implementation
  • Accountable Communities of Health (ACH) model and guide data driven strategies to a successful implementation
  • Create innovative solutions to support trending healthcare transformation efforts  
  • Oversee implementation and execution of select statewide strategies to advance population health efforts