Population Health: Cockroaches, Health Behaviors, and Social Determinants

By Nalini K Pande, JD

I was at a conference a year ago on dual eligibles when I heard that a health plan was going to focus on pest control to help its patients. What? A health plan was going to hire exterminators for its patients? Then, I realized just how brilliant this idea was.  Cockroaches present numerous health issues, including triggering asthma attacks.  If you want to stop expensive Emergency Room (ER) asthma visits, then attacking the root cause of the problem would be a good start.  In essence, treating the asthma attack in the ER would be only one piece of the puzzle.  Focusing on how to make sure you don’t send your patient home to a cockroach infested housing complex would make much more sense.   Had the health plan stumbled upon something innovative, cutting edge and timely? Yes!  In fact, it did so by adopting a population health focus.  

What is Population Health?

Population health can be defined as  “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”  Population health shifts our concept of health away from individual, clinical health, and instead complements public health by emphasizing a more community health focus.  David Kindig’s County Health Rankings Model (below) provides a nice overview of key factors to consider beyond clinical care.  In fact, we see that health behaviors, social and economic factors and physical environment are even more critical to health outcomes.  Thus, if you want to improve the health of vulnerable, sick and poor populations, perhaps moving outside the clinical walls of the doctor’s office might be the best place to start.

County Health Rankings Model

Aligning Forces For Quality and Population Health

Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s “signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities and provide models for national reform.”   These targeted communities, known as Alliances, have played a unique role in improving the population health of their communities. Alliances, as neutral conveners, have, among other things, created strong partnerships to improve Health Behaviors and address Social Determinants. 

Health Behaviors: Providers and health plans need to focus on activities that help identify and assist patients in managing their own care and modifying their health behaviors.  Their ability to proactively reach out to patients who need preventive and chronic care and help them access care management will require them to transform their systems for communicating with patients.  AF4Q Alliances have stepped up to help:

• • Puget Sound  Health Alliance conducted an outreach campaign to engage consumers in their health care.  Own Your Health is a campaign to empower consumers to become active participants in their own health and health care. 
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• • P2 Collaborative of Western New York worked with New York eHealth Collaborative (NYeC) to gather consumer input for the design of a patient portal to help New York state residents better manage their health and health care.
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• • Let’s CHANGE (Commit to Healthy Activity and Nutrition Goals Every day) is a partnership with the Healthy Memphis Common Table and the Shelby County Health Department to fight childhood and family obesity.  It includes 37 organizations spanning a broad spectrum of businesses, community-based organizations, and government.

Social Determinants: “Bridging the gap” between health care and population health stakeholders, includes a recognition of the importance of social determinants of health ranging from poverty, to education, to housing.     P2 Collaborative of Western New York is working with the Mayor’s Task Group for Creating a Healthier Niagara Falls on an empowerment approach for Niagara Falls. 

Can hospitals, health plans and other providers “go it alone” to address every category of Kindig’s model?  Perhaps the more important question to ask is: “Why would they?”  By partnering with community groups such as RWJ’s AF4Q Alliances, as well as public health entities, health systems can finally treat the whole individual and truly impact health outcomes. 


Nalini Pande, Managing Director, Sappho Health Strategies has nearly 20 years of experience in healthcare policy and reform.  She has considerable experience in Medicare and Medicaid, population health, and emerging payment models including accountable care organizations and patient-centered medical homes. Ms. Pande also has strong expertise in dual eligibles and the specific issues facing this unique population.  Ms. Pande is a graduate of Harvard Law School and Princeton's Woodrow Wilson School of Public and International Affairs.
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Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.

Top Stories:

CMS Says Some Providers are Obstructing Dual-Eligible Demonstration
The CMS official in charge of coordinating care for Americans covered by both Medicare and Medicaid says some healthcare providers are illegitimately trying to dissuade dual-eligible beneficiaries from participating in a managed-care initiative designed to test ways to reduce costs and improve quality. She said her agency has increased its surveillance of these providers, though she did not identify any by name.

Plans Say Duals Bring Down Star Ratings, Beneficiary Advocates Not Convinced
(Subscription Required)
As CMS looks at possible changes to the Medicare Advantage star ratings program, health plans say that poorer beneficiaries are causing lower-than-appropriate star ratings for some MA plans, though the Medicare Rights Center says that current data do not show that beneficiaries' low income is the root cause of lower quality care for those beneficiaries.

Work Group Submits Comments to CMS on Sovaldi, Breakthrough Therapy Designation Medications
The Medicaid Work Group sent a comment letter to the Centers for Medicare and Medicaid Services on the introduction of Sovaldi and other new  Breakthrough Therapy Designation medications and their potential impact on Medicaid costs.

Vitamin B Doesn't Reduce Cognitive Risk in Healthy Elderly
Lowering plasma homocysteine levels with oral vitamin B12 and folic acid does not appear to be an effective strategy for reducing memory loss and Alzheimer's risk, according to findings from a randomized, clinical trial of elderly people in the Netherlands with elevated homocysteine.

Joint Commission Report: U.S. hospitals are getting better, but there is still room for improvement
If the Joint Commission‘s assessment of a hospital is any indication – and by just about all accounts, it’s the indication – hospitals across the U.S. are improving, with more than 1,200 having achieved “top performer” status. A total of 1,224 made that cut, an increase of 11 percent from last year. The top performers represent nearly 37 percent of more than 3,300 Joint Commission-accredited hospitals that contributed data, according to its annual report.



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