Care Transformation Center Blog

Who really influences a population's health? (Hint: It's not just providers.)


At its most basic, population health management means actively working to keep your community healthy. When you think about it that way, it makes you wonder, “Who or what is influencing the health of individuals in my community the most?”

To date, population health strategy has focused mainly on the role health care providers themselves play as the main influencers of health outcomes. And health care providers are certainly important. But the reality is that we are not the only ones influencing the health status of the people we serve.

In my own middle Tennessee community, we are surrounded by the savory smell of food that is deep fried and covered with gravy—delicious, but less than ideal for cardiovascular health. A short plane flight away, my colleagues in Washington, D.C., spend an average of 70 hours each year in the nation’s worst traffic, which is one of the main reasons Forbes ranked D.C. the fourth most-stressed city in the U.S.—and as we all know by now, stress is linked to a host of chronic and acute diseases.

These types of socioeconomic factors play a major role in maintaining or preventing good health, but they are all too often ignored when health systems are considering their population health management strategy. Typically, health systems see non-medical determinants of health as outside their purview. But they don’t have to be.

Partner with non-provider influencers

In our research for health system CEOs this year, we have been emphasizing the urgency of focusing on network development. Health systems need to be building a network with the scale, scope, and assets needed to realize their vision for population health and to achieve profitable growth.

Many health systems will need to partner with other types of providers—retail, ambulatory, acute, and post-acute—to accomplish this, especially if the system’s goal is to build a regional or super-regional, state-wide network. But if you really think about the basic objective of population health management, partnering with health care providers is not going to be enough.

Systems will need to engage with organizations that impact the health determinants in your community and influence individuals’ behavior when they’re between provider visits. A few examples of these organizations are religious entities promoting health behaviors, transportation companies facilitating access, the housing authority optimizing living arrangements, gyms and workout facilities, restaurants focusing on healthy living, and malls with walking programs.

What’s more, these are not entities health systems will need to own or operate, nor will the partnership arrangements require a large financial investment. But alliances can nonetheless have a big positive return.

Where to begin

When it comes to addressing the non-medical factors influencing population health, we advise our clients to take a few steps to begin with:

  • Identify the lifestyle patterns and socioeconomic determinants of health status in your community: Where people eat, where they shop, what activities they engage in, and in particular, what negative lifestyle choices they are making.

  • Focus your evaluation on multiple sub-populations, such as children, the frail, and the elderly, and comorbidities (not just chronic illnesses), such as obesity and stress, while continuing to keep prevention at the forefront of your strategy.

  • Identify and enfranchise non-provider organizations that can help get people on the right track toward a healthier lifestyle.

  • Identify the specific patient interventions you would like to see as the outcome of partnering with each non-provider organization.

  • Establish a dialogue with the non-provider organizations and together design partnership arrangements that will achieve the outcomes previously set forth.

  • Determine how you will measure the outcomes of the partnership.

Understand the impact

Over the past five years, I have been working extensively with the Adirondack Health Institute (AHI) to improve the population’s health a vast rural area. The local providers affiliated with AHI have designed a community health program specifically around pediatric obesity. In addition to engaging pediatric and family practices, the health system partnered with schools, a local community extension center, the local university, and the YMCA.

Outside the physician practice, community partners held activities such as school fairs, community lectures, and city-wide contests. Inside the practice, providers employed a patient navigator, nutritionist, exercise physiologist, nurse case manager, community resource advocate, and counselor.

One practice measured the results by looking at the percentage of patients with a BMI of greater than 95%. The year after the program was established, the percentage of patients with a BMI of greater than 95% decreased from 16% to 14%. A second practice measured the outcomes by percentage of patients who returned to a normal BMI. That number went from 4% of patients with a normal BMI to 14% of patients with a normal BMI.

As a physician myself, I feel the weight of providers’ responsibility for population health. But that doesn’t mean that we are the only ones accountable. We need to facilitate action from others who influence our population’s health and wellness.