Understanding the

Numbers
HCA 528 – Week 5
 Review
• Conventional vs. behavioral economic principles
• Key terms in Behavioral Economics: loss aversion, present bias, decision
fatigue, groupthink, framing, choice architecture, nudge, automated
hovering, and many more
• Stages of change
 Learning Objectives
• Distinguish primary purposes of Population Health Measurement
• Utilize analytic framework for assessing & measuring population health
outcomes & improvement
• Define key metrics in population health and their usage in practice
 Introduction
• Data Driven Environment
• Improvement vs. Accountability
• Issues & Unintended Consequences
• Capability to measure contributions to total population health
improvement within and across stakeholder organizations is an emerging
paradigm.
 Purposes for Measurement in PH
• Advocacy
• Improvement of care
• Accountability
• New knowledge through Research
• Improvement of professional training
 Advocacy
• Indicators can be used, or not used, to advocate for different ideologies.
• Indicators may not be employed neutrally; they can classify situations as
“unfavorable” or “favorable,” to show “improvement” or “deterioration”
over time.
 Measurement for Improvement
• SMART: specific, measurable, attainable, realistic, and time bound
• Plot data over time (run chart)
• Compare with control chart
• Identify process change – PDSA cycle
• Predictive modeling
• Specificity vs. sensitivity
 Measurement for Accountability
• Care Experience & its Determinants
• Cost – from supply, demand, and intermediary lens
• Population Health – Overall Value & Efficiency (Return of Investment)
 Measurement for Research
• Efficacy vs. Efficiency
• Health Disparities Research
• Comparative Effectiveness Research
 Improvement of Training
• Educate professional for the 21st century practice: evidence-based models
and value-based system (accountable for continuous quality improvement)
in a data-driven environment.
 Analytic Framework
• Assessing and measuring determinants of health, improvement activities
and outcomes
• The frameworks differ in: relevant stakeholders, community focus, use of
evidence-based interventions, and shared responsibility.
 Types of Analytic Framework
• Healthy People 20/20
• Centers for Medicare & Medicaid Innovations (CMMI) Measurement
Framework
• Mark Friedman “Results Accountability” Framework
• Evans and Stoddart Field Model
• IOM Logic Model for Public Health Measurement
Healthy People
2020
• 26 leading health
indicators
• No examples of
integrated measures…
• http://www.healthypeo
ple.gov/2020/Leading-
Health-Indicators
 CMMI
Measurement
• Places the first two
aims of the Triple Aims
in the context of total
population
health(community)
outcomes
 Results
Accountability
• Two different sets of
measures: total
population health
outcomes and health
improvement activities
 Evans &
Stoddart Field
Model
• Use for the County
Health Ranking
initiatives
• Use BRFSS
• http://www.countyhealthra
nkings.org/resources/count
y-health-rankings-model
 IOM Logic
Model
• The determinants of
health linked to health
improvement activities
(resources, capacity,
process, intervention,
and policy) to reflect
priority across
stakeholders
Meaningful
Measures
• Launched in 2017
• Identifies high priority
areas for quality
measurement &
improvement
 Meaningful Measures
• High impact that safeguard public health
• Meaningful to patients
• Minimize burden for providers
• Incorporate new payment model
• Align across programs and/or with other payers
 Types of Data
• Census and vital stats
• Surveys
• Administrative data
• Non-health data
• Map data
• Qualitative data
 Ideal Indicators
• Built on consensus • Reliable and sustainable
• Based on a conceptual framework • Understandable
• Valid • Timely
• Sensitive • Comparable
• Specific • Flexible for use at different
organizational levels
• Feasible
 Domains
• Health status and health-related quality of life
• Health outcomes
• Health-related behaviors
• Social environment
• Physical environment
• Health improvement activities (processes, outcomes, and capacity
building)
 Indicators/ Measures Examples
Domain: Health improvement activities – outcomes
Measures:
• Preventable hospitalizations and readmissions
• Patient satisfaction
• Timely and appropriate care received
 Summary
• Developing shared definitions and conceptual frameworks across systems
is always challenging, especially in the U.S. where a variety of
organizations create reports reflecting various and differing priorities for
measuring health status, health outcomes, health-related behaviors,
determinants of health, and health improvement activities.
• The key to success is the synchronization of leadership and
communication between the clinical care and government public health
systems.
• Emerging Internet-based data sources…
The New Demographic Realities
 Demographic Trends
• World vs. US
• By Region and State
• By Race and Ethnicity
• In Longevity
 World Demographic Trends
• 1800: 1 billion
• 1930: 2 billions
• 1960: 3 billions
• After 1960: 1 billion/ 12 – 14 years

• http://www.census.gov/popclock/
Population of the World
 Population of the World
• Africa has the highest population growth at 2.5% annually.
• Europe projected to have shrinking population. Fertility has been below the
replacement level for several decades.
• Within 7 years India will surpass China. Nigeria’ population is growing the most
rapidly. By 2050, it will surpass the US.

Source:
http://esa.un.org/unpd/wpp/Publications/Files/Key_Findings_WPP_2015.pdf
United States Demographic Trends
Population of the US
 Population of the US

Source: http://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf
Demographic Trends by
State
 2018 Environmental Scan
Access, Value, Partners, Well-being, Coordination
 Data Sources
• State Health Facts: http://kff.org/statedata
• Health Indicators Warehouse: http://www.healthindicators.gov
• The Dartmouth Atlas of Health Care: http://www.dartmouthatlas.org
• The CMS Chronic Conditions Data Warehouse (CCW):
https://ccwdata.org/web/guest/home
• Medicare Enrollment Dashboard
• OSPHD: http://www.oshpd.ca.gov/HID/