Resource Library: Population Health Management

  • People’s health is changing, and care needs are evolving. People are living longer, but with more years in poorer health and it is increasingly common for people to have two or more long term health conditions. This reinforces the need to focus on prevention and integrated care, reflected in the Government's three big shifts and a key theme of the NHS 10 Year Plan.

    Population Health Management (PHM) is an approach that links a wide range of health, social care, and socioeconomic data to help identify opportunities for proactive, preventative care. It is a key enabler for neighbourhood health approaches and will also support the ICB in its core future role as strategic commissioner.

    In Herefordshire and Worcestershire ICS, our vision for PHM is to improve the health and wellbeing of the population of Herefordshire and Worcestershire, and reduce health inequalities, by making better, evidence-based decisions for planning and delivery of services using joined up data, capabilities, and insights. We will do this through the three 'I’s.

    • Integrate: Bringing together both quantitative and qualitative data from health, social care, socioeconomic and asset-based sources to build a more complete picture of the health and wellbeing of our population
    • Insight: Use PHM analysis approaches (including population segmentation, risk stratification and impactability) to identify groups who will benefit most from proactive care

    • Impact: Work in partnerships across the system to strengthen community assets for health and support individual patients in an integrated way to deliver more effective, efficient, and proactive care targeted at these groups
     
    Colleagues across Herefordshire are already using PHM approaches but these aren’t always recognised or named as such. If you are using population level data to understand health needs in part of the population and doing something different to target support in a proactive way, then you are using PHM.

    The ICB is also leading work to support the strategic development of PHM. This involves identifying and building on examples of PHM happening across the system, supporting opportunities to scale these up, and ensuring that these reflect a path to achieving a long-term vision for PHM. You can find out more about our approach to PHM here:

    Developing our approach to population health management :: Herefordshire and Worcestershire Integrated Care System


    The resources below have been collated to help you find high quality information and learning resources for PHM, and build-up from short reads and videos to links to more in-depth e-learning.


    • What Is A Population Health Approach? This short read from the Kings Fund sets out key definitions and ideas about population health. It discusses the factors that influence our health and how we can identify opportunities to influence these in a way that supports better health throughout life, and reduces the risk of ill health. It includes a summary video. 


      Population Health Management This NHSE resource summarises key definitions for PHM and describes how this looks in practice for the NHS. It includes a summary video. 


      If you would like to learn more, you can complete the 'Introduction to population health management' session available on the NHS Learning Hub. Login to access this 30-minute course.


      • Population Health Management This NHSE Long Read document describes in greater detail some of the terms and approaches used in PHM. It covers key approaches including population segmentation and risk stratification. These can also be explored through the individual themed sessions from the Population Health Management course of the NHS Learning Hub.


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