How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency

Abstract

Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served and are willing to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.

Building trust in American hospital-community development projects: a scoping review

“…The question of with whom to form partnerships is the most commonly addressed aspect of trust building in the existing literature. Several articles identified establishing partnerships with trusted community agencies, or at least entities interested in working within them, as a central component to building trust [ 8–17 ]. In some cases, organizations already earned the confidence of the populations that a project aims to serve.…”

“…They note that because health systems have not traditionally undertaken community outreach or development work, they have historically struggled to develop trust. This shortcoming can only be remedied by working in an intentional and active way with community partners [ 8 ].…”

Reframing implementation science to address inequities in healthcare delivery

“…Given the reality that vulnerable populations tend to be absent from clinical trials, implementation scientists need to examine where the populations from our implementation trials are, where they are served, and who is providing services to them. For example, conducting studies in non-traditional settings, such as faith communities, family resource agencies, barbershops, and community centers, can increase reach because vulnerable populations may not go to traditional healthcare settings due to stigma, mistrust and discrimination [30,[34][35][36][37]. Implementation and health inequity researchers should aspire to conduct studies that mirror the context of vulnerable populations.…”

The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families

“…59,89,90 This pivot from "follow-up" to "follow through" is accelerated by patient-level social needs screening, the use of electronic health record (EHR) data in combination with complementary datasets to support population-level pattern recognition, and bolstered clinical-community partnerships driving both patient-and population-level action. [91][92][93][94][95][96] Many such actions elevate the relevance of SDH, which, in many ways, are thought to be "fundamental causes" of disease, factors that place individuals and populations at "risk of [having] risks." 97 The National Academy of Medicine and American Academy of Pediatrics, among others, now recommend routine SDH-related screening.…”