Defining Population Health at the University of Maryland Medical System
At the University of Maryland Medical System (UMMS), we strive to deliver the best health care within Maryland in the communities we serve. Our goals include improving health outcomes, quality, and experience for our patients, providers, and employees while reducing unnecessary utilization and cost throughout the continuum.
We believe that we have the opportunity to make change every day and are committed to delivering the best health care for all – one patient at a time.
Our comprehensive approach coordinates care across the continuum. We are dedicated to population health management, which means ensuring high-quality care is delivered at the right place and at the right time through our network of hospitals, practices, and other health care providers in our community. Our comprehensive and integrated approach includes:
- Promotion of wellness and community health
- Managing acute illness that is high-quality, timely, and efficiency
- Partnering with healthcare providers beyond our facilities to meet the patient's needs at home or in other locations like nursing facilities
- Addressing Social Determinants of Health (SDOH) impacting access
- Socio-economic factors, education disparity, unemployment, food scarcity, transportation, etc.
- A combination of traditional healthcare with public health, community health, and policy initiatives to improve health equity
Population Health works in three main areas: Population Health Care Approach, Accountable Care Organization, and Community Health Improvement.
Population Health Care Approach
Moving from traditional delivery to a population-focused care model requires a need to understand the populations we serve and build a scalable approach. Effective care is not about managing one population but multiple populations with unique health needs. We are inching closer towards a care approach that accounts for the multiple determinants of health that impact health outcomes, including medical care, genetics, behaviors, social factors and environmental factors.
We leverage analytic tools to identify and segment patients by care needs. Risk-stratified, predictive modeling algorithms help determine appropriate preventive measures and early interventions for each group and each patient. Our data-driven approach helps strengthen care coordination, empowers providers to make more fully informed clinical decisions, and ensure that essential resources are distributed equitably and in a way that appropriately addresses the unique needs of all patients.
Multiple Services, One Goal
Our 12 hospitals in collaboration with community provider groups through the Population Health Services Organization (PHSO) are aligned under one common goal: to provide patients with high-quality, efficiently coordinated, and cost-effective healthcare services. Collaboration across UMMS enables our hospitals, providers, leadership and staff to leverage best practices across the health system and within our communities.
- UM Hospitals offer a variety of initiatives and programs designed address the clinical, emotional, and social needs of our patients and our communities. Marylanders benefit from access to a connected network of healthcare providers offering a broad range of services that allow residents to remain close to home to receive quality care.
- UM Quality Care Network (UMQCN) is a physician-led, clinically integrated network and accountable care organization that supports population health efforts and value-based care contracts for Medicare, Medicaid, and commercial payers. UMQCN is comprised of UMMS's primary and specialty care providers and select independent community practices.
- Transform Health MD is a Transformation Organization supporting a network of primary practices located throughout the State achieve their advanced primary care goals through Medicare's Maryland Primary Care program.