New Approaches to Improving Population Health Featured in The American Journal of Accountable Care®, an AJMC® Publication

A new population health care model, how team functioning affects the health of patients, the factors that contribute to patient complexity, and how multistakeholder partnerships can come together to improve care are highlighted in the September issue of The American Journal of Accountable Care®.

How do clinicians and healthcare systems balance between providing population-centered care as well as patient-centered care in an era of new payment models focused on value-based care? In a paper in the current issue of The American Journal of Accountable Care® (AJAC), authors Sanjula Jain, PhD; Adam S. Wilk, PhD; Kenneth E. Thorpe, PhD; and S. Patrick Hammond, MHA, propose a Population Health Care Delivery Model to guide and coordinate delivery systems across the continuum of patient care, encompassing prevention, well care, and disease management.

To overcome implementation challenges, payers, delivery systems, and clinicians must work together to align each other’s incentives, and how they do that will depend on the maturity of their operating environment as well as the organizational capacity of delivery systems, the authors write in “A Model for Delivering Population Health Across the Care Continuum.”

The theme of population health and patient-centered care is carried throughout the September issue of AJAC, with articles focused on improving the healthcare experience for both consumers and clinicians.

  • How well teams function in patient-centered medical homes (PCMHs) has a significant impact on patient satisfaction, write Deirdre A. Shires, PhD; Amir Alishahi Tabriz, PhD, MD, MPH; Carrie A. Miller, MPH; and Jennifer Elston Lafata, PhD. The researchers surveyed primary care doctors and nursing staff in 26 PCMH-designated primary care clinics and linked their responses with information from electronic health records on portal activation, patient satisfaction surveys, and internal health system quality reports. Understanding how a primary care clinic team functions can affect care quality and patient outcomes, the authors say.
  • A survey of general internists from three hospitals pinpointed the 10 most frequent factors that contribute to patient complexity, according to a report by Baptiste Crelier, MMED; Sven Streit, MD; and Jacques D. Donzé, MD, MSC. The authors write that knowing more about the specific factors that are likely to lead to patient complexity could help hospitals customize interventions to reduce readmissions and improve quality of life.
  • In a web exclusive article, senior author Anupam B. Jena, MD, PhD, and co-authors discuss how multistakeholder partnerships can allow data mining across organizations to improve population health and overcome barriers that have traditionally held back population health initiatives. The paper describes the findings of a working group of payer, provider, academic, and pharmaceutical industry stakeholders that met to brainstorm ways to overcome the fragmentation that currently exists.

Other articles this month discuss trends in healthcare payment systems, “lean” improvement efforts, and the effectiveness of enhanced primary care services. AJAC, a quarter-yearly publication, is dedicated to providing a platform for healthcare professionals and organizations to share research and best practices in the realm of accountable care.

About  The American Journal of Managed Care®:

The American Journal of Managed Care® (AJMC®) is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC® family include The American Journal of Accountable Care®, and two evidence-based series, Evidence-Based Oncologyand Evidence-Based Diabetes Management. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC® publications, please contact Gil Hernandez at 609-716-7777, ext. 139.


AJMC® Media:

Alexandra Ventura, 609-716-7777, ext. 121

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