McGuire, J. (2016). Population health investment by health plans and larger provider organizations: Exploring the business case. Boston, MA: Northeastern University.

Year: 2018


This report had two objectives: 1) To determine if there is a business case for the population health investments made by health plans and large provider organizations; and, if so, 2) To understand how business interests inform decision-making and affect the outcomes of population health investments. The author conducted an exploratory study composed of a convenience sample of 5 health plans and provider organizations currently investing in population health initiatives. Two kinds of investments qualified for the project: 1) those that focused on patient panels with interventions outside the delivery of clinical care; or 2) those that focused on the broader community and included patient populations. Exploration of the topics included a combination of interviews with participant organizations and independent experts in the population health field, literature review, analysis of organizations’ reports and documents, site visits, and follow-up confirmatory inquiries. Findings demonstrate that there is a business case for the population health investments of these five organizations. The business case is shaped by organizational missions, changes in the marketplace, payment pressures, partner expectations, as well as current and future costs resulting in pressure for upstream interventions. Among these study organizations, launching successful population health initiatives relied on a complex alignment of internal and external partners, resources, and delivery capacities. Measuring the impact of population health interventions continues to be a challenge. Investments vary considerably in their ability to command long-term commitments.

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