Topics:

• Patient groups and population segments
• Enrolled populations, prepayment and risk adjustment
• Health status and demographics of patients, panels and populations
• Epidemiology, demographics, and other population-based factors for determining health care needs and utilization patterns
• Health improvement strategies for populations and individuals
• Targeted health strategies for healthy and ill segments, from prevention to disease management

Content and topic goals: Population-based care begins with a profile of the patients enrolled with a physician, practice, or network. This topic area discusses ways of segmenting the population-by payer, demographics, and health status-and the resources allocated or anticipated for each group. It describes techniques for adjusting prepayment amounts to reflect the mix and risk factors of the covered patients. This information on the distribution of one’s patients and finances provides a baseline for setting priorities and implementing programs to meet the needs of patients, individually and collectively.

Topics:

• Services for health promotion and disease prevention
• Principles of behavior change
• The link between healthy lifestyles, prevention, and the cost of health care
• Office-based and non-office strategies for reaching out to patients and enrollees

Content and topic goals: Along with the care and treatment of acute illness, a population-based or care management practice environment places greater emphasis on prevention, health promotion, and disease management. In integrated delivery systems, practitioners assume responsibility for the long-term health of their patients. Learners are trained to understand and apply tools and techniques to assess risk factors and promote preventive care tailored to the needs of individuals and groups of patients.

Topics:

• Advocacy roles vis-à-vis individuals and patient populations
• Stewardship and distribution of resources; distributive justice ethics
• Risks of under-utilization and over-utilization in different financing systems

Content and topic goals: The complexity of practice today, and the role that physicians play in relation to patients, health plans, and purchasers, require a strong understanding of the principles of medical ethics and how to apply them. This topic area reviews the variations in incentives for resource allocation in different delivery and payment systems. It conveys how to advocate successfully for legitimate patient and population needs within the context of constrained resources, while resisting patient expectations for services and treatments that are not necessary at that time.