10 | Purpose, Fall/Winter 2023
Q & A with Population Health
While the population health department at CCI is not new, the team recently underwent a restructuring to increase its impact and service to patients. Since then, they have organized and participated in numerous outreach events to close gaps in patients’ health care. By using data from various sources such as a patient’s Electronic Health Record (EHR), pharmacy records, hospital utilization, and social determinants of health, the team is able to understand patient population trends, characteristics, and barriers. In turn, they use this information to tailor outreach programs that improve health outcomes, reduce the cost of care, and enhance the overall patient experience. Here we talk with the team about their critical work.
WHAT IS POPULATION HEALTH?
“We work with the clinical staff to meet gaps in care. Many patients aren’t aware of care gaps, we bring patients into their care.”
Gilbert Rose Population Health & Patient Panel Coordinator
“The heartbeat or pulse to get patients back to care.”
Candeth Gravette Clinical Care Coordinator
