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Population Health | Mass General Brigham

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href="/en/patient-care/patient-visitor-information/planning-your-visit/shuttles" target="_self"> <span>Shuttles</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/patient-care/patient-visitor-information/planning-your-visit/visitor-policy" target="_self"> <span>Visitor Policies</span> </a> </li> </ul> </li> </ul> </div> </li> <li class="cmp-global-header-main-nav-item-wrapper"> <button type="button" aria-expanded="false" aria-controls="id_hospitalsservicesspecialties" class="cmp-global-header-main-nav-item mainNavigation-inactive"> Hospitals, Services &amp; Specialties <div class="cmp-global-header-main-nav-expand-icon"></div> <div class="cmp-global-header-main-nav-collapse-icon"></div> </button> <div class="cmp-global-header-main-nav-expanded-wrapper"> <ul id="id_hospitalsservicesspecialties" class="cmp-global-header-main-nav-expanded" style="display: none"> <li class="cmp-global-header-main-nav-expanded-column-one"> <div 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target="_self"> <span>Virtual Care</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/patient-care/services-and-specialties/healthcare-at-home" target="_self"> <span>Healthcare at Home</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/patient-care/services-and-specialties/heart" target="_self"> <span>Heart Care</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/patient-care/services-and-specialties/community-physicians" target="_self"> <span>Mass General Brigham Community Physicians</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/patient-care/services-and-specialties/rehabilitation" target="_self"> <span>Rehabilitation</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/patient-care/services-and-specialties/sports-medicine" target="_self"> <span>Sports Medicine</span> </a> </li> 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<li> <ul class="cmp-global-header-main-nav-expanded-children-wrapper"> <li class="cmp-global-header-main-nav-expanded-childHeader"> For Industry </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/research-and-innovation/innovation/venture-capital-and-investments" target="_self"> <span>Venture Capital and Investments</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="https://worldmedicalinnovation.org/" target="_blank"> <span>World Medical Innovation Forum</span> <span class="sr-only"> (opens link in new tab)</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/research-and-innovation/innovation/for-industry/featured-licensing" target="_self"> <span>Featured Licensing Opportunities</span> </a> </li> </ul> </li> <li> <ul class="cmp-global-header-main-nav-expanded-children-wrapper"> <li class="cmp-global-header-main-nav-expanded-childHeader"> For Innovators </li> <li 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Researchers &amp; Collaborators</span> </a> </div> </li> <li> <ul class="cmp-global-header-main-nav-expanded-children-wrapper"> <li class="cmp-global-header-main-nav-expanded-childHeader"> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/research-and-innovation/for-researchers-and-collaborators/information-for-researchers" target="_self"> <span>Information for Researchers</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/research-and-innovation/for-researchers-and-collaborators/compliance-office" target="_self"> <span>Compliance Office</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/research-and-innovation/for-researchers-and-collaborators/research-cores" target="_self"> <span>Research Cores</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/research-and-innovation/centers-and-programs/clinical-trials-office" target="_self"> 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class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/residencies-and-fellowships/brigham-and-womens-hospital" target="_self"> <span>Brigham and Women&#39;s Hospital</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/residencies-and-fellowships/massachusetts-general-hospital" target="_self"> <span>Massachusetts General Hospital</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/residencies-and-fellowships/mass-eye-and-ear" target="_self"> <span>Mass Eye and Ear</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/residencies-and-fellowships/newton-wellesley-hospital" target="_self"> <span>Newton-Wellesley Hospital</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/residencies-and-fellowships/salem-hospital" target="_self"> <span>Salem Hospital</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/residencies-and-fellowships/integrated-programs" target="_self"> <span>Integrated Mass General Brigham Programs</span> </a> </li> </ul> </li> <li> <ul class="cmp-global-header-main-nav-expanded-children-wrapper"> <li class="cmp-global-header-main-nav-expanded-childHeader"> Centers of Expertise </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/centers-of-expertise/global-community-health" target="_self"> <span>Global &amp; Community Health</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/centers-of-expertise/health-policy-and-management" target="_self"> <span>Health Policy &amp; Management</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/centers-of-expertise/healthcare-quality-patient-safety" target="_self"> <span>Healthcare Quality &amp; Patient Safey</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/centers-of-expertise/medical-education" target="_self"> <span>Medical Education</span> </a> </li> </ul> </li> <li> <ul class="cmp-global-header-main-nav-expanded-children-wrapper"> <li class="cmp-global-header-main-nav-expanded-childHeader"> For trainees </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/for-trainees/prospective" target="_self"> <span>Prospective trainees</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/for-trainees/incoming" target="_self"> <span>Incoming trainees</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/graduate-medical-education/for-trainees/current" target="_self"> <span>Current trainees</span> </a> </li> </ul> </li> </ul> </div> </li> <li> <a class="cmp-global-header-main-nav-item no-children mainNavigation-inactive internal" href="/en/education-and-training/continuing-professional-development" target="_self"> <span>Continuing Professional Development</span> </a> </li> <li class="cmp-global-header-main-nav-item-wrapper"> <button type="button" aria-expanded="false" aria-controls="id_otherlearningopportunities" class="cmp-global-header-main-nav-item mainNavigation-inactive"> Other Learning Opportunities <div 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href="/en/education-and-training/learning-opportunities/internships" target="_self"> <span>Internships</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/learning-opportunities/medical-laboratory-science-training-program" target="_self"> <span>Medical Lab Science Training Program</span> </a> </li> <li class="cmp-global-header-main-nav-expanded-subChildren"> <a href="/en/education-and-training/learning-opportunities/workforce-development" target="_self"> <span>Mass General Brigham Workforce Development</span> </a> </li> </ul> </li> </ul> </div> </li> <li class="cmp-global-header-main-nav-item-wrapper"> <button type="button" aria-expanded="false" aria-controls="id_oureducationalcommitment" class="cmp-global-header-main-nav-item mainNavigation-inactive"> Our Educational Commitment <div class="cmp-global-header-main-nav-expand-icon"></div> <div class="cmp-global-header-main-nav-collapse-icon"></div> </button> <div 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data-cmp-data-layer="{&#34;breadcrumb-9543b5f91a-item-d36eddb09d&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/breadcrumb/item&#34;,&#34;repo:modifyDate&#34;:&#34;2022-09-07T21:28:58Z&#34;,&#34;dc:title&#34;:&#34;Centers and Programs&#34;,&#34;xdm:linkURL&#34;:&#34;/en/research-and-innovation/centers-and-programs&#34;}}" itemprop="itemListElement" itemscope itemtype="http://schema.org/ListItem"> <a class="cmp-breadcrumb__item-link" itemprop="item" data-cmp-clickable href="/en/research-and-innovation/centers-and-programs"> <span itemprop="name">Centers and Programs</span> </a> <meta itemprop="position" content="2"/> </li> <li class="cmp-breadcrumb__item cmp-breadcrumb__item--active" aria-current="page" data-cmp-data-layer="{&#34;breadcrumb-9543b5f91a-item-be3e54ffbc&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/breadcrumb/item&#34;,&#34;repo:modifyDate&#34;:&#34;2022-09-07T21:28:59Z&#34;,&#34;dc:title&#34;:&#34;Population Health&#34;,&#34;xdm:linkURL&#34;:&#34;/en/research-and-innovation/centers-and-programs/population-health&#34;}}" itemprop="itemListElement" itemscope itemtype="http://schema.org/ListItem"> <span itemprop="name">Population Health</span> <meta itemprop="position" content="3"/> </li> </ol> </nav> </div> <div class="alert cmp-alert cmp-alert-page aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-alert-main-container"> <div class="cmp-alert-container hidden" role="alert" tabindex="-1"> <div class="cmp-alert-content"> <div class="cmp-alert-icon-container"></div> <div class="cmp-alert-content-container"> <div class="cmp-alert-closed"> <h2 class="cmp-alert-primary-title"></h2> <div class="cmp-alert-body-toggle-icon-container"> <button class="cmp-alert-body-toggle-icon cmp-alert-body-toggle-icon-expand hidden" type="button" aria-expanded="false"><span class="sr-only">More alert details</span></button> </div> </div> <div> <div class="cmp-alert-body alert-hidden"> <div 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data-cmp-data-layer="{&#34;teaser-eb14192452&#34;:{&#34;@type&#34;:&#34;core/wcm/components/teaser/v2/teaser&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;dc:title&#34;:&#34;Population Health&#34;,&#34;dc:description&#34;:&#34;&lt;p>Mass General Brigham’s Population Health team is focused on providing resources and offerings to consumers that improve their overall health care experience, engages them in their care, and is affordable.&amp;nbsp;&lt;/p>\r\n&#34;}}" role="region" aria-label="Featured Content"> <div class="cmp-teaser__content" data-teaser-id="teaser-eb14192452"> <div class="cmp-hero-banner-text-animation-wrapper"> <div class="cmp-hero-banner-text-animation-content"> <h1 class="cmp-teaser__title"> Population Health </h1> <div class="cmp-teaser__description"><p>Mass General Brigham’s Population Health team is focused on providing resources and offerings to consumers that improve their overall health care experience, engages them in their care, and is affordable. </p> </div> </div> </div> </div> <div class="cmp-teaser__image-container"> <div class="cmp-teaser__image"> <div data-cmp-is="image" data-cmp-src="/content/mgb-global/global/en/research-and-innovation/centers-and-programs/population-health/_jcr_content/root/container_924996778/hero_banner_copy.coreimg{.width}.jpeg/1703872526751/couple-walking.jpeg" data-asset-id="af6b56b9-aa7d-44ea-b621-f999dd13e002" data-cmp-filereference="/content/dam/mgb-global/en/patient-care/services-and-specialties/home-care/images/couple-walking.jpg" id="teaser-eb14192452-image" 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data-cmp-hook-image="imageV3" class="cmp-image" itemscope itemtype="http://schema.org/ImageObject"> <img src="/content/mgb-global/global/en/research-and-innovation/centers-and-programs/population-health/_jcr_content/root/container_924996778/hero_banner_copy.coreimg.jpeg/1703872526751/couple-walking.jpeg" loading="lazy" class="cmp-image__image" itemprop="contentUrl" width="1600" height="1067" alt="Man and woman walking on a path with a dog "/> </div> </div> <div class="cmp-teaser__mobile-image"> <img src="/content/dam/mgb-global/en/patient-care/services-and-specialties/home-care/images/couple-walking.jpg"/> </div> <div class="cmp-video-player " data-teaser-id="teaser-eb14192452"> <div class="cmp-video-player-modal" role="dialog" aria-labelledby="cmp-video-player-modal-label" aria-modal="true" tabindex="-1"> <div class="cmp-video-player-modal-label">Video Player <span></span></div> <button class="cmp-video-modal-close-button" type="button"> <img class="cmp-video-modal-close-button__img" src="/etc.clientlibs/aem-mgb/clientlibs/clientlib-site/resources/images/blue-x-close-icon.svg" alt=""/> <span class="sr-only">Close video player modal</span> </button> <iframe src="https://www.youtube.com/embed/?rel=0&showinfo=0" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture;" allowfullscreen></iframe> </div> </div> </div> <div class="cmp-teaser__mobile-video-container--single"> <div class="cmp-video-player " data-teaser-id="teaser-eb14192452"> <div class="cmp-video-player-modal" role="dialog" aria-labelledby="cmp-video-player-modal-label" aria-modal="true" tabindex="-1"> <div class="cmp-video-player-modal-label">Video Player <span></span></div> <button class="cmp-video-modal-close-button" type="button"> <img class="cmp-video-modal-close-button__img" src="/etc.clientlibs/aem-mgb/clientlibs/clientlib-site/resources/images/blue-x-close-icon.svg" alt=""/> <span class="sr-only">Close video player modal</span> </button> <iframe src="https://www.youtube.com/embed/?rel=0&showinfo=0" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture;" allowfullscreen></iframe> </div> </div> </div> </div> </div> </div> </div> </div> <div class="experiencefragment aem-GridColumn aem-GridColumn--default--12"> </div> <div class="container responsivegrid cmp-container-1440-gutters aem-GridColumn aem-GridColumn--default--12"> <div id="container-79982f0244" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="text aem-GridColumn aem-GridColumn--default--12"> <div data-cmp-data-layer="{&#34;text-82b5f42012&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/text&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;xdm:text&#34;:&#34;&lt;h2>Delivering value-based care for all consumers&lt;/h2>\r\n&lt;p>We develop products and programs to provide consumers with what they want when they want it. This consumer-first model provides health care that is tailored to each individual. By leveraging innovative technologies and methods, our value-based care models support the needs of the whole patient, no matter how complex.&amp;nbsp;&lt;/p>\r\n&lt;p>Accountable Care Organizations (ACOs) are a core component of the  &lt;a href=\&#34;https://www.healthcare.gov/glossary/affordable-care-act/\&#34; target=\&#34;_blank\&#34;>Affordable Care Act&lt;/a>  and a framework Mass General Brigham uses to deliver value-based care. ACOs have agreements with insurance companies to provide special services and care coordination for certain patients. These agreements set performance standards for quality and spending. There are financial incentives to meet the standards. If Mass General Brigham does not meet the standards it faces financial penalties. Since 2012, Mass General Brigham has undertaken new contracts with all the major insurers including the Centers for Medicare and Medicaid Services (CMS), commercial payers, and MassHealth.&amp;nbsp;&lt;/p>\r\n&lt;h2>Health care consumers&lt;/h2>\r\n&lt;p>Consumers have a choice in the health care they receive. Their choice is influenced by many factors, with insurance coverage playing a major role.&lt;/p>\r\n&lt;p>Most of our patient population is covered by “commercial payers”—insurance fees people pay for independent coverage or receive through their employers.&amp;nbsp;&lt;/p>\r\n&lt;p>The Medicare population represents individuals with federal health insurance who are typically aged 65 or older or certain younger people with specific conditions or disabilities.&amp;nbsp;&lt;/p>\r\n&lt;p>Medicaid patients (MassHealth) are enrolled in a joint state and federal insurance program for individuals and families with limited resources. To create a more sustainable health care ecosystem, Massachusetts has distributed and shared the responsibility, accountability, and financial risk for many of its patients by &amp;nbsp;adapting the ACO model.&amp;nbsp;&lt;/p>\r\n&#34;}}" id="text-82b5f42012" class="cmp-text"> <h2>Delivering value-based care for all consumers</h2> <p>We develop products and programs to provide consumers with what they want when they want it. This consumer-first model provides health care that is tailored to each individual. By leveraging innovative technologies and methods, our value-based care models support the needs of the whole patient, no matter how complex.&nbsp;</p> <p>Accountable Care Organizations (ACOs) are a core component of the  <a href="https://www.healthcare.gov/glossary/affordable-care-act/" target="_blank">Affordable Care Act</a>  and a framework Mass General Brigham uses to deliver value-based care. ACOs have agreements with insurance companies to provide special services and care coordination for certain patients. These agreements set performance standards for quality and spending. There are financial incentives to meet the standards. If Mass General Brigham does not meet the standards it faces financial penalties. Since 2012, Mass General Brigham has undertaken new contracts with all the major insurers including the Centers for Medicare and Medicaid Services (CMS), commercial payers, and MassHealth.&nbsp;</p> <h2>Health care consumers</h2> <p>Consumers have a choice in the health care they receive. Their choice is influenced by many factors, with insurance coverage playing a major role.</p> <p>Most of our patient population is covered by “commercial payers”—insurance fees people pay for independent coverage or receive through their employers.&nbsp;</p> <p>The Medicare population represents individuals with federal health insurance who are typically aged 65 or older or certain younger people with specific conditions or disabilities.&nbsp;</p> <p>Medicaid patients (MassHealth) are enrolled in a joint state and federal insurance program for individuals and families with limited resources. To create a more sustainable health care ecosystem, Massachusetts has distributed and shared the responsibility, accountability, and financial risk for many of its patients by &nbsp;adapting the ACO model.&nbsp;</p> </div> </div> <div class="accordion panelcontainer aem-GridColumn aem-GridColumn--default--12"> <div id="accordion-4577350af5" class="cmp-accordion" data-cmp-is="accordion" data-cmp-data-layer="{&#34;accordion-4577350af5&#34;:{&#34;shownItems&#34;:[],&#34;@type&#34;:&#34;core/wcm/components/accordion/v1/accordion&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;}}" data-placeholder-text="false"> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{&#34;accordion-4577350af5-item-bd94d64a35&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/accordion/item&#34;,&#34;dc:title&#34;:&#34;Our products and services &#34;}}" id="accordion-4577350af5-item-bd94d64a35"> <h3 class="cmp-accordion__header"> <button id="accordion-4577350af5-item-bd94d64a35-button" class="cmp-accordion__button" aria-controls="accordion-4577350af5-item-bd94d64a35-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Our products and services </span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-4577350af5-item-bd94d64a35-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-4577350af5-item-bd94d64a35-button"><div class="container responsivegrid cmp-container-1440-no-gutters"> <div id="container-bd94d64a35" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="text aem-GridColumn aem-GridColumn--default--12"> <div data-cmp-data-layer="{&#34;text-1819870c7f&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/text&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;xdm:text&#34;:&#34;&lt;p>Redesigning care strategies and focusing on the whole patient is the mission of Population Health. Population Health designs, develops, implements, and evaluates innovative care programs that put consumers at the center of their care. Our programs are available through our academic medical centers, community hospitals and smaller affiliated practices. Regardless of where we deliver care, our value-based care models support the needs of the whole patient, no matter how complex.&lt;/p>\r\n&#34;}}" id="text-1819870c7f" class="cmp-text"> <p>Redesigning care strategies and focusing on the whole patient is the mission of Population Health. Population Health designs, develops, implements, and evaluates innovative care programs that put consumers at the center of their care. Our programs are available through our academic medical centers, community hospitals and smaller affiliated practices. Regardless of where we deliver care, our value-based care models support the needs of the whole patient, no matter how complex.</p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{&#34;accordion-4577350af5-item-609bd6fb17&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/accordion/item&#34;,&#34;dc:title&#34;:&#34;Care management&#34;}}" id="accordion-4577350af5-item-609bd6fb17"> <h3 class="cmp-accordion__header"> <button id="accordion-4577350af5-item-609bd6fb17-button" class="cmp-accordion__button" aria-controls="accordion-4577350af5-item-609bd6fb17-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Care management</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-4577350af5-item-609bd6fb17-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-4577350af5-item-609bd6fb17-button"><div class="container responsivegrid cmp-container-1440-no-gutters"> <div id="container-609bd6fb17" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="text aem-GridColumn aem-GridColumn--default--12"> <div data-cmp-data-layer="{&#34;text-b43256e3d5&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/text&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;xdm:text&#34;:&#34;&lt;p>Chronically ill patients with multiple medical conditions often need the most help coordinating their care. The Integrated Care Management Program (iCMP) is focused on caring for patients with the most complex care needs. The objective of the iCMP program is to help patients stay healthier longer by providing the specialized care and services they need to prevent complications and avoid hospitalizations. The iCMP program matches high-risk patients with a nurse, social worker, or other care providers who work closely with patients and their families to develop and implement a customized care plan. Studies have shown that iCMP is a population health strategy that helps control health care costs.&lt;/p>\r\n&#34;}}" id="text-b43256e3d5" class="cmp-text"> <p>Chronically ill patients with multiple medical conditions often need the most help coordinating their care. The Integrated Care Management Program (iCMP) is focused on caring for patients with the most complex care needs. The objective of the iCMP program is to help patients stay healthier longer by providing the specialized care and services they need to prevent complications and avoid hospitalizations. The iCMP program matches high-risk patients with a nurse, social worker, or other care providers who work closely with patients and their families to develop and implement a customized care plan. Studies have shown that iCMP is a population health strategy that helps control health care costs.</p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{&#34;accordion-4577350af5-item-15b8d778cc&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/accordion/item&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;dc:title&#34;:&#34;Transitional care&#34;}}" id="accordion-4577350af5-item-15b8d778cc"> <h3 class="cmp-accordion__header"> <button id="accordion-4577350af5-item-15b8d778cc-button" class="cmp-accordion__button" aria-controls="accordion-4577350af5-item-15b8d778cc-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Transitional care</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-4577350af5-item-15b8d778cc-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-4577350af5-item-15b8d778cc-button"><div class="container responsivegrid cmp-container-1440-no-gutters"> <div id="container-15b8d778cc" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="text aem-GridColumn aem-GridColumn--default--12"> <div data-cmp-data-layer="{&#34;text-ed84ae8580&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/text&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;xdm:text&#34;:&#34;&lt;p>Through our Transitional Care program, we develop and implement innovative programs to provide patient care outside of the hospital and in more comfortable care settings, such as a patient’s own home. We call this the “Care Continuum.” Our evidenced-based innovations include Post-Acute Care and End-of-Life Care.&lt;/p>\r\n&lt;p>We are working to make the journey of providing palliative care as peaceful and stress-free as possible through acute care, skilled nursing, and rehabilitation facilities.&lt;/p>\r\n&#34;}}" id="text-ed84ae8580" class="cmp-text"> <p>Through our Transitional Care program, we develop and implement innovative programs to provide patient care outside of the hospital and in more comfortable care settings, such as a patient’s own home. We call this the “Care Continuum.” Our evidenced-based innovations include Post-Acute Care and End-of-Life Care.</p> <p>We are working to make the journey of providing palliative care as peaceful and stress-free as possible through acute care, skilled nursing, and rehabilitation facilities.</p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{&#34;accordion-4577350af5-item-8bb3114b5d&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/accordion/item&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;dc:title&#34;:&#34;Risk capture&#34;}}" id="accordion-4577350af5-item-8bb3114b5d"> <h3 class="cmp-accordion__header"> <button id="accordion-4577350af5-item-8bb3114b5d-button" class="cmp-accordion__button" aria-controls="accordion-4577350af5-item-8bb3114b5d-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Risk capture</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-4577350af5-item-8bb3114b5d-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-4577350af5-item-8bb3114b5d-button"><div class="container responsivegrid cmp-container-1440-no-gutters"> <div id="container-8bb3114b5d" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="text aem-GridColumn aem-GridColumn--default--12"> <div data-cmp-data-layer="{&#34;text-e76625506f&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/text&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;xdm:text&#34;:&#34;&lt;p>Risk Capture is the coding and documentation of chronic and complex diagnoses in a face-to-face patient/provider encounter each calendar year. The result of this encounter generates a risk score that reflects the predicted overall resource use (claim dollars) for each person relative to the claim dollars for an average risk person.&amp;nbsp;&lt;/p>\r\n&lt;p>Accurate risk capture ensures patients are connected to care and resources that address their medical conditions. It promotes data integrity to reflect the true illness cost of patients and drives favorable performance in value-based care arrangements.&lt;/p>\r\n&lt;p>Risk coding relies on a risk-adjustment model designed to estimate future health care costs for patients. The Center for Medicare and Medicaid Services established this model, and it has become increasingly prevalent as health care systems move to value-based payment models.&lt;/p>\r\n&#34;}}" id="text-e76625506f" class="cmp-text"> <p>Risk Capture is the coding and documentation of chronic and complex diagnoses in a face-to-face patient/provider encounter each calendar year. The result of this encounter generates a risk score that reflects the predicted overall resource use (claim dollars) for each person relative to the claim dollars for an average risk person.&nbsp;</p> <p>Accurate risk capture ensures patients are connected to care and resources that address their medical conditions. It promotes data integrity to reflect the true illness cost of patients and drives favorable performance in value-based care arrangements.</p> <p>Risk coding relies on a risk-adjustment model designed to estimate future health care costs for patients. The Center for Medicare and Medicaid Services established this model, and it has become increasingly prevalent as health care systems move to value-based payment models.</p> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="text aem-GridColumn aem-GridColumn--default--12"> <div data-cmp-data-layer="{&#34;text-b5749f83ed&#34;:{&#34;@type&#34;:&#34;aem-mgb/components/text&#34;,&#34;repo:modifyDate&#34;:&#34;2023-12-29T17:55:26Z&#34;,&#34;xdm:text&#34;:&#34;&lt;h2>Measuring our success and adapting to provide better care&lt;/h2>\r\n&lt;p>Population Health manages Mass General Brigham’s care transformation by evaluating and analyzing the impact of our &amp;nbsp;programs  on patient and provider experiences, clinical outcomes, and health care costs. The Product Development and Data and Analytics teams conduct and support evaluations and analyses of the care delivery transformation projects we sponsor. &lt;/p>\r\n&lt;h2>Our team&lt;/h2>\r\n&lt;p>Population Health’s leaders, together with clinical and administrative teams, oversee population health management initiatives. They work toward improving the quality of care for Mass General Brigham patients while reducing overall costs.&amp;nbsp;&lt;/p>\r\n&lt;p>&lt;b>Lindsay E. Jubelt, MD, MS&lt;/b>&lt;br>\r\nChief Population Health Officer&lt;br>\r\n&lt;/p>\r\n&lt;p>&lt;b>Helen Chan&lt;/b>&lt;br>\r\nVice President, Clinical Product Development&lt;/p>\r\n&lt;p>&lt;b>Michael Esters&lt;/b>&lt;br>\r\nSenior Director, Clinical Program Operations&lt;/p>\r\n&lt;p>&lt;b>Stanley M. Hochberg, MD&lt;/b>&lt;br>\r\nSenior Medical Director, Planning and Performance&lt;/p>\r\n&lt;p>&lt;b>Adam Licurse, MD&lt;/b>&lt;br>\r\nSenior Medical Director, Planning and Performance&lt;/p>\r\n&lt;p>&lt;b>Channah Rubin&lt;/b>&lt;br>\r\nSenior Director, Administration&lt;/p>\r\n&lt;h2>Learn with us&lt;/h2>\r\n&lt;p>Population health management is a recognized solution to improve quality of care and reduce health care costs.&amp;nbsp;&lt;/p>\r\n&lt;p>Currently, there are limited pathways for training clinical and administrative leaders in population health management. In response, Mass General Brigham created the Population Health Fellowship and Resident Elective Rotation.&amp;nbsp;&lt;/p>\r\n&lt;p>These comprehensive educational programs provide direct experience and leadership development to spark innovation for the next generation of population health leaders:&amp;nbsp;&lt;/p>\r\n&lt;ul>\r\n&lt;li>&lt;a href=\&#34;/content/mgb-global/global/en/research-and-innovation/centers-and-programs/population-health/fellowship-program.html\&#34; style=\&#34;background-color: rgb(255, 255, 255);\&#34;>Fellowship Program &lt;/a>– Offers graduating medical residents the opportunity to participate in a population health management fellowship.&lt;br>\r\n&lt;/li>\r\n&lt;li>Residency Electives – Provides current medical residents the opportunity to participate in brief rotations for exposure to population health management concepts and operations.&lt;br>\r\n&lt;/li>\r\n&lt;li>Internship Program – Engages rising-senior college students, or students in graduate school, in roles and functions within Population Health as potential career paths.&lt;br>\r\n&lt;/li>\r\n&lt;/ul>\r\n&#34;}}" id="text-b5749f83ed" class="cmp-text"> <h2>Measuring our success and adapting to provide better care</h2> <p>Population Health manages Mass General Brigham’s care transformation by evaluating and analyzing the impact of our &nbsp;programs  on patient and provider experiences, clinical outcomes, and health care costs. The Product Development and Data and Analytics teams conduct and support evaluations and analyses of the care delivery transformation projects we sponsor. </p> <h2>Our team</h2> <p>Population Health’s leaders, together with clinical and administrative teams, oversee population health management initiatives. They work toward improving the quality of care for Mass General Brigham patients while reducing overall costs.&nbsp;</p> <p><b>Lindsay E. Jubelt, MD, MS</b><br> Chief Population Health Officer<br> </p> <p><b>Helen Chan</b><br> Vice President, Clinical Product Development</p> <p><b>Michael Esters</b><br> Senior Director, Clinical Program Operations</p> <p><b>Stanley M. Hochberg, MD</b><br> Senior Medical Director, Planning and Performance</p> <p><b>Adam Licurse, MD</b><br> Senior Medical Director, Planning and Performance</p> <p><b>Channah Rubin</b><br> Senior Director, Administration</p> <h2>Learn with us</h2> <p>Population health management is a recognized solution to improve quality of care and reduce health care costs.&nbsp;</p> <p>Currently, there are limited pathways for training clinical and administrative leaders in population health management. In response, Mass General Brigham created the Population Health Fellowship and Resident Elective Rotation.&nbsp;</p> <p>These comprehensive educational programs provide direct experience and leadership development to spark innovation for the next generation of population health leaders:&nbsp;</p> <ul> <li><a href="/en/research-and-innovation/centers-and-programs/population-health/fellowship-program" style="background-color: rgb(255, 255, 255);">Fellowship Program </a>– Offers graduating medical residents the opportunity to participate in a population health management fellowship.<br> </li> <li>Residency Electives – Provides current medical residents the opportunity to participate in brief rotations for exposure to population health management concepts and operations.<br> </li> <li>Internship Program – Engages rising-senior college students, or students in graduate school, in roles and functions within Population Health as potential career paths.<br> </li> </ul> </div> </div> <div class="custom-links aem-GridColumn aem-GridColumn--default--12"><div> <div class="cmp-navigation-tile cmp-navigation-tile__small"> <ul class="cmp-navigation-tile__list"> <li class="cmp-navigation-tile__container"> <a class="cmp-navigation-tile__tile cmp-navigation-tile__text cmp-navigation-tile__internal" href="/en/research-and-innovation/centers-and-programs/population-health/fellowship-program" target="_self"> <div class="cmp-navigation-tile__title">About the Population Health Fellowship</div> <!-- screen reader external link new tab/window --> <!-- update this --> <div class="cmp-navigation-tile__description"> </div> </a> </li> <li class="cmp-navigation-tile__container"> <a class="cmp-navigation-tile__tile cmp-navigation-tile__text cmp-navigation-tile__download" href="/content/dam/mgb-global/en/research-and-innovation/centers-and-programs/population-health/PHM-Fellowship-App-Revised-2021.pdf" target="_blank"> <div class="cmp-navigation-tile__title">Download the Fellowship Application</div> <!-- screen reader external link new tab/window --> <!-- update this --> <div> <span class="sr-only">(opens in new tab)</span> </div> <div class="cmp-navigation-tile__description"> </div> </a> </li> <li class="cmp-navigation-tile__container"> <a class="cmp-navigation-tile__tile cmp-navigation-tile__text cmp-navigation-tile__internal" href="/en/research-and-innovation/centers-and-programs/population-health/contact-us" target="_self"> <div class="cmp-navigation-tile__title">Contact us for more information</div> <!-- screen reader external link new tab/window --> <!-- update this --> <div class="cmp-navigation-tile__description"> </div> </a> </li> </ul> </div> </div> </div> <div class="vertical-spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-vertical-spacer cmp-space-small" aria-hidden="true"></div> </div> <div class="expandable-form aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-expandable-form"> <div 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/*Hidden by default */ position: fixed; /* Stay in place */ z-index: 100148; /* Sit on top */ left: 0; top: 0; } .footer__notice.modal::backdrop { position: fixed; top: 0; left: 0; right: 0; bottom: 0; background-color: rgba(0, 0, 0, 0.6); } .footer__notice .modal-content{ background-color: rgba(0, 0, 0, 0.7); color: #fefefe; position: fixed; left: 50%; margin: 0 auto; bottom: -6rem; transform: translate(-50%, -50%); font-size: .9375rem; padding: 5px 20px; width: 80%; /* Could be more or less, depending on screen size */ border: 1px solid rgba(0, 0, 0, 0.4); border-radius: 6px; box-shadow: 0 3px 7px rgba(0, 0, 0, 0.3); } .footer__notice .modal-body tr{ background-color: rgba(0, 0, 0, 0); color: #fefefe; border: none; } .footer__notice .modal-body td{ padding:0; font-size: .9375rem; vertical-align:top; } @media (min-width: 768px){ .footer__notice .modal-content { bottom: -1rem; } } .footer__notice .close { color: #fefefe; float: right; font-size: 1.5rem; font-weight: 600; padding: 0 0.5em; } .footer__notice .modal-content .btn{ min-width:75px; padding:.15em .25em; margin-left:2rem; margin-top:.5rem; font-size: 0.95rem; } .footer__notice .modal-body{ padding: 0.25rem 0; } .footer__notice .modal-body p{ margin-top: 0; } .footer__notice .privacy_policy { font-size:1.1rem; color: #fefefe; border-bottom: 1px solid transparent; font-weight: 800; transition-property: background-color,color; } .footer__notice .modal-body a:focus-visible{ outline: 2px dashed #ffffff; outline-offset: 3px; } </style> <div id="footerModal" class="footer__notice modal" aria-controls="footerNoticeClose"> <div class="modal-content"> <div class="modal-header"> </div> <div class="modal-body"> <table> <tr> <td><p><span id="cookieNotice"></span>We use cookies and other tools to enhance your experience on our website and to analyze our web traffic. For more information about these cookies and the data collected, please refer to our <a target="_blank" href='/en/notices/web-privacy-policy' class="privacy_policy" aria-label='Privacy Policy'><span>Privacy Policy</span></a>. </p> </td> <td style="min-width: 1rem;"> <a href='#cookieNoticeClose' aria-label='Cookie Notice Close' id='cookieNoticeClose'><span class="close">&#215;</span></a> </td> </tr> </table> </div> </div> </div> <script type="text/javascript"> var modal = document.getElementById('footerModal'); var closeBtn = document.querySelector('.footer__notice .modal-body #cookieNoticeClose'); //var okBtn = document.querySelector('.footer__notice .modal-body a'); var footerNotifyIndex = document.cookie.indexOf("privacynotifymgb"); closeBtn.focus(); closeBtn.onclick = function(event) { event.preventDefault(); modal.style.display = "none"; var now = new Date(); now.setTime(now.getTime() + 365 * 24 * 3600 * 1000);//One year document.cookie = "privacynotifymgb=; expires=" + now.toUTCString() + "; path=/"; } if(footerNotifyIndex === -1){ modal.style.display = "block"; } document.addEventListener('keyup', function (e) { if(e.target.hash){ var id = e.target.hash.replace(/[?#]/gi, ''); var spanBtn = document.querySelector('.footer__notice .modal-body .close'); if(id && id == 'cookieNoticeClose' && e.code == 'Tab'){ spanBtn.style.border = "1px solid #01b9e8"; } else{ var skipContent = document.getElementById('skipContent'); skipContent.focus(); spanBtn.style.border = "none"; } } }); </script> </div> </div> </div> </div> </div> </footer> </div> </div> </div> <script src="/etc.clientlibs/aem-mgb/clientlibs/clientlib-site.lc-09901b4a0a833ac7cb0c1adfb0ae67d0-lc.min.js"></script> <script src="/etc.clientlibs/clientlibs/granite/jquery/granite/csrf.lc-652a558c3774088b61b0530c184710d1-lc.min.js"></script> <script src="/etc.clientlibs/aem-mgb/clientlibs/clientlib-base.lc-27ce2d211fdf41ad5837f5a0cbd77961-lc.min.js"></script> </body> </html>

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