Activity ID
IA_PM_6Activity Weighting
MediumSubcategory Name
Population Management
Activity Description
Address inequities in health outcomes by using population health data analysis tools to identify health inequities in the community and practice and assess options for effective and relevant interventions such as Population Health Toolkit or other resources identified by the clinician, practice, or by CMS. Based on this information, create, refine, and implement an action plan to address and close inequities in health outcomes and/or health care access, quality, and safety.
Objective
Decrease healthcare inequities and improve health status in underserved communities.
Suggested Documentation
Evidence of activity to decrease healthcare inequities. Include both of the following elements:
1) Population health data analysis resources used – Documentation of resources used to identify health inequities in the practice’s population and to assess options for intervention; AND
2) Implementation report – Report with action plan for implementing the selected intervention (including the health inequity targeted, detailed plan for improvement, and the specific outcomes targeted for improvement), and results from its implementation.
Example/Information
- National Rural Health Resource Center Population Health Toolkit: https://www.ruralcenter.org/population-health-toolkit
- CMS Network of Quality Improvement and Innovation Contractor (NQIIC) program health equity resource page: https://qi.ipro.org/health-equity/; https://qi.ipro.org/health-equity-resources/
- Novartis Foundation Urban Population Health Toolkit (cardiovascular disease focus): https://www.novartisfoundation.org/urban-population-health-toolkit