HRET and ACHI Survey Hospitals on Population Health

The U.S. health care field is moving in a new direction — toward population health. The alignment of expanded access to care with the adoption of value-based reimbursement models has primed health care for unprecedented transformation. Succeeding in this new environment requires hospitals not only to provide high-quality patient care, but also to look outside their walls to promote the health of their communities.

To support hospitals that embark on the population health journey, the Health Research & Educational Trust and the Association for Community Health Improvement, both American Hospital Association affiliates, conducted a nationwide survey of hospitals to assess the state of population health in 2015. Questions addressed how population health initiatives are structured in the hospital, partnerships with community organizations, and the process for assessing community health needs.

Survey Findings

Hospitals were asked to assess their commitment to population health on a spectrum from “no commitment” to “total commitment.” While 91 percent of the 1,418 respondents reported at least some commitment, 31 percent indicated total commitment. Exploring the characteristics of hospitals that already are doing this work reveals what it takes to make a total commitment to population health.

Hospital size: For population health, size doesn’t matter. Among survey respondents, large hospitals were only slightly more likely than small hospitals to be totally committed to population health (36 vs. 30 percent).

Urban vs. rural: Though size doesn’t matter, location does. Urban hospitals were more likely to be committed to population health than rural hospitals (73 vs. 27 percent).

Financial support: Hospitals with a total commitment to population health were significantly more likely than the rest of the sample to “agree” or “strongly agree” that their organization had allocated adequate financial resources for population health (83 vs. 51 percent).

Socioeconomic determinants of health: Aligned with a vision of population health addressing the needs of all individuals in a geographic service area, nearly three quarters of hospitals totally committed to population health have developed initiatives to address the socioeconomic determinants of health.

Collaboration: Hospitals that are committed to population health are significantly more collaborative with external organizations than those that are not, reporting strong partnerships with community organizations (94 vs. 80 percent) and priorities aligned with local public health (81 vs. 61 percent). Notable partnerships include those with federally qualified health centers/community clinics (55 percent), other hospitals (52 percent), public health departments (52 percent), healthy community coalitions (48 percent) and community development organizations (30 percent).

Takeaways for Boards

Population health is no longer a mission restricted to a few ambitious hospitals. Though this survey shows clear trends among hospitals and health care systems strongly committed to population health, any hospital can work toward improving population health. The main precondition for engaging in population health is making an organizational commitment to a mission and vision that health care systems can, and should, make the health of the community a top priority along with patient care. By aligning resources to support population health goals and collaborating with community organizations, hospitals can contribute to long-term improvements in the health of their patients and community.

Improving the health of populations is challenging, and hospitals cannot accomplish it alone. Succeeding in the new frontier of health care will take leadership, staff, patients, families and community partners working together to improve the health of our communities.

Visit the Hospitals in Pursuit of Excellence website at for complete survey results. 

Julia J. Resnick, M.P.H. (, is a program manager for the Association for Community Health Improvement and the Health Research & Educational Trust, Chicago.