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Population Health Mangement

Population Health Management (PHM) is an approach used to improve the current and future health and well-being of people within a defined area, and reduce the health inequalities experienced by patients and service users. It includes action to:

  • Reduce ill health
  • Plan and deliver the health and care services people need
  • Address the wider issues that affect people’s health outcomes

PHM uses data from a variety of available, local sources to guide the planning and delivery of care to have the greatest positive impact on the health of local people.  It includes techniques to identify and prioritise those most at risk of ill health, so services and resources can be targeted in the right place, at the right time.

Using a Population Health Management approach provides a better understanding of the health needs of the local population by joining up information related to:

  • Health behaviours and lifestyle
  • Access to clinical care and services
  • The current use and quality of existing services
  • The wider / social determinants of health (such as housing, employment and education).

Protect NoW is the Norfolk and Waveney Integrated Care System’s proactive response to reducing health inequality and improving the healthy life expectancy of local people and is a dynamic collaboration of NHS organisations, Local Authorities, the voluntary sector and independent partners. Together, we are using local data and PHM approaches to plan and deliver services for maximum impact. 

This programme of work grew out of the award winning Covid Protect project and encompasses a growing number of distinct projects, each focused on a common cause of mental and/or physical ill health.  Current Protect NoW projects include supporting people to access cervical screening, flu vaccination, covid vaccination, talking therapies and the diabetes prevention programme.  We do this by:

1. Identifying the patients with the greatest need or ‘reversible risk’ opportunity (using a risk stratification tool)

2. Identifying the existing or new services that could benefit them most

3. Proactively contacting the identified patients to facilitate a link to those services.

The ongoing learning from the Protect NoW programme is informing a wider Population Health Management strategy for Norfolk and Waveney as we develop as an Integrated Care System.

You can read more about both Protect NoW and You can read more about both Protect NoW and Covid Protect

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