Care Management & Population Health
Effective care management that supports patient-centered care, improves care transitions and connects local resources is critical for value-based care. Strategies that focus on improving the population health across the community are also essential.
Most recent resources are listed first. Click on the title to view the document(s)
Rural Community Engagement Resource Guide
Provides rural health care leaders a variety of toolkits, strategies, and information to help initiate, improve, and inspire community engagement strategies that support value. The accompanying Infographic highlights strategies for community engagement and benefits aligned with value-based care. (2023)
Understanding the Social Determinants of Health: A Guide for Rural Health Care Leaders
Provides rural health care leaders and teams with foundational knowledge, strategies, and resources to understand the impact of social determinants of health (SDOH) on patients and communities and to recognize local needs and opportunities for action. (2022)
Serving High Need/High Cost Patients in the Emergency Department
This brief describes design, implementation, operation, and assessment of programs to serve high-need, high-cost patients in the Emergency Department. (2021)
Innovative Health Care Provider Roles
Address health care workforce challenges in creative ways, by expanding current provider roles and employing community members in new health care capacities using this Rural Health Value resource. (2020)
Using Data to Understand Your Community
Using data to understand your community's population is a critical first step in considering strategies to improve community and population health. (2020)
Care Coordination: A Self-Assessment for Rural Health Providers and Organizations
This Rural Health Value tool helps healthcare leaders assess the current state of critical elements in care coordination and develop and enhance care coordination efforts. Fillable MS-Word version (2020)
Population Health: A Self-Assessment Tool for Rural Health Providers and Organizations
Developed by the Rural Health Value team, designed to provide a preliminary review of critical success factors for rural organizations looking to develop, expand, or enhance a population health focused approach. Fillable MS-Word version. (2020)
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