The United States (U.S.) spends nearly twice the average of other Organization for Economic Co-operation and Development (OECD) countries’ expenditures on health, but has the lowest average life expectancy, performs worse than average on many population health outcomes, and has more outcome-related disparities compared to peer OECD countries (OECD, 2023; Gunja, et al., 2022). An analysis of 2020 Commonwealth Fund International Health Policy Survey data found lower income adults in the U.S. fare relatively worse on affordability and access to primary care and income-related disparities across domains than those in ten other high-income countries (Doty et al., 2020). The 2021 Commonwealth Fund report (Schneider et al., 2021) notes the U.S. has the largest disparities between income groups, except for preventive services and safety of care.

The U.S. and CMS acknowledge the importance of quality measurement and that quality reporting and value-based programs have improved outcomes and how measured entities deliver care. Additionally, population health measurement is critical to improving the nation’s overall health. As such, CMS is committed to four principles for improving population health:

• Establish health access for all as a strategic priority
• Empower and enable measured entities and other interested parties to take a data-driven approach to measuring and improving population health
• Leverage state innovation and local leadership through partnerships
• Address all drivers of health including clinical, social, behavioral, and environmental factors.

This content provides a high-level overview and definition of population health. It addresses considerations for population health quality measures with respect to the Measure Lifecycle. As population health measures evolve, so will this content. 

Introduction to Population Health

Population health refers to “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”. (Beck, et. al.) Note that this definition does not delineate how to define the groups themselves. When developing population health measures, clarity of the denominator is critical for measurement. The current approach for commonly published summary measures of population health, such as mortality rates, primarily uses geopolitical areas.

However, other population identifiers may include panels of patients (e.g., persons assigned to a specific measured entity or measured entity team), members of a health plan, or members of a specific social, economic and geographic factors" and remove the parenthesis. Ex: However, other population identifiers may include panels of patients (e.g., persons assigned to a specific measured entity or measured entity team), members of a health plan, or members of a specific social demographic. Social, economic, and geographic factors also impact population health significantly (Green & Zook, 2019).

CMS defines a population health measure as an indicator that reflects the overall health and well-being of a group. Examples of population health topics include access to care, clinical outcomes, coordination of care and community services, health behaviors, preventive care and screening, and utilization of health services. While there is no definitive guidance on how measure developers should define a group, these distinctions are important for differentiating population health measures from other quality measures. Quality measures are typically designed to assess the quality, cost, or efficiency of services provided to individuals within specific health care settings and are therefore closely tied to particular services and measured entities. In contrast, population health measures are not necessarily restricted to specific services or entities, allowing for a broader assessment of the health of a group. Thus, population health measures represent a type of quality measure that enables a wider evaluation of group health outcomes.