Operationalizing Population Health Management in Practice.

We synthesized practitioner perspectives on how to integrate a community-based program into a healthcare system. Three focus groups and four in-depth interviews in Greene County, Missouri addressed: the population served, collaborations, service delivery design, training, data collection, and funding. Participants identified the following: integration as a way to increase population health outcomes through mutually beneficial partnerships; education and awareness of community-based resources; coordination of services to avoid duplication and maximize niche skills; smooth transitions across programs; and information sharing.