Improving population health one person at a time? Accountable care organisations: perceptions of population health—a qualitative interview study

OBJECTIVE This qualitative interview study explored perceptions of the phrases 'population health', 'public health' and 'community health'. SETTING Accountable care organisations (ACOs), and public health or similar agencies in different parts of the USA. PARTICIPANTS Purposive sample of 29 interviewees at four ACOs, and 10 interviewees at six public health or similar agencies. RESULTS Interviewees working for ACOs most often viewed 'population health' as referring to a defined group of their organisation's patients, though a few applied the phrase to people living in a geographical area. In contrast, interviewees working for public health agencies were more likely to consider 'population health' from a geographical perspective. CONCLUSIONS Conflating geographical population health with the health of ACOs' patients may divert attention and resources away from organisations that use non-medical means to improve the health of geographical populations. As ACOs battle to control costs of their population of patients, it would be more accurate to consider using a more specific phrase, such as 'population of attributed patients', to refer to ACOs' efforts to care for the health of their defined group of patients.