Improving Tri-County Population Health
Identifying service gaps through tracking Social Determinants of Health Data
Program Overview
As healthcare delivery systems evolve, there is a clearly identified need to address the socioeconomic and social determinants of health impacting community members’ ability to achieve optimal wellness. Population Health is a term encompassing various approaches to preventing disease and promoting health through organized efforts to change the way care is accessed, provided, and utilized.
Here at NCPPC, we are continually working to improve the Population Health of the tri-county area. Our home visiting, health education, and insurance programs work with clients to improve the access, knowledge, and skills necessary to navigate health care and social systems.
Additionally, our wide range of Professional Development offerings help to build skills to improve client services across the spectrum of professional, community, and healthcare services, ensuring a systems-level approach to Population Health. Using systems-thinking and design practices, we work to resolve long-standing issues through community collaboration and innovation.
84%
Of clients surveyed in 2020 reported having Health Insurance
76%
Of people reported having trouble paying for basic needs
89%
Identified having positive social supports
42%
Identified having unpaid medical bills
At A Glance
01
Who
Tri-County Residents
02
What
Identifying Community Needs
03
Where
Jefferson, Lewis, St. Lawrence CountiesResources
Analyze Community Needs
Identifying gaps in services through community needs assessments and data tracking.
Community Partnerships
Use Social Determinants of Health Data to create opportunities for community collaboration and growth.
Access to Resources
NCPPC is committed to helping all community members by providing Community Health Advocate services and linkage to community resources.