The Cleveland Clinic is adopting a new, community-based population health approach in its effort to reduce the negative impact social determinants of health (SDOH) have on its patients’ outcomes, the health system’s chief population health officer told Health Leaders‘ Christopher Cheney in a recent interview.

Adam Myers said that his organization has achieved success by using health data analytics to discover the most prevalent barriers to care in the various communities and patient populations it serves, then tailoring its approach to knocking down those barriers — often on a clinic-to-clinic basis.

“Rather than assume what each community needs, Cleveland Clinic Community Care will partner with municipalities, community organizations, businesses, churches, existing healthcare teams in the communities, and other health systems to address the needs defined by both stakeholders and focused healthcare analytics,” Myers explained.

“At the Stephanie Tubbs Jones Family Health Center in the east side of Cleveland, we found that getting to appointments was a real struggle. Transportation was very difficult,” he noted. “We made a simple intervention that was a value-add intervention for the community. We provide 30 to 50 patient transportation opportunities per day.”

Rather than seeking to supplant existing community health services, the health system will work to provide them additional resources — or to fill gaps that it identifies in the safety net system.

Read the full interview here, in Health Leaders.