| # | Assessment Elements | Answer Options | What looks immature | What looks mature | Evidence Type |
| | Do you have a documented and implemented process to drive population health improvement? (e.g. obesity, CHF) | -Yes
-No | No process in place for population health improvement | Documented and implemented process to drive population health improvement in those subsets that have chronic diseases (e.g., obesity, CHF) | Please attach the documented process to drive population health improvement that is adopted by your organization |
| | Do local health /social care providers have digital access to information from your organisation? | -Yes (both health/ Social care provider)
-Yes, partially (health or Social care provider)
-No | No or limited shared information | Relevant medical information is up-to-date and readily available for other social care providers to access | Please provide a screen sample that proves their full or partial access. |
| | Is your organisation's data available to local population health initiatives to support the identification of patient cohorts? | -Yes
-No | Unavailable | The organization's data is readily available to local population health initiatives to support the identification of patient cohorts | Please provide a screen sample that proves the availability of data to local population health initiatives that support the identification of patient cohorts |
| | If your organization uses predictive analytics, which of the following does it include? | - Monitoring and reporting on levels of engagement
- Monitoring and reporting on level of understanding of conditions/diagnoses
- Monitoring and reporting on levels of motivation and/or ability to achieve health goals
- Ability to afford and access recommended treatments and severity of illness.
- Not applicable | No predictive analytics methods used | Populations are profiled and modelled (population health) using predictive analytics down to the patient level, which might include monitoring and reporting on levels of engagement, level of understanding of conditions/diagnoses, levels of motivation, and/or ability to achieve health goals, ability to afford and access recommended treatments, and severity of illness. | Please provide a screen sample of the predictive analytics work done by your organization |
| | Does the organization target specific disease types in order to show improvements in population health? | -Yes
-No | The organization does not target any specific disease type to show improvement | The organization targets specific disease types to show improvement | Please give an example of a specific disease type that was targeted by your organization to show improvement to population health (Provide a screen sample of a minute meeting or email of decisions made with regards to this matter)
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