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2023 Population Needs Assessment Identifies HPSM’s 2024 Health Priorities

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2023 Population Needs Assessment Identifies HPSM’s 2024 Health Priorities


2023 Population Needs Assessment Identifies HPSM’s 2024 Health Priorities

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2023 Population Needs Assessment Identifies HPSM’s 2024 Health Priorities

In June 2023, HPSM completed our annual Population Needs Assessment (PNA) to assess our Medi-Cal members’ needs. The PNA process includes: 

  1. Gathering data from a variety of sources—including claims, Healthcare Effectiveness Data and Information Set (HEDIS) results, language assistance services, utilization data, and results from member surveys.
  2. Assessing member demographics and segmenting our member population based on factors such as age, gender, language preference, race/ethnicity, disability status, and health conditions.
  3. Analyzing findings to identify health disparities and evaluate member subgroups’ health status.
  4. Developing an action plan with targeted Health Promotion, Population Health Improvement, and Culturally and Linguistic Appropriate Services (CLAS) program strategies.

Key demographic information highlighted in the PNA

81% of HPSM’s membership is covered under our Medi-Cal program. Of that population:

  • 42% are under 21 years old.
  • 44% identify as Hispanic, 17% as Asian/ Pacific Islander and 11% as Caucasian. 
  • 91% choose English or Spanish as their preferred language. 

Population Health priority areas

The PNA findings help to prioritize HPSM’s work in health equity, chronic disease management, health promotion and population health improvement. We identified these priority areas for 2024:

  • Adolescent well visits: Compliance rates for teens between the ages of 18 and 21 are low. 
  • Gestational diabetes: While the overall rate of pregnant members diagnosed with gestational diabetes decreased from 13.6% in 2021 to 12% in 2022, disparities in gestational diabetes rates have been identified among Asian and Pacific Islander members.
  • Cancer screenings: Overall breast, cervical and colorectal cancer screening rates show room for improvement. Disparities in breast and cervical cancer screening exist for people with disabilities.  
  • Hypertension: Hypertension rates have increased. 

In upcoming provider forums and communications, the Population Health Management team will share more details about the PNA results, as well as the plan to address priority areas and ways that providers can partner with the Population Health Management team to help reduce disparities. 

To learn more about the PNA findings or discuss opportunities to collaborate with HPSM’s Population Health Management team at your clinic or facility, please email