Crouse Population Health Incentive Program (2022)

Please provide responses to the questions below related to the Population Health Incentive Program. The purpose of this questionnaire is to survey program participants to determine program impact.

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* 1. Primary Care Provider (PCP) Relationship

This program prompted me to establish with a primary care provider

I already had a primary care provider prior to my first year participating in this program

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* 2. Frequency of PCP Visits (program requires annual visit)

I see my PCP more frequently because of this program

This program has not changed how often I see my PCP

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* 3. For program required LAB WORK, please select the answer that most accurately relates to you:

I obtained lab work that I may not have gotten if I wasn’t participating in this program

I obtained lab work that I may have delayed if I wasn’t participating in this program

This program did not have an impact on my obtaining lab services

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* 4. For program required SCREENINGS, please select the answer that most accurately relates to you:

I obtained screenings that I may not have gotten if I wasn’t participating in this program

I obtained screenings that I may have delayed if I wasn’t participating in this program

This program did not have an impact on my obtaining screenings

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* 5. Check all that apply:

I have made lifestyle changes because of this program

I am more aware of my health and services I need to obtain because of this program

I have identified something about my health I can work to improve because of this program

I identified a significant health issue because of the PCP visit or screenings, that I may not have found if I did not participate in this program

Provide details or other comments as desired:

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* 6. Health Status:

	1 Excellent	2 Very Good	3 Good	4 Fair	5 Poor
Your health status PRIOR TO participating in this program	Your health status PRIOR TO participating in this program 1 Excellent	Your health status PRIOR TO participating in this program 2 Very Good	Your health status PRIOR TO participating in this program 3 Good	Your health status PRIOR TO participating in this program 4 Fair	Your health status PRIOR TO participating in this program 5 Poor
Your health status AFTER you began participating in this program	Your health status AFTER you began participating in this program 1 Excellent	Your health status AFTER you began participating in this program 2 Very Good	Your health status AFTER you began participating in this program 3 Good	Your health status AFTER you began participating in this program 4 Fair	Your health status AFTER you began participating in this program 5 Poor

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* 7. To what extent did this program play a role in your health improvement:

Significant role in my health improvement(s)

Moderate role in my health improvements(s)

Slight role in my health improvement(s)

I have made health improvement(s), but this program didn't play a role

I have not made health improvements

Provide details as desired:

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* 8. Program Participation:

2022 was my first year participating in the program

I participated in 2022 and have also participated in previous years