For decades, neuropsychologists have been experts in understanding the brain. The next frontier is applying that expertise to improve the cognitive health of entire populations. Integrating neuropsychological practice into primary care has already demonstrated how our field can expand access to assessment in attempting to improve the early identification of cognitive symptoms. When our respective papers on primary care neuropsychology were published (Fallows, 2019; Lanca, 2018), this represented a substantial departure from traditional practice. That work required reimagining the role of the neuropsychologist from providing comprehensive evaluations alone to offering warm handoffs and curbside consultations, briefer neuropsychological assessments with targeted triaging, and other professional activities requiring cognitive expertise such as psychoeducation on dementia prevention, and ADHD symptom management.
However, primary care was never the destination. It was proof that neuropsychologists could practice differently. Population health provides the broader framework through which these innovations can extend across specialty clinics, hospitals, community programs, and healthcare systems. Population health seeks to improve outcomes across the entire continuum of care from prevention and early detection to chronic disease management while emphasizing equitable access, quality of care, and patient experience. Achieving this vision will require neuropsychologists not only to expand innovative models of clinical care but also to play larger roles in research, implementation science, and healthcare leadership
But what exactly is population health? There are indeed many different definitions; however, the core tenets of population health are generally consistent and deceptively simple: create equitable access to healthcare that improves quality of life while enhancing both patient and provider experience through prevention, early detection, and timely intervention. In so doing, population health scientists often talk about “moving care upstream” through various levels of strategic interventions:
| Primary Strategies | Secondary Strategies | Tertiary Strategies | |
|---|---|---|---|
| Description | Impacting health prior to the occurrence of disease | Early detection, with the focus of early intervention and reducing disease impact | Minimizing the impact of a chronic disease or development of comorbid condition |
| Traditional Strategy Example | Nutrition and exercise education | Breast cancer screening program | Chronic care monitoring and intervention in diabetes to reduce risk of kidney disease and cerebrovascular burden |
| Possible Neuropsychology Example | Cognitive wellness education in a primary care clinic for individuals with a negative cognitive screener at the annual wellness visit | Routine screening of all patients within an epilepsy clinic, triaging those with two or more cognitive complaints to brief neuropsychological assessment | Patients who have a positive brief neuropsychological assessment are triaged to more routine monitoring with recommendations for additional interventions (e.g., psychotherapy, speech therapy, etc.) to reduce risk of additional symptom burden and improve quality of life |
This framework fundamentally changes the role of the neuropsychologist. Rather than entering only after significant cognitive concerns arise, neuropsychologists can contribute across the continuum of prevention, early detection, intervention, and chronic disease management. The goal is ultimately to keep expanding primary prevention as the population becomes “less sick”; however, one should not downplay just how impactful secondary and tertiary prevention can be in improving quality of life while reducing total cost of care. Ultimately, the impact of care should be measurable and focus not just on care delivery, but also the built environment and other social determinants of health (SDOH) which account for 30-55% of health outcomes (World Health Organization, 2023).
Although population health adaptations to neuropsychology may have gotten their start in primary care, there are many other professional avenues where neuropsychologists can get involved. In our upcoming book , Advancing Neuropsychology Through Population Health (Lanca & Fallows, 2026), we explore many of these expansion possibilities across a wide range of settings from clinical practice to research. In the clinical setting, Dr. Caleb Pearson demonstrates how to expand access to care by implementing a cognitive triage model in an epilepsy clinic. In this model, every patient who enters the clinic will have their cognitive health formally integrated as a part of their whole person care. Pediatrics is another setting where a neuropsychology population health framework has improved healthcare. Pediatric comprehensive neuropsychological evaluations are typically longer than adult evaluations and wait lists are significant. Drs. Molly Colvin and Trevor Hall illustrate how their clinics modified their clinical approach with better triaging systems and levels of care. Other clinical neuropsychologists are also adopting similar population health frameworks by incorporating implementation science strategies to devise and refine systems to reduce waitlists through scheduling logistic revamps (Cass et al., 2020). Using this work as a template where we can learn to modify practice and workflows through quick evidence-based cycles of change will be important for neuropsychologists to adopt (e.g., Plan-Do-Study-Act, or PDSA cycles). Without these kinds of improvements to expand access to neuropsychology care, we risk relegation to a “luxury” service whose voice is not included in important healthcare decisions with administrator and clinical leaders, health insurers, and other decision makers.
Population health’s central focus on improving health equity is not only centered on expanding access to care but also understanding and reducing the impact of detrimental social determinants to health. Having greater understanding of cognitive social determinants of health offers a remarkable opportunity for neuropsychologists to become more nuanced in their practice. For example, there have appropriately been vocal calls for neuropsychology to move away from race based norming (American Academy of Clinical Neuropsychology, 2021); however, race (as a social construct) still represents an important proxy reflecting many factors we cannot yet control for (e.g., exposure to race-based discrimination). Through continued neuropsychological research on SDOH, neuropsychologists can inform public policy that positively influences built environment/neighborhood, income level, adverse childhood events, quality of education and other factors impacting cognitive functioning. Understanding of the impact of SDOH in neuropsychology can, in turn, provide a more robust roadmap for replacing race-based norming with precision variables for neuropsychological evaluations. Exciting research incorporating occupational status in normative data that can be implemented in a brief assessment triage process is already occurring (Freilich et al., 2025).
Perhaps one of the biggest challenges for neuropsychology will be continued demonstration of its value within this evolving healthcare landscape. As insurers continue to intentionally disrupt the status quo of a very expensive US healthcare delivery system that has some of the worst health outcomes among well-resourced countries, neuropsychologists will be required to demonstrate how our services are cost-efficient and effective. With technological advances moving rapidly, neuropsychologists will need to strategically embrace technology to our benefit, while putting guardrails on technological threats to our profession, and maintaining ethical practices. We are undoubtedly at a pivotal time in healthcare. Yet, perhaps one of the most dangerous outcomes for the field of neuropsychology is failure to adapt. Healthcare has demonstrated growing appreciation for cognitive health and will find a way to circumvent us in pursuit of measuring cognitive health, should we not rise to the challenge of meeting the needs of all of our communities, equitably and efficiently.
References
Cass, J., Fristad, M., Valleru, J., Gallup, J., & Butter, E. (2020). Improving Wait Times for Pediatric Neuropsychology Services. Evidence-Based Practice in Child and Adolescent Mental Health, 5(2), 128–138. https://doi.org/10.1080/23794925.2020.1784057
Fallows, R. (2019). Integration of neuropsychology into primary care: A retrospective analysis of outcomes and lessons learned from a single provider practice. Professional Psychology: Research and Practice, 50(6), 419–426. https://doi.org/10.1037/pro0000254
Freilich, B. M., Scharaga, E., & Holtzer, R. (2025). Montefiore Einstein Robust Geriatric Normative Project: Robust Age- and Regression-Based Demographic Norms for the Repeatable Battery for Neuropsychological Status and Select Neuropsychological Tests in Older Adults. Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists, 40(5), 1011–1029. https://doi.org/10.1093/arclin/acaf010
Lanca M. (2018). Integration of Neuropsychology in Primary Care. Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists, 33(3), 269–279. https://doi.org/10.1093/arclin/acx135
Lanca, M., & Fallows, R. (Eds). (2026). Advancing Neuropsychology through Population Health: From Concept to Implementation. Springer.
World Health Organization. (2023). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health
Robert Fallows, PsyD, ABPP
Correspondence: RobertFallows@gmail.com
Margaret Lanca, PhD
Correspondence Email mlanca@challiance.org