Population health management
Population health management is a healthcare strategy that aims to improve the health of a defined population by preventing and managing disease, promoting wellness and reducing health disparities. Population health management programs typically target specific populations in the healthcare system, such as Medicare beneficiaries or patients with chronic conditions, and use data-driven approaches to identify individuals at risk for poor health outcomes. Population health management initiatives may include disease prevention and management, care coordination, patient education and engagement, and other activities aimed at improving population health.
Population health management programs are often led by healthcare organizations, but may also involve community partners, such as public health departments or social service agencies. Population health management initiatives typically require investment from multiple sectors, including healthcare, government, business and philanthropy.
There is growing evidence that population health management programs can improve population health and reduce healthcare costs within the healthcare system. A recent study found that a population health management program in New York City led to improved health outcomes with significant reductions in mortality and hospitalizations among Medicare beneficiaries. Other studies have shown that population health management programs can improve care for patients with chronic conditions and reduce avoidable emergency department visits and hospitalizations.
Despite the potential benefits of population health management, many challenges remain for improving health outcomes. Population health management programs require a comprehensive understanding of population health data, which can be difficult to obtain. Additionally, designing and implementing effective population health management programs require engagement from multiple sectors, which can be challenging to coordinate. Nevertheless, the potential rewards of population health management – improved population health and reduced healthcare costs – make it an important strategy for improving clinical outcomes within the US healthcare system.
Like many advances in healthcare, a population health management program can be a win for providers and patients. The best population health management tools combine clinical, financial and operative data from across the organization and produce actionable healthcare analytics for caregivers to improve productivity and patient care. A proper population health management program requires sound care administration, a strong understanding of risk management, and a well managed delivery system.
A typical population health management platform will use a business intelligence (BI) tool to collect data and provide a long-view record of each patient. In most cases, data is used individually by each caregiver and very rarely is the same BI tool used across the continuance of care. Even less common is a BI tool used that integrates patient data from billing, electronic health record systems, claims data, pharmacies and even lab results.
A fully-integrated BI tool with a population management system can close gaps in care by enabling healthcare providers to have up to date information to manage patient needs. Labs, billing, electronic health record data and prescription information is all combined and providers can easily identify gaps in care.
The most successful population health management tools offered by the largest population health companies give real-time healthcare improvement insight to both clinicians and administrative staff. A sound care management program is essential to improving clinical outcomes, care coordination and cost savings, particularly in populations with chronic disease such as diabetes or chronic obstructive pulmonary disease (COPD). Population health management tools can help improve care for patients with chronic and expensive conditions by offering resolutions that document and keep close track of their care.
Care management is an essential part of a population health management program, and while the goals of care management may differ between various groups and healthcare professionals, they tend to all have the same end-goal of improving patient self-management, better medication administration, and reducing the overall cost of care provided.
Population Health in Value-Based Care
In case you haven’t heard by now, the healthcare industry is changing. In turn with the changes in the industry, population health management tools are becoming more aligned with value-based care delivery systems as opposed to more conventional fee-for-service systems.
Value-based payment models incentivize providers to deliver high-quality, cost-effective care. Under these models, providers are reimbursed based on the quality of care they deliver, rather than the quantity of care. This shift in focus has the potential to improve population health by reducing unnecessary tests and procedures, and by providing more coordinated and targeted care.
There is evidence that value-based care can improve population health. One study found that patients who received care under value-based healthcare had lower rates of hospitalization and emergency department visits than those who received care under a traditional fee-for-service model. Another study found that value-based programs were associated with improved quality of care and reduced costs for Medicare beneficiaries.
Under the traditional fee-for-service model, healthcare providers are compensated by payers based on each service or procedure they arrange. Each service is billed separately per patient, then covered by third party payers, even if the service provided was not valuable or even essential to the care of the patient.
In comparison, the value-based care delivery model takes into account the quality of service or procedure being administered and the overall health result of the patient when determining cost analysis. This non-traditional system of healthcare represents an approach to treating patients with an emphasis on coordination and communication between physicians across all branches of the patient’s care. Healthcare providers using products from the best population health companies that enable successful treatment and better quality care will be eligible for incentive payments under this value-based care model.
Population health management and value-based care are two approaches that have the potential to improve population health. By working together, these two approaches can complement each other and help to create a more effective and efficient healthcare system.
A Population health management program has the potential to improve population health by:
Identifying and addressing health disparities
Improving access to care
Enhancing quality of care
Reducing costs
Population Health Management Tools
Population health management software aggregates data across healthcare systems and stores patient data for analysis. The best population health software tools provide large amounts of patient data and analytics tools to better predict patient health conditions and reduce health disparities. Other functions of a population management system help to manage care delivery across a population.
The intention of products designed by population health software companies are to improve efficiency and operating costs of the practice and enhance the quality of patient care. The access of accurate patient data guides better prediction of patient health risks, and a better overall view of community health trends. Population health management software platforms are used by healthcare providers, population health managers and institutions alike and the best population health software systems have data analytics proficient in advancing quality and cost of care.
There is no one-size-fits-all answer to the question of which are the best population health management tools. However, there are a few key considerations that can help you or your population health manager choose the right tool for your needs.
First, consider what type of data analytics you need to collect and manage. Population health data analytics can include everything from patient medical records and health status to community health surveys. You'll need to choose a tool that can collect and manage all of the different types of data you need.
Second, think about how you'll use the data you collect. Will you be using it to track trends over time? Will you be sharing it with other healthcare providers? Make sure you choose a tool that offers the features you need to improve outcomes.
Third, consider your budget. There are a variety of population health management platforms available, from simple data-collection apps to complex enterprise-level software. Choose the tool that fits your needs and your budget.
Finally, don't forget to test out the population health management tool with your population health manager before you roll it out to your entire organization. Make sure it's easy to use and provides the features you need. By taking the time to choose the right tool, you can ensure that you're getting the most out of your population health data.
Population Health Success
The strategy of a patient health management system should extend beyond the traditional visit-based structure of care. Healthcare organizations implementing a patient health management system or a new population health management strategy often quickly detect that the highest-risk patients from a clinical view need more hands-on management to produce improved outcomes.
As the healthcare landscape continues to evolve, so too must the way we manage population health and reduce health disparities. In order to be successful, population health management requires a comprehensive and coordinated approach that engages all stakeholders - patients, providers, payers, employers, and policy makers.
There are four key areas that must be addressed in order to achieve success with population health management:
Patient engagement
Patients must be engaged in their own care in order to make healthy choices and adhere to treatment plans. This can be accomplished through education, support groups, and other resources that empower patients to take control of their health.
Provider engagement
Providers must be engaged in the care of their patients in order to provide high-quality care that is responsive to the needs of the population. This can be accomplished through training, quality improvement initiatives, and provider networks that facilitate communication and collaboration.
Payer engagement
Payors must be engaged in the care of their members in order to ensure access to high-quality, affordable care. This can be accomplished through provider contracts that incentivize quality care, benefit design that promotes prevention and early intervention, and provider networks that deliver coordinated care.
Employer engagement
Employers must be engaged in the health of their employees in order to promote a healthy workforce and control healthcare costs. This can be accomplished through workplace wellness programs, health insurance benefits that encourage preventive care, and involvement in community health initiatives.
By engaging all stakeholders in the care of the population, we can achieve the Triple Aim of improved health outcomes, improved patient experience, and reduced healthcare costs.
ForeSee Medical’s risk adjustment software uses proprietary disease algorithms and machine learned natural language processing to rationalize your patient data across the healthcare system. Using artificial intelligence (AI) we discover diseases from text notes and data from electronic health records you already have. Then, we empower you with insightful HCC risk adjustment support and integrate it seamlessly with your population health management platform.
Request a Demo today to learn more about how ForeSee Medical can help your practice.