Population Health Management: Breaking Down the Population

by Mary Sirois on Sep 19, 2017

Breaking_Down_Walls_-_Health_IT.jpgThe following content has been reposted with permission from our channel partner, Pursuit Healthcare Advisors (view original).

Population Health Management (PHM)…three simple words, yet so much complexity. This blog will be the first of three to focus on the concept of PHM by looking at each element separately…starting with POPULATION.

Wikipedia defines population as follows:

“A population is all the organisms of the same group or species, which live in a particular geographical area, and have the capability of interbreeding.”

Interbreeding aside, healthcare organizations likely have a mission statement that includes something along the lines of providing quality care to a particular community or area or group or population being served.

In the context of Population Health Management, populations are broken down into subsets. Herein lies the challenge. Do we have the confidence in the data to truly define a subset of a population in a manner that then lets us define and deliver models of care (that’s for another blog) to know if we have made a difference in the quality and cost of care?

Who am I?

In large organizations, the simple act of ensuring that I am me, a member of a population, across the organization is a challenge. An effective and reliable identity management approach, or enterprise master patient identifier, is necessary for confidence in identifying each member of a population.

In our July 20 blog, Kurt Wolter brought to light the challenges associated with record management specific to revenue cycle integrity. Now the issue expands into the world of care delivery when trying to define populations and develop care models based on population risk.

Populations can be “attributed Medicare members”, “patients diagnosed with congestive heart failure”, “patients with diabetes and obesity”, “members of a self-insured health plan”…the ability to create population subsets is endless. The key to defining a population is in confidently knowing who the patient is and having all appropriate data tied to that patient’s record…problems, medications, providers, allergies, etc.

What is my health risk and what care do I need?

Once a population is defined, risk stratification becomes the key in developing care delivery and patient engagement models that drive towards improved health outcomes and lower costs of care. There are numerous risk stratification models available that use a combination of clinical, claims, and social data. Organizations need to understand these risk stratification models as a foundation for developing population-based care.

This is where the rubber meets the road. Organizations with a strong data analytics strategy, inclusive of a data management and governance strategy, will find themselves in a more confident position regarding risk stratification and the ability to design, manage, and measure care programs and population outcomes. The lack of interoperability across systems warrants an immediate focus on data analytics and business intelligence strategy that makes use of currently available data, the right data, at the right time, being provided to the right person (provider, care team member, or even patient) to make informed decisions about gaps in care, medications, completed/planned tests, and network of care, to name only a few.

The challenge of interoperable EHRs and the multiplicity of different applications on the revenue cycle, patient access, claims and financial front, add to the complexity of understanding the individual within a population. This is where Pursuit can help. We bring an understanding of the intersection of data and process together, along with supporting tools, to help organizations truly understand their data about populations.

Our tools enable organizations to bring in data from disparate systems and quickly begin to understand outcomes and cost data, to interrogate the data in a way that enables actionable decisions on programs and performance to improve clinical outcomes and decrease cost.

Our consultants come with a background in clinical and financial operations enabling them to efficiently analyze and design processes and remove waste and streamline workflow. They are always focused on getting the right data into the hands of the right people who need it to make decisions. We can work with your organization to understand opportunities for improved cashflow, reduced cost, and improved clinical quality and compliance reporting. We will focus on helping you understand your population so that you are better able to assume and manage risk while exploring opportunities for evolving models of care and ongoing organizational success.

What does health mean to me, as part of a population?

This blog started with the definition of a population and ends with something greater than an individual. At the heart of managing the health of a population is to engage the individual in a manner that successfully moves the needle on improving their health and minimizing the impact of an acute episode of care and/or chronic health condition.

The second installment of this blog will focus on the concept of health, and therefore healthCARE.

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