What Is Population Health?
HEALTHCARE GOALS: The goal of any healthcare strategy is to keep the population healthy and foster better clinical outcomes across
the community and lower the total cost of care
CURRENT APPROACH: Traditional healthcare has a focus on delivery of sick care and is episode-based care in an inpatient setting
whereas in outpatient setting it is more transactional care for the management of a patient. It is disconnected across settings and providers
from both an IT and a process perspective. This makes delivery of coordinated care challenging, often to the detriment of the patient.
This has led to an increasing flow of patients into the hospitals for adverse events or events that went unnoticed in the current out of hospital
settings. This has lead to an unsustainable increase in the cost that is not sustainable. We build Treatment Plans here.
POPULATION HEALTH APPROACH: In contrast, a population health approach is patient-centered and goes back to the goals of what
providers and payers all want to do well at —the Triple Aim:
- Improve the patient experience of care (quality and satisfaction)
- Improve the health of populations
- Reduce the cost of care
A population health approach needs data from across the healthcare continuum to improve quality of care while gaining efficiencies and reducing cost.
This covers the complete wellness, prevention, risk assessment and sick event data that generates a Continuity Of Care Record allowing a holistic
view of the patient to build Care Plan here.
The population health approach is supported by a comprehensive set of tools to support the care team as they engage the patient to drive behavioral
changes and ultimately better health.
Population Health Management Promotes Quality Of Care And Lowers Cost By
- Identifying individual patients and patient populations who are most likely to benefit from intervention to proactively enable better care.
For example, patients who are at high risk for hospitalization
- Managing transitions of care, such as hospital discharge, to support the whole patient and prevent unnecessary readmission
- Matching patients with an appropriate care team of primary care physicians and specialists who are focused on both treatment
and prevention
- Identifying problems early on to can significantly reduce cost by preventing the need for expensive tests or future hospitalization
Enable and ensure physician engagement with providing evidence-based care guideline and clinical care pathways at the point of care to reduce
variation and avoid inefficient or costly approaches to care
Effectively managing a provider network to identify opportunities for cost improvement, such as in the areas of pharmacy, imaging, and
network leakage
Fostering quality improvement through identification and closure of evidence-based gaps in patient care
Providing transparency to quality compliance on a real-time basis to make adjustments as needed
The population health approach requires fundamental changes to the focus, technology platform, and delivery models of provider
networks, including:
A Care Model Strategy Of How To Implement Value-based Care Delivery At Scale Across Your Network
- What are the rules of engagement?
- How will you deploy your resources?
- What best practices will you adopt with respect to both quality
and utilization?
- How will the care model vary for different patient populations?
A strategy that focuses on key goals with respect to targeted patient populations and success measurement
Active Wellness Solution enables organizations to move from solely a hospital or physician office view to a full continuum of care view across
providers and care teams and care settings such as home, outpatient clinic, hospital care, long-term and urgent care etc.
Building a more holistic view of patients health and make it available across the care teams and provider organizations in a connected
distributed environment.
Change management training to gain acceptability and credibility with physicians both with respect to strategic vision and, importantly, the data
Putting into place the right governance model and processes, incentives, training, and organizational structures to engage physicians and the
broader care team to deliver patient value.