As we move away from encounter-based medicine that bases doctors’ compensation on individual visits, and towards a value-based public health system that focuses on patient outcome, there is an increasing demand for population health management or PHM. If you’ve wondered what population health management is exactly, our goal is to help you understand the basics, what it is, how it works and the goals and benefits of using population health management in today’s ever-changing healthcare landscape.
What Is Population Health Management?
In general, the population health management definition is understood as accumulating patient data from various resources in healthcare and technology, in one location. This allows professionals to analyze data and create actionable plans to improve the healthcare outcomes of communities.
In 2003, Doctors David Kindig and Greg Stoddart proposed this population health management definition in the American Journal of Public Health, “The health outcomes of a group of individuals, including the distribution of such outcomes within the group.”
While a concrete definition of population healthcare management hasn’t fully been established, the definition isn’t nearly as important as a solid understanding of the goals. In 2015 Dr. Kindig emphasized that it’s important to keep sight of the end goal when considering population health management. The more complex the definition, the harder it is to keep track of the goals, Dr. Kindig stated: “I believe, however, that including multiple determinants in the definition could lead to confusion between the outcome goal and the determinants needed to achieve that outcome.”
Instead of worrying over definitions, healthcare providers should focus on the main goals of population health management, including improving the financial outcome and lowering medical costs, improving clinical proficiency and improving patient engagement. As we move towards a system of population health management, we will learn more about how healthcare professionals can improve patient health while lowering the cost of healthcare.
How Does Population Health Management Work?
In today’s rapidly advancing healthcare industry, effective healthcare providers utilize BI (Business Intelligence) technology and data analytics to compile data from clinical, operational and financial sources. For example, some providers use business intelligence systems to look at competitors’ patient demographics, payer mix and diagnoses to look at how they can better serve patients and increase referrals. Improving patient engagement and service results in a better health population as a whole.
In order for population health management to be effective, healthcare analytics with real-time insights that monitor individual behavior are necessary. Additionally, strong care management, risk stratification, delivery systems and a good partnership network can help population health management systems realize their full potential. Unfortunately, this is difficult due to the lack of communication between various platforms used in inpatient and hospital outpatient care and other healthcare areas.
The proper implementation of PHM will dramatically assist healthcare providers in monitoring and improving patient care. There is especially high potential in the care management area of PHM because implementation will increase patient engagement with their own healthcare. Healthcare providers can help more people manage their medication and chronic conditions without relying on frequent hospital or care facility admittance.
What Is the Purpose of Population Health Management?
America has a long way to go when it comes to how we utilize population health management. Among high-income nations, the U.S. has a lower life expectancy, despite spending more on healthcare than other nations. Poor performance for chronic health conditions, high spending and a lower life expectancy can all be attributed to a lack of application of PHM. Despite spending more, we’re not seeing the return we expect because of our continued focus on encounter-based medicine rather than patient outcomes.
The 3 main goals of population health management seek to solve many of these systemic healthcare problems:
- Improve the financial outcome and lower medical costs: PHM aims to allocate resources more efficiently, as well as manage and prevent chronic diseases to lower healthcare costs.
- Improve clinical proficiency: There are many gaps in the healthcare system that can be identified through process and outcome metrics. Creating and following through with initiatives that improve things such as physician relationships, onboarding and recruitment increase the proficiency of health organizations. This helps healthcare professionals work at a higher level of performance, which will in turn improve the overall population health. The Ascend and Scout solutions from Marketware are great examples of how a system helps providers discover and complete initiatives from data insights.
- Improve patient engagement: Engaging patients and encouraging them to take initiative with their health keeps people healthy and, therefore, keeps them out of care facilities and other healthcare centers.
By focusing on where improvements in healthcare can be made, PHM helps providers find ways to improve overall patient health. Providers can feel confident knowing they can take action based on the data they receive. As a value-based healthcare system drives us towards population health management, the disparity between spending and outcome in American healthcare should decrease.
Where Can Population Health Management Be Applied?
PHM has a place in the future of medicine as it helps healthcare professionals predict and anticipate the medial needs of populations and communities, create better outcomes for patients, and lower the cost of healthcare as a whole. Several of the ways population health management can assist in the future involve analyzing data relating to:
- Inpatient metrics: For effective PHM, inpatient metrics must account for care in a broader sense, including primary care and post-acute care. Getting a wide understanding of these metrics helps the community as a whole.
- Demographic data: An important piece of data for population health management is the demographics of a community. This includes features like gender, age, occupation, income, educational level and socio-economic standing. Demographic data plays a large role in developing healthcare management initiatives in a particular community.
- Claims data: A patient’s health status, how they receive continued care, hospital admissions, emergency room visits and prescription drug costs are just some of the aspects that can be managed using claims data. Not only can claims data allow health professionals to monitor the health status of an individual, but also that of the population at large.
- Behavioral & lifestyle data: Lifestyle and behavior data can help healthcare professionals separate individuals into risk categories and population cohorts to assist in a proactive approach to future healthcare needs.
- Clinical risk: Monitoring communities for their disease risk utilizes a variety of resources including case management files, disease registries, electronic medical records and more. Understanding which communities are most at risk allows professionals to design better healthcare utilization, and to better manage a community’s disease risks.
With access to more data and preventive services through population health management, healthcare providers can recognize where improvements need to be made in preventive medicine. For example, a 2015 CDC Morbidity and Mortality Weekly Report analyzed screening rates for breast cancer, colon cancer and diabetes. They found that out of women 50 to 74 years of age, only 61.6% had undergone breast cancer screening; out of men 50 to 75 years old, only 23.6% had colon cancer screenings; and out of all responders over 18 years old, only 45.3% had been screened for diabetes. Clearly, there is room for improving these rates, especially when preventive care can do so much in these instances.
Benefits of Population Health Management
The American healthcare system can reach new heights with PHM and reap significant benefits for community health. The aggregation and analysis of patient data have several main benefits in population health management including:
- Improvement of health outcomes: One of the most important aspects of PHM is that of lowering spending while improving patient healthcare outcomes.
- Addressing gaps in patient care: Real-time access to patient information like health records, lab tests, billing information and prescription information allows healthcare providers to address patient care gaps and improve public health.
- Managing disease: Chronic disease management is a major expense for the healthcare industry, but PHM can assist in chronic disease care using IT to track and improve patient engagement and provide better outcomes.
- Reducing costs for providers: Through data and actionable insights from healthcare analytics, providers can reduce the cost of medicine by taking a preventive stance on healthcare.
Improving patient health outcomes, addressing gaps in patient care, managing disease, reducing costs for providers and providing healthcare professionals with real-world action plans to treat communities are only some of the benefits of population health management.
Despite all these great benefits the real value of PHM in American healthcare is the movement away from encounter-based medicine towards a value-based care approach focusing on patient outcomes. The better healthcare providers understand the health of communities and how to treat them, the better success they will have with patient engagement and improved community health.
Does Population Health Management Work?
The quick answer to whether population health management works is a resounding yes. PHM strategies are implemented using a three-tier prevention strategy that works in stages. Primary prevention strategy focuses on vaccine programs and educating the public about health. Secondary prevention strategies utilize early detection and biometric testing, and tertiary prevention strategies work to manage different diseases and disabilities that chronically affect communities.
These preventive strategies have been put to good use and in 2008, the journal Population Health Management published a study on the effect of preventive health strategies for over 2,600 individuals. All three tiers of PHM strategy were employed with the end result of a 5.8% reduction of individuals classified as high-risk, and a 3.6% reduction of moderate-risk individuals, which meant increasing the low-risk classification by 9.4% of the individuals in the high- and moderate-risk categories.
Breaking up subjects into risk groups can be a highly effective way to focus on improving public health, improving patient engagement and achieving better health outcomes for patients. This way healthcare professionals can focus their efforts on those who will benefit the most by keeping low-risk individuals in the low-risk category and moving those in moderate-and high-risk groups to a lower risk group.
Marketware Solutions for Population Health Management
Now that you know the answer to, “What is population health management?” you may wonder where the solution lies in aggregating big data and providing actionable data for healthcare providers. Thankfully, there are advances in software on the market that are allowing better integration across medical platforms. Marketware provides tools for physicians and healthcare providers that allow for seamless data integration through healthcare analytics so physicians can get actionable insights faster, and act on the information to facilitate growth and service. Start learning how you can improve your physician and patient engagements by requesting a Marketware demo today to learn more about how we can help you better integrate your data solutions.