Improving Outcomes for Your Patients: Population Health Management


Every time you turn around it seems the healthcare industry has created a new “buzzword”, making it more and more difficult to keep up on the latest definitions and industry trends. One of those buzzwords is population health. You’ve probably been hearing this term more and more over the past few years, but what exactly is population health and why should your healthcare organization take note?

Let’s dive deep into this healthcare trend and discover if population health management is right for your organization.

What is Population Health and Population Health Management (PHM)?

One of the most referenced definitions of the term is Kindig and Stoddart’s (2003) definition as “an approach [that] focuses on interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations.”

So, what does that really mean? In simple terms, population health is the science and art of aiming to preventing disease, prolonging life, and promoting health through informed choices from society, organizations, public and private communities and individuals. Population health is focused on improving outcomes for the population as a whole, addressing disparities in healthcare and encouraging communities to make healthy lifestyle decisions. It will come as no surprise to those in the health care industry that population health initiatives are closely tied to the industry’s move from fee-for-service to value-based health care. As more and more health care providers must start showing improved outcomes for future reimbursements, the importance of integrating population health management systems and increasing patient engagement into workflows will continue to grow in the coming years.

Population Health Outcomes

While population health management (PHM) certainly sounds great, its definition can be vague without recognizing the specific outcomes these initiatives are trying to achieve. A few of these outcomes include:

  • Reducing the frequency of health crises and costly ER visits and hospitalizations.
  • Lowering the cost per service through integrated delivery of care team approaches, including clinicians, social workers, physical therapists and behavioral health care professionals.
  • Improving the overall patient experience, in part by providing improved access to care.
  • Promoting patient engagement and empowering patients to better self-manage their health and participate in the decision-making process.

Overall, the goal of using a population health management system is to use data-driven, patient-centric solutions in order to improve community health and patient satisfaction while reducing costs.

Population Health Challenges

One major challenge to achieving a comprehensive outlook on population health is the sheer number of data sources PHM programs require for success, including:

  • Electronic health record (EHR)
  • Insurance claims data
  • Socioeconomic data about social determinants of health
  • Patient-generated health data
  • Prescription medication adherence data

Furthermore, most healthcare organizations lack electronic access and integration of all these databases, which are collected from various sources such as patients, specialists, pharmacies, public health organizations, insurance payers and more. In order to achieve the full scale solutions of population health, all of these systems and data sets must be integrated and work together to find the right data balance. This is where population health management software solutions come into play; they can help you integrate your existing data sets to provide clear, actionable big data for your health care organization to make sound population health decisions. Later, we’ll outline how to get started in selecting your PHM vendor.  

PHM Outlook

Some pundits have questioned the future of population health during an era of uncertainty in the U.S. healthcare market with a repeal of the Affordable Care Act (ACA) up in the air; however, even amidst the political uncertainty, population health initiatives are not slowing down. In fact, a recent study found more than 80 percent of healthcare executives feel that the effort to repeal and replace the Affordable Care Act (ACA) has not caused them to pause or otherwise change their approach to population health management. Additionally, 68% of healthcare executives surveyed reported that population health management is “very important” to their healthcare delivery strategy during the next two years, while fewer than 3% assign no importance to it at all.

A recent Signify Research study predicted the number of lives managed by PHM solutions in the U.S. and Canada will rise to 245 million in 2021, up more than 80 percent from 135 million lives in 2016.

Using Telemedicine to Address Population Health Challenges

We’ve talked a great deal on our blog about the power of telemedicine technologies and services to expand access to care and eliminate distance barriers in delivering quality care to rural populations. These enormous benefits of telemedicine can also positively affect your population health efforts. Remote patient monitoring encourages patients to be more active in their own health journeys, and video conferencing increases patient engagement with their care providers and leads to increased patient satisfaction. All of these benefits will aid in population health efforts especially if your health care facilities serve rural or underserved patient populations who would benefit most from population health management.

Choosing a Population Health Management Vendor

As with any software solution platform, in-depth research needs to be done to ensure the best solution is being chosen for your particular healthcare facilities. Here are a couple articles to get your research started:

·      6 Strategies to Get the Most Out of Investing in Population Health

·      Top 10 Challenges of Population Health Management

·      Which Healthcare Data is Important for Population Health Management?

·      Achieving ROI from Population Health Investments: How Realistic is it?  

·      10 Most Promising Population Health Management Solution Providers 2016

Has your organization expanded to include PHM software and initiatives? What lessons did you learn during implementation? Tell us!

Start a conversation and leave comments below with your lessons and experience!