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Why Population Health Management Matters

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One Example That Shows Why Population Health Management Really Matters

By Kathleen Merkley, DNP, APRN, FNP , Senior Vice President of Professional Services

I was recently talking with a colleague about my decision to transition from working as an Emergency Department (ED) nurse practitioner to healthcare IT. I shared with her a story about a bad outcome related to an order set for an ED patient I was working with. This incident happened shortly before I was offered a job helping to develop an electronic ED documentation system. As I was deliberating about taking this new position, the thought came to me that I would have the opportunity to impact thousands of patient lives all at once versus just one patient at a time. That realization solidified in me the importance of Population Health Management and its outcomes. I soon embarked on a journey of integrating my clinical expertise with healthcare technologies.

Delivery of Care to Populations

Population Health Management is an approach that also strives to impact the delivery of care to a group of individuals with similar healthcare needs. Kindig and Stoddard (2003), define population health 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.” They propose that population health is concerned with both the definition of measurement of health outcomes and the pattern of determinants. Determinants include medical care, public health interventions, genetics, and individual behavior, along with components of the social (ex: income, education, employment, and culture) and physical (ex: urban design, clean air, and water) environments.

Population Health Management Results Driven by an Enterprise Data Warehouse (EDW) and Healthcare Analytics

There is a lot of conversation around Population Health Management today. One of our clients recently launched a Population Health Management initiative in just eight weeks to ten percent of their clinics, potentially improving care delivery for approximately 2,300 patients. When the initiative is completed it will impact nearly 50,000 patients. This medical center is also leveraging the same Health Catalyst Late-Binding ™ Data Warehouse and Population Health Advanced Application in a coordinated care program for their employees and dependents.

The interdisciplinary team of clinicians, IT, care coordinators, and business analysts now have a single source of truth and near-real time results to proactively engage and work with their patients to manage care. According to their Director of Clinical Business Analytics, “What we’ve accomplished with Population Health is something we’ve been trying to do for over 20 years with our various clinics. We used to manually pull together reports, all with varying data, and we had no way to proactively monitor our populations. Now, we have near real-time data that enables our care coordinators to drive preventive care and ultimately lower our population health costs.”

Population Health Management Outcomes

Why is there so much focus on Population Health Management? You have just read one reason, from a client’s perspective, namely the need to manage healthcare costs. From my perspective, Population Health Management helps:

  1. Reduce the frequency of health crises and costly ED visits and hospitalizations.
  2. Lower the cost per service through an integrated delivery of care team approach which includes clinicians, social workers, physical therapists and behavioral health care professionals.
  3. Improve the overall patient experience, in part by providing improved access to care.
  4. Promote patient engagement and empowers patients to better self-manage their health and participate in the decision making process.