Implementing a Population Health Management Program

Are you looking to concentrate on the management of health issues for populations at your workplace? If you already focus on population health management Are you planning to intensify your efforts? Whichever location you’re in in managing your population at a higher level ensure that you first establish targets to reach to implement the plan. Each planning event that is focused on improving the care provided at your site should first begin with objectives.

I agree with many healthcare professionals that the Triple Aims from the IHI (Institute for Health Improvement) are excellent goals. These goals are to improve the health of the population as well as improve the outcomes and the experience of patients and lower the per capita cost of health care in your community simultaneously. I like to add improve overall performance of providers. Fortunately, these can be completed in parallel with the proper strategy, though the job can be very demanding. Visit:-

Set and achieving targets for the health of the population at provider sites is not a new concept in the field of healthcare. Fortunately, health departments and epidemiologists have many tools which practitioners can make use of or adapt to. One of them is collecting and analysing data at a scale and then applying procedures based on research (standardized procedures) that impact on the general population. Other fields also use populace level management for their operations or processes. Most of them are service-based. Recently, I completed a community analysis for the Salvation Army and an energy supplier.

In the next part of this publication, I’ll explain two population-level management programs, and outline some of their strategies. Before I do this, let me remind you that population level management can provide a great return on investment for health providers. In a recent discussion of Healthcare Informatics,Robert Fortini, R.N., M.S.N., and chief clinical officer at Bon Secours Medical Group based in Richmond, Virginia, stated that he’s experienced the ROI at 3:1 within Bon Secours population level health initiatives. I think that this ROI is achievable for many healthcare providers who have an effective risk management program.

One medical group working on community-based health initiatives are the Hill Physicians Medical Group in the East Bay area of California. It’s comprised of 3,500 physicians. This group has established virtual teams consisting of social workers, pharmacists Case managers, pharmacists, etc. to aid their physicians. The management of health for populations is a team effort to be successful. Hill Physician Medical Group works in the ACO model, which is shared with a number of its insurance providers. This method encourages teamwork and removes barriers that are traditionally imposed to provide better care. It is as Darryl Cardoza, the CEO of the company, says, “And what the ACO model has enabled us to do is to begin to break down some of those walls, and to help us all work within the same system, and align incentives,” as stated in an interview with Healthcare Informatics.

Cardoza says that health care for the population management is distinct from earlier managed healthcare. Based on Cardoza, “It’s not a matter of just preventing people from using certain kinds of resources, but rather, of managing the entirety of their care. And we were doing it by the seat of our pants, because we didn’t have the tools. It was just very, very difficult to use data, to consolidate it and evaluate it and draw meaning from IT; but those tools are available now.” Additionally, Cardoza states that it is vital to integrate HIT across the network of providers so that teams can work more effectively. Additionally, Hill Physicians Group needs to be very good partners alongside other organizations in the area as well as local hospitals and with health plans. Hill Physicians Group is very focused on being a good partner to other providers.

The result of their investments in virtual teams and physicians and the integration of their HIT internally and to its partners via Health Information Networks has been positive financial performance and better health for patients through enhanced care delivery.

Another group who is engaged in community-based health initiatives includes Bon Secours, mentioned above. The Bon Secours group employed 530 physicians. Robert Fortina stated that “The major bulk of our work has been around supporting our medical home project, and that has involved delivery system redesign, more robust use of technology, and then good old-fashioned nursing-based case management using those tools, so the development has been multi-factorial.”

One element in Bon Secours population management is community (patient) outreach powered with software from Phytel. The software is responsible for about 75,000 contact per year. The basis for this outreach is the 20 protocols for chronic illness as well as 15 preventive protocols. This is an excellent start to improve the care they provide to their patients. However, Fortina predicts that in the future, their data will get better and they can do a better job of stratifying patients into risk groups. Doing so will enable them to offer healthcare that is more suited to the specific needs of the patient.

As one can see Bon Secours Medical Group and Hill Physicians Medical Group are trying to develop an effective population health model for the benefit of the patient and to the providers. Both employ team-based models. The return on investment is high for both groups. However, there are differences between the two groups too. Hill Physicians is a much larger company and could use its size to gain financial benefits. Both organizations use different models to guide their practices. Hill Physicians uses an ACO model, which contracts with different payers, which makes their approach to care more complicated because different payers have different requirements to meet in the terms of their contracts. Bon Secours bases its population model upon the patient-centered medical home, which is a well-established method of chronic treatment.


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