Population Health Management Case Study

help healthy members keep fit and help chronically ill members successfully manage their conditions, including individuals who may not be seeking care or visiting multiple care providers.

Population health management is a patient-focused approach to care as opposed to managing on a case-by-case or disease-by-disease basis. Yet it views clinical and financial risk across a group of people, employing metrics and interventions that boost patient experience (satisfaction), clinical outcomes and cost savings.

The five principles of population health management

1. Identify and engage patients : It’s necessary to understand both the patient’s behavior and health status. Include individuals who haven’t visited a primary care provider for over a year,

Nurture sustainable care delivery models: New payment and care delivery models need to contain or reduce costs throughout the entire system, not shift costs from one setting to another. New models must also reward innovation and excellence.

How population health can prepare an organization for value-based payment

Population health management principles and capabilities can benefit any healthcare system, regardless of how much reimbursement is at risk. Even organizations that operate within a hybrid fee-for-service model can use population health management to identify high-cost and at-risk patients, understand the impact of adverse events, and implement prevention programs to minimize quality-based penalties. How does population health management help?

• Providers learn to identify high-risk patients and prevent adverse events as they understand the costs of delivering episodes of care as opposed to single encounters. They develop systems to engage patients.

• Payers and providers gain better visibility into effective care delivery. They align incentives, harmonize performance metrics and prioritize resources (e.g., care management) to respond to the distinct health needs of different patient

Will it impact the Triple Aim? The measure should capture the provider actions that lead to the goals of the Institute for Healthcare Improvement’s Triple Aim: improved population health, better patient experience of care and reduced per capita costs.

2. Is it consistent with the principles of good primary care? This means that the measure tracks person-focused care (instead of disease-focused) that is comprehensive and coordinated.

3. Does it measure and support system change? Good value measures examine performance across the entire spectrum of care, from hospital stay to discharge to follow-up.

4. Does it minimize administrative burden? Measures based on easily-collected claims reduce the workload for providers and health systems, making it easier to collect performance data more often.

5. Does it support continuous care improvement? Effective value measures give frequent feedback for improvement, both over time and across the entire care continuum.

6. Is it a composite score? Instead of using separate scores from multiple measures to assess value, an effective measure gives you a single number to represent overall provider and system