In order to address population health management, we must first understand what the concept of population health. A straightforward definition of population health is that it is the science and art of preventing diseases, prolonging life, and promoting health through the organized efforts of informed choices of society, organizations, public and private communities and individuals. Now when you see “science of preventing diseases” you might automatically think of the Center for Disease Control (CDC) which is right but that’s not all. Population health, as the definition implies’ requires the involvement of all branches of health and also everyday individuals like you and I. Now what is population health management? Population health management is the aggregation of patient data across multiple health platforms and information technology resources. Population health involves big data so it goes hand in hand with population health management. Population health management aids and champions the understanding of health systems and their practices. Population health management enables health organizations and individuals to adopt better and improved practice systems and continuously works to enable health practitioners to figure out what they need.

 

Why Should We Care About Population Health Management?

 

   Rise of Chronic Diseases

The concept of population health management became more and more intriguing to health systems and healthcare organizations because of the escalating costs of treating chronic diseases and because of the increasing notoriety of these chronic diseases. According to the Center for Disease Control (CDC), chronic diseases are the leading cause of death and disability in the united states. For example seven out of the 10 Americans that die each year die from a chronic disease. Heart disease, Cancer and stroke account for more than 50 percent of these deaths. Arthritis is the most common cause of disability, with almost 19 million Americans reporting activity limitations. Also, Diabetes continues to be the leading cause of kidney failure. These deaths and disability caused by the chronic disease can no longer go unnoticed and/or ignored.

 

Shift in Government Payment Modules

Government payment modules have shifted from fee-for-service to pay-for-value. The Centers for Medicare and Medicaid Services (CMS) champions the implementation of pay-for-value models which offers financial incentives for disease prevention and management but penalizes poor outcomes. Dues to this, many health systems are moving patients away from high-cost, acute settings to the most appropriate, lowest-cost settings and with good reason. The shift in government payment modules is necessary because the fee-for-service model has proven to be unsustainable. In contrast, the pay-for-value model will significantly reduce the government’s spending on healthcare and curtail the growing budget deficits.

Providers and payers now have powerful incentives to change with the new payment model. But to survive, they will need to access and analyze vast amounts of population data from many different outpatient settings. In particular, the following groups and programs need accurate data about the outcomes for various patient populations: Patient-Centered Medical Home (PCMH), Accountable Care Organizations (ACOs), and CMS’s Bundled Payments for Care Improvement initiative (BPCI).

 

Patient Care

The Healthcare Industry needs to do a better job of collecting true patient outcomes data, rather than proxies for care. For example, it inherently does not matter if a person with diabetes has had a foot exam—but it matters very much if that foot exam discovers an open wound that will not heal. Additionally, organizations must also understand cost at a granular, individual level instead of guessing at costs by looking at the average cost of overall patients or members. That approach is almost meaningless when managing margins. Healthcare organizations that have learned and mastered these steps and possess these abilities and capabilities have the essential components for an effective population health management program.

An effective and efficient population health management program requires fundamental changes to the way patient care management is handled and practiced. To have effective population health management, healthcare organizations have to be smart about accelerating development of the right areas and manage expectations about what can be achieved.