Breaking Down Population Health Management

Healthcare reform mandates that the quality and efficiency of health care delivery constantly increase, while the fiscal limitations and multiple compliance requirements increase as well. The historic shift from basing medical reimbursement to doctors and hospitals on a fee-for-service system to a value-based system that rewards quality is taking some getting used to. The decades of ordering and administering unnecessary tests and excess treatments are over.



Population health management is defined as the discipline of managing the clinical and financial risk of a defined group of individuals. Most healthcare providers agree that the goal of population health management is to keep the healthy individuals as healthy as possible in a proactive, prevention-focused way in order to reduce reactive, costly interventions, such as emergency room visits, excessive tests, hospitalizations, and speculative procedures.

The second part of the goal is ensuring that the chronically ill in the population do not get sicker. But what does a healthy population look like? How is “at risk health” defined and correlated to potential financial risk? What measurements will be used to assess the progression of chronic diseases? How will emergency department patients be accounted for?

Plenty of things make tackling population health management difficult. The proper collection and use of data is central to those issues.

The challenge is no longer that there is insufficient data in the healthcare field. The opposite is true: practitioners and providers are inundated with data. However, many healthcare providers lack the resources — be they the time, understanding, information technology, or data management skills — required to efficiently and effectively use population health management principles.

How can all of the advanced IT systems be integrated and utilized by a facility’s staff in real time, to both improve patient health and lower costs? As we remind our clients often, “Population Health Management is not a series of one-time projects. It requires systemic and sustained efforts across a system to win and maintain hard-fought gains.”

The Not So Good News about Population Health Management

An April 15th Forbes article cites a survey that was released at the annual HIMSS (Healthcare Information and Management Systems Society) conference. Only one-third, or 38 percent, of the hospitals and health systems that participated stated that they “have the necessary information technology systems in place to manage populations of patients.”
Approximately 25 percent surveyed said that they “didn’t provide any population services listed in the report such as telemedicine, enterprise population health management, remote coaching, or education of patients, let alone real-time remote patient monitoring.”

This deficit in population health services is causing major health insurers to spend billions of dollars to help medical providers manage population health. Clearly, the opportunities for IT providers are also great.

Carla Smith, executive vice president of HIMSS North America, said in a statement to Forbes: “With data-driven analytics technologies maturing, we expect to see a further uptick this year in the use of health IT to enable a 360-degree view of patient populations.”

The Good News about Population Health Management



HIMSS survey respondents were asked for the first time this year to quantify the degree to which they felt IT helped them to achieve success. The results found:

    • 74% reported that IT was helping their organizations achieve success in care coordination.
    • 73% said IT was helping them with mandated quality metrics improvement.
    • 69% indicated that IT was helping them to achieve primary care provider efficiency.
    • 58% stated IT was helping them to be successful with patient experience management.

Many healthcare software companies have developed breakthrough healthcare data warehouse platform and analytics applications that are well suited to the challenge of handling all of the complexities unique to healthcare data. Real time access to comprehensive and meaningful data has a profound effect on every aspect of today’s healthcare delivery system. Most importantly, it allows healthcare organizations to improve patient care, being certain that the right treatment is offered every time.