What is Driving Population Health Management?

Population health is a field that has to continue to grow and develop in it process because populations will continue to grow and be dynamic. As a population changes and evolves, so will the management of that population’s health otherwise it will become ineffective. So what is Driving Population Health Management? It’s good to understand what it means exactly first before we can understand what drives it?

What is Driving Population Health Management?

There are many definitions of population health management or research and there really is no formal consensus on its definition but there are many definitions that have been generally accepted. Some definitions are:

Population health research is an interdisciplinary field focusing on the health outcomes of groups of individuals, which can be defined variously (e.g., workers at a workplace, residents of a neighborhood, people sharing a common race or social status, or the population of a nation).

Population health researchers view health as the product of multiple determinants at the biologic, genetic, behavioral, social, and environmental levels and their interactions among individuals and groups and across time and generations.

The field addresses health outcomes, health determinants, and policies and interventions that link the two (Kindig & Stoddart, 2003) in efforts to improve population health and ameliorate health disparities.

David Kindig and Greg Stoddart, who first tried to define the term back in 2003, described it as “the health outcome of a group of individuals, including the distribution of such outcomes within the group.”

In 2016, “population health management” can perhaps be better described as “the process of using big data analytics to define patient cohorts, stratify members by their risk of experiencing certain events, deliver care targeted to the individual needs of those members, and report on individual and group outcomes to ensure quality and accountability.”

Population health research is not just about the general state of health. It contains a lot more nuanced areas, disciplines, methodologies, and theories. Population health is able to address a diverse set of health outcomes that could help not only cure illnesses but prevent them.

Populations health research hopes to a achieve a systemic reform that solves the problem of systemic chaos. Howbeit, healthcare providers are well aware by now that there is no magic solution to the incredibly complex conundrum of systemic reform. One way population health hopes to tackle this is through Triple Aim.

But the available answer is either more technology, less technology, more acquisitions and mergers, increased provider autonomy, less quality reporting, more federal oversight, more incentives for performance, or less of a push towards value-based care. If performed correctly, population health management can indeed help healthcare organizations meet all three parts of the Triple Aim: improving the patient experience, lowering per capita costs, and raising the overall level of health for large segments of the population.

What is Driving Population Health Management?

Below are some discussions on what is driving population health management and what needs to be done to make it better

  • All across the care continuum, healthcare stakeholders are jostling to make their opinions heard, even as regulatory programs like meaningful use and MACRA continue to exert indisputable influence over the financial and clinical landscapes – and generate plenty of controversy as they do so.
  • Taking a data-driven approach to proactive, preventative population health management is likely to produce more positive long-term outcomes for patients. How exactly providers can accomplish that, and whether or not they are appropriately incentivized to do so, are topics that are still up for debate.
  • But there is a growing body of evidence to suggest that population health management can curb the impact of chronic disease, lower improper utilization of services, improve patient quality of life, and even help providers meet their value-based reimbursement goals.
  • Given the fact that providers are increasingly acknowledging that they can’t escape the shift to pay-for-performance care, they are starting to turn their attention to developing the strategies and programs that will help them make the switch with the least amount of financial and operational discomfort. Population health management is at the top of that list, since it sits squarely at the nexus of health IT implementation, big data analytics, value-based reimbursement, improved operational efficiencies, and increased patient engagement. Using clinical quality measures (CQMs) set by regulatory programs or individual accountable care arrangements, providers report on how often they conduct routine screenings, how well they adhere to industry treatment guidelines for common conditions, and whether or not their efforts are producing results.
  • High performers may receive value-based financial rewards from payers like Medicare, Medicaid, and private insurance companies, who are themselves saving money on high-end expenses like long-term hospitalizations and emergency department visits.

  • Providers engaging in accountable care contracting may receive a portion of these savings – or be at risk for failing to meet their quality goals.  These financial motivations are envisioned to be the most effective lever for driving improvements across the care continuum, fostering a collaborative environment of safe, standardized, high-quality care based on personalized data for individuals. Important data for risk stratification may include the number and type of chronic diseases, a history of high utilization or frequent hospitalizations, a mental health or substance abuse diagnosis, advanced age, and an address in a low-income or underserved community.
  • Using an analytics tool, which can be as simple as Excel or as advanced as a dedicated population health module linked into a local health information exchange, the provider then assigns each patient a risk score.
  • Patients with higher risk scores may receive extra attention, including more frequent follow-up, social and community support, enhanced care coordination services, medication adherence advice, or an invitation to enroll in an educational patient support program.