From the November 2016 issue of HealthCare Business News magazine
Population health management (PHM) is an increasingly popular term in today’s health care vernacular, but a quick review of the literature reveals that the term is not defined consistently by health care executives and health IT providers. PHM’s meaning seems to morph based on who is speaking and who is listening. However, a few core concepts around PHM seem to be emerging. The most salient point is that PHM involves efficiently managing the provision of health and health services across the care continuum, for a specified group or population. The focus is on care coordination, quality and the cost/risk equation.
This is especially true for chronic conditions, where the opportunity and potential for value and cost savings are the greatest. One thing is certain: Successful PHM requires solid data and trusted information from a variety of sources for decision-making at the clinical and the business level. Reliable information helps to identify health issues, prevent new and recurring health problems and effectively manage the health and health services of the patient population. Essential information for population health management includes:
• Patient outcomes: This means both individual outcomes and those aggregated for the population. Since patients don’t typically receive all care from one source, this almost always means information from other providers.
• Cost: Today the delivery of care is episodic and the organization likely can account for the cost of services it provides. However, real value will only be recognized when cost data is aggregated from multiple sources that give the full picture of the cost to care for an individual or population, in order to better understand real cost and value. In other words, how costs impact the whole system and the value that particular services or approaches have.
• External determinants of health: Frequently outside the reach of traditional collection/ capture methods, this means data and information about lifestyle, education, socioeconomic status, family support, community, environment and other factors that impact disparities in populations and health
This data and information come from a variety of sources both within and outside of the typical organizational sources. Health care professionals may wonder: Can it be trusted? Does it have consistent meaning regardless of the source? Is it valid? These questions, among others, are important and must be able to be answered with confidence. However, due to the inability of some organizations to consistently and accurately identify individual patients (due to a lack of the right information or information processes), the answers to these questions are not always easy.
