Implementing a Population Health Management Program

Are you planning to put more emphasis on population health management at your site? If you already focus on the management of health issues for populations is it time to strengthen your focus? No matter where you are in your plan for management of the population make sure you’ve first established objectives to meet for the plan. Every planning event that focuses on improving the care provided at your place should begin with objectives.

I agree with many healthcare professionals that Triple Aim of the IHI (Institute of Healthcare Improvement) are extremely beneficial goals. These goals are to improve the health of the population to improve outcomes and the experience of the patient and cut the cost per capita of care for your community all at once. I am keen to increase their bottom lines of service providers. It is possible to do this done in tandem with the right approach, although the work is extremely challenging. Visit:-

Set and achieving targets for the health of the population in the clinics of providers is a fairly new focus in healthcare. Health departments and epidemiologists have a variety of tools that providers can use or adapt. Some of these include collecting and analysing data at a population level and then implementing methods based on evidence (standardized procedures) that have an impact on the general population. Different fields also have used the concept of population-level management to manage their operations or processes. A lot of these are service based programs. The last time I worked on a community analysis for The Salvation Army and an energy service provider.

In the remainder of this issue, I’ll explain two population-level management programs and provide a brief overview of their strategies. Before I go on this, let me remind you that population level management could offer a very high return on investment for health providers. In a recent online conversation in conjunction with Healthcare Informatics,Robert Fortini, R.N., M.S.N. and chief clinical officer for Bon Secours Medical Group based in Richmond, Virginia, stated that he’s seen a 3:1 return on investment for Bon Secours population level health initiatives. I believe that this ROI is possible for many health care providers that have the right risk management strategy.

One medical organization that works on the health of the population can be found in the Hill Physicians Medical Group in the East Bay area of California. It’s a group of more than 3,500 physicians. This group has established virtual teams consisting of social workers, pharmacists and case managers. to aid their physicians. Population health management requires a team approach to be efficient. Hill Physician Medical Group works through the ACO model, which is shared with a number of its payers. This model encourages collaboration and eliminates traditional barriers to provide better care. It is as Darryl Cardoza, the CEO of this group, states, “And what the ACO model has enabled us to do is to begin to break down some of those walls, and to help us all work within the same system, and align incentives,” as explained during an interview by Healthcare Informatics.

Cardoza says that health care for the population management is very distinct from earlier managed care. As per Cardoza, “It’s not a matter of just preventing people from using certain kinds of resources, but rather, of managing the entirety of their care. And we were doing it by the seat of our pants, because we didn’t have the tools. It was just very, very difficult to use data, to consolidate it and evaluate it and draw meaning from IT; but those tools are available now.” In addition, Cardoza states that it is very important to integrate HIT across the network of providers so that teamwork can be more efficient. Furthermore, Hill Physicians Group needs to be a great partner with other providers in the area as well as local hospitals and with health insurance plans. They are very committed to being a good partner to other providers.

The outcome of their investing in virtual teams with doctors and the linking of its HIT internally as well as with partners through health information networks has resulted in positive financial performance as well as improved health for patients because of an improved quality of care.

Another organization which is focusing on population level health initiatives are Bon Secours, mentioned above. It employed 530 physicians. Robert Fortina stated that “The major bulk of our work has been around supporting our medical home project, and that has involved delivery system redesign, more robust use of technology, and then good old-fashioned nursing-based case management using those tools, so the development has been multi-factorial.”

One aspect in Bon Secours population management is community (patient) outreach, which is powered by software developed by Phytel. The software produces around 75,000 contacts a year. This outreach is based upon 20 chronic disease protocols and fifteen preventive strategies. This is a good beginning to improve the care they provide to their patients, but Fortina anticipates that the time will come when their analysis will be much more accurate and they will be able to do a better at stratifying patients into risk groups. By doing this, they will be able to offer care that is better aligned to the specific needs of the patient.

As you can see, Bon Secours Medical Group and Hill Physicians Medical Group are striving to implement an effective population level health model for the benefit of the patient and to the health professionals. Both of them employ team-based strategies. The ROI is high for both teams. Contrasts exist between the two groups , too. Hill Physicians is a much larger company and could use its size to benefit financially. Both have different models for their approaches. Hill Physicians uses an ACO model, contracting with several different payers. This makes its approaches to care more complicated as each payer has different requirements for their contract. Bon Secours bases its population model on the model of a patient-centered medical home, which is an established chronic care model.


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