September 01, 2016
"The health outcomes of a group of individuals, including the distribution of such outcomes within the group." David Kindig, Institute for Healthcare Improvement
Population health has infiltrated the healthcare industry, and it is here to stay. Population health seems to be the answer for many of my graduate school test questions, it's included in all of my project solutions, and honestly, the first time I heard about it, I wrote it off because it seemed too simple to actually work. In fact, population health is so simple that healthcare professionals across the country glaze right over it, too. This is why we at Clarify stress the importance of great population health management strategy with all of our clients.
Let's restate the obvious: The U.S. healthcare system is in the midst of a major transition, and for the first time in a long time, managing the health of a given population is taking priority over individualized healthcare. In graduate school, my professors teach me and help me develop skills to navigate our evolving healthcare system. But most importantly, they are teaching me how to think. Population health has a definition, but it is more importantly a mindset about how we provide healthcare. When we change our mindset to focus on groups of patients in order to put processes and reliable systems in place, everyone wins.
Population health can encompass an endless number of different types of groups. They can be as broad or as specific as needed. Who makes up the group(s) will vary based on patient populations, health conditions, socioeconomic status, geographic location, and so on.
Here are a few examples:
Population of a town
Employees at a company
Diabetics in a given state
Patients at a primary care practice with any given condition
Once the population is defined, the next step is figuring out how to effectively manage it. That's where population health management (PHM) comes into play:
Population Health Management is effective and impactful
Population Health Management (PHM): "The compilation of patient (or group) data, the analysis of that data into a single, actionable patient record, and the actions through which providers can improve both clinical and financial outcomes of the group. PHM involves the design, delivery, coordination, and payment of high-quality health care services to manage the populations we identify while using the best resources available."
New partnerships between providers and payers
Effective utilization of technology
Care management models
Implementation of non-traditional healthcare professionals
Risk to be successfully transferred from payers to healthcare organizations
Implementation of and reliance upon processes and systems to make appropriate and necessary patient care more predictable
"We frequently hear from health care professionals and sometimes even clients that they're skeptical. It's always enjoyable to hear positive feedback and stories from these same people when they see the difference PHM makes for their organization, providers, care teams, contracts, and patients. It's a really powerful moment when the light bulb comes on." Amber Winkler, Clarify CEO
PHM principles and activities can be applied at every level of the healthcare industry and in many different ways.
The possibilities are endless. Current trends include:
Accountable Care Organizations (ACOs)
Patient-Centered Medical Homes (PCMH)
Risk stratification methods
Large companies who are self-insured
We love working on population health with our clients. We research how PHM can benefit different healthcare organizations. We know PHM helps improve patient outcomes. We watch PHM improve the quality of care our clients provide. We see our clients drive business and gain critical reimbursement dollars. And finally, we are strong believers that a population health mindset has the power to make your organization strong enough to excel and stand out from your competition in this ever-changing healthcare climate.
Amber Winkler, MHA, PCMH, CCE, is the CEO and founder of Clarify based in Charleston, SC. She and her teams have successfully achieved NCQA Quality Recognitions, and worked in the population health, research, process improvement, EHR optimization and software space since 2006. Previous experience includes work as Director of Strategic Development for a large, progressive Regional Healthcare Provider group, and Research Executive at The Governance Institute where she focused on national hospital industry trends and best practices. Her work and projects are recognized by or featured in Modern Healthcare, the Patient-Centered Primary Care Collaborative (PCPCC), HealthLeaders, AAFP, Healthcare Finance News, Healthcare Benchmarks and Quality Improvement, Case Management Advisor, BlueCross BlueShield of South Carolina, and at conferences across the US. Amber is a graduate of the University of North Carolina at Chapel Hill and the Medical University of South Carolina. She serves on local and national panels and advisory boards.
Anderson Wiksell is a graduate of Clemson University where she majored in Health Science including focuses in Business Administration and Engineering. She is currently pursuing her Masters in Health Administration at the Medical University of South Carolina. Interests and strengths include project management, strategic planning, customer experience and global health. Clarify is a healthcare and technology consulting firm born in Charleston, SC in 2011. Healthcare is complicated, and our goal at Clarify is to provide effective and simple consulting to healthcare organizations and community health centers. We enjoy taking big ideas, concepts, documents and data and making them easier to understand. We are honored and proud of the clients we work with and the results we achieve together. . www.getclarify.com