The Key to Care Management: Understanding Your Population

Cynthia KilroyAs providers take on more risk, they will need to build robust population health management capabilities – prevention, wellness, disease management and care management – to achieve performance and shared savings goals. To do this successfully, providers must craft population health management solutions that meet the needs of their specific population mix.

If they have a large Medicaid population, for example, they may need a health management program that focuses on developing a high-risk perinatology program and a well-baby program. But if they have a large Medicare population, the focus would need to be different, such as continuity of care programs or medication adherence outreach. These programs also need to be customized for the population to include the right tools and messaging to ensure full engagement of the members.

Developing the right programs for a provider’s population requires three steps:

  • First, identify what population health management programs the provider currently has in place, and how well they are working. Those products not performing at the desired level need additional clinical and quality evaluation to determine what investments will improve margins.
  • Second, develop a risk profile to understand the instance and cost of disease in the population. This will help determine which programs that provider needs to invest in for care and outreach. It’s important to look at both disease instance and cost. For example, multiple sclerosis (MS) might be one of the top disease costs, but it has a low instance. This means that investing in a full-blown MS disease management program may not yield desired results – especially because costs may be due to a necessary drug regimen – and MS would be better managed by the physician. On the other hand, diseases that are high instance and high cost, such as cancer, may call for a comprehensive program supported by care managers to ensure improved management based on evidence-based guidelines.
  • Third, it is important to track results of programs through monthly financial, clinical and quality metrics. This allows providers to understand product utilization, costs, patient satisfaction, evidence-based adherence, trends and outcomes, in order to adjust strategies and investments as needed.

When providers clearly understand the financial, clinical and quality performance overall and for specific populations, they can use this information to determine what investments to make in population health management in order to ensure the best return on investment and their overall profitability. And by focusing these programs on their specific audiences,  providers can make great strides in keeping their populations healthy.

One thought on “The Key to Care Management: Understanding Your Population

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