As organizations move to value-based care the risk dynamics change from an operational to a population focus. Population risk focuses on the value of care delivered to a defined population requiring innovative and transformational care delivery models to manage different risk segments.
The stratification and risk segmentation of the population assists risk-bearing provider organizations in aligning the appropriate population health care delivery models with the clinical needs of the population. In addition, it allows provider organizations to target investments in improving quality, managing costs and delivering patient-centric care.
Population health care delivery focuses on five areas with each area leveraging different clinical care models.
- Preventative Care – Care delivery is focused on convenience and wellness to promote health for healthy or at-risk individuals. Examples include: Health Coaches and Wellness Clinics.
- Primary Care – Refining the traditional practice beyond the patient-centered medical home to support different levels of patient illness. Innovative models evaluate the care delivery team, provider panel size and the intensity of patient care. Examples include: Ambulatory ICU, Complex Pediatrics and Extensivists.
- Episodic Care Management – Targeting inpatient and outpatient care for a specific problem that drives efficiency, best practices and clinical integration. Examples include: Hospitalists, Centers of Excellence, Surgical Focused Factories.
- Chronic Care Management – Care models and associated care teams that target specific diseases and conditions to educate patients and manage conditions to ensure the highest quality of life for the patient. Examples include: Specialty Clinics, Specialty PCMH, Comprehensive Care Clinics.
- Post-Acute Care – Integration of post-acute care to support the patient’s continued recovery from illness or management of a chronic illness or disability. Examples include: SNFist, Hospital at Home and Integrated Home Care.
As provider organizations take on risk that requires managing a population, applying new care delivery models will support the goals of the patient, the physician, the employer, the payer and the overall market.
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