Engagement: The top fundamental to successful population health management

Accountable Care Organizations (ACOs) are in a unique position to engage patients faster and closer to the point of care than traditional models. This is true because of its reliance on population health management (PHM). Over the next few posts, we’ll discuss the five fundamental principles that drive PHM.

  • Physician engagement
  • Information transparency
  • Provider incentives
  • Population scale
  • Patient engagement

Physician engagement is at the top of the list for good reason. An ACO may have the greatest processes, technology and clinical expertise, but without solid buy-in by physicians, a population health management program will suffer and likely fail.Miles Snowden, MD, MPH, CEBS Chief Medical Officer, OptumHealth

Care coordinators are key players for population health management programs. Often a role filled by a registered nurse, care coordinators interact with patients outside of a clinical environment, in person, by phone, by chat, or by email. They generally help high-risk patients—or those predicted to become high-risk—follow their care plan, take the right prescriptions and, generally, manage their conditions.

Often, PHM programs are run not by physician practices but by payers or sometimes hospitals. When a doctor isn’t aware of the program or is aware of it and doesn’t support it, that physician can limit the patient’s engagement and adherence to the program.

The quickest way to a successful program is to gain physician support. Organizations need to prove the value that care management can provide. Show physicians that the care coordinators can benefit their practice by increasing patient satisfaction, ensuring that patients keep their appointments, and helping improve quality scores. Once physicians are on board with population health management, patients are more likely to engage.

In the coming weeks, I’ll discuss in more detail each of these elements and how ACOs can best leverage them for clinical and financial success. If you want to get the full story now, please download the white paper: “Managing Populations to Improve Individual Care: Best Practices for Physician-based Population Health Management.”

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