Providers making the transition to value-based care are looking for new ways to deliver appropriate, cost-effective care and optimize their performance.
Population health management, or PHM, is one strategy they’re using to get there. By transitioning from acute, episodic care to a more coordinated, long-term approach, they’re helping patients stay healthier while controlling costs.
But this transition must be carefully planned. Providers groups who have successfully used PHM principles to provide higher-quality, lower-cost care consistently cite the same four areas of critical focus:
- Optimizing network management
- Managing care transitions
- Investing in in-home intervention
- Expanding chronic disease management
Throughout this series of blogs, we’ll explore these four areas of PHM and find out just what it takes to navigate the journey from providing care to managing health.
Before we launch into the four steps, however, we need to briefly discuss the data you’ll need to lay a solid foundation for PHM. There are two major types of data that inform PHM: claims and clinical.
Claims data helps answer questions about the types of people who receive care, the care settings in which they receive the care, the categories of care they receive, their demographics and the general type of care that is being delivered. It’s great information for population health discovery and research studies. Claims data aren’t the end-all in health care data, however. Claims don’t include, for instance, all of the conditions a patient may have — just the one for which the provider is being paid. And they’re dated, becoming available weeks or even months after the date of care.
This is where clinical information can fill the gaps. Electronic medical records make a rich store of data available for analysis. Unlike claims data, they are timely, they are longitudinal and they reflect how medicine is actually practiced.
One final point regarding data needed for PHM: regardless of its source, data must be timely, relevant and comprehensive.
In our next blog, we’ll talk about the first step of population health management: optimizing network management.
For an in-depth discussion on the four steps to population health management, download our white paper The Four Steps of Population Health Management.