What is Population Health Management Really About?

Post by Neal Singh

Chief Executive Officer, Caradigm

Population health management is still such a new concept that I often get asked the question, “what is pop health really about?” It’s a question that I enjoy having discussions about because it helps put into perspective where healthcare is today and why it needs to take a different path in the future.

Healthcare has historically been transactional. A sick patient visits a physician when they need care, receives that care and the physician gets paid for the transaction. Physicians get paid every time they see patients, whether patients get healthier or not. Electronic Medical Record systems (EMRs) also emerged to facilitate this type of episodic care. However, the downside of transactional healthcare is that it’s reactive and not coordinated, which leads to lower quality of care and higher costs. The passing of the Affordable Care Act in 2010 and the shift in reimbursement models to value-based care have challenged the transactional model.  

Hospital networks are now incentivized to make a population of patients healthier under risk-bearing financial arrangements. By aligning the economic incentives for care delivery and utilization among the patient, provider and payer, population health seeks to improve quality and reduce costs through proactive and coordinated care. New healthcare information technology has emerged to enable population health, and that’s what Caradigm delivers in four key capabilities: 1) Data Control 2) Healthcare Analytics 3) Care Coordination and Management 4) Wellness and Patient Engagement.

Here’s an example of the power of population health. Imagine a large provider with a total population of 1.6 million patients, 77,000 of whom are diabetics. Whereas many population health solutions can predict which 55,000 of those 77,000 diabetics are going to incur the highest costs next year, Caradigm® Risk Management powered by LexisNexis with MEDai Science can identify which patients should be prioritized because of their cost savings potential based on a number of factors including clinical risk, inpatient and emergency room visit risk, forecasted costs, patient motivation, and movers risk (i.e. the risk of transitioning to high risk over the next 12 months). In the case of this particular population, there are 900 patients who will be highly impacted by intervention and management and yield a significant cost savings.  That’s meaningful intelligence that helps large providers with constrained resources know where to take action today.

As exciting as that intelligence is, it’s just one part of the population health story. The story continues in better managing the care of those 900 patients and empowering them to take greater responsibility for their own care, but we’ll save those discussions for another time.

I am passionate about population health because it’s next-generation healthcare that benefits everyone – patients, clinicians, providers and payers. Leading healthcare organizations are already executing on it today, which will help them be the healthcare leaders of tomorrow. To learn more, please check out the resources page on our website at http://www.caradigm.com/en-us/resources/.