Population Health: Connecting the Dots with Your Provider Network | Geneia

Population Health: Connecting the Dots with Your Provider Network

December 14, 2016
Shelley Riser, Director, Population Health And Consumer Engagement


I believe this is an exciting time for healthcare. Ever-improving data and analytics give us great promise for genuine transformation. We now have the ability to help increasing numbers of people stay healthier longer. But there’s a catch. Turning data into meaningful action is a challenge.

I’m going to let you in on a secret – innovative health plans know they must help their provider networks meet their population health management goals. Successful health plans utilize population health experts to help their provider networks connect the dots between analytics, action and outcomes.

Working collaboratively and consistently with physician leadership, these population health experts dive into the data and create effective plans of action to address variations across members, providers and facilities.

My team of population health consultants works directly with providers and their clinical teams and understands the following fundamentals to be true and helpful

  1. A population is made up of one person at a time -- analytics need to create actionable insights
  2. A holistic picture of each member is necessary to drive member engagement and interventions
  3. The clinical context in which insights are delivered is key -- this helps drive outcome measurement and improvement

One person at a time makes up a population.

One person at a timeThe heart of transforming healthcare is identifying and addressing the needs and goals of each member, and identifying what services can help them get to or maintain their optimal state of health. On paper this looks simple, but it takes effort to plan it out, put it into action, measure outcomes, adjust as necessary, measure again, and so on.

Within this need is opportunity for health plans to strengthen their provider relationships and help them further align around value-based care. We take a big snapshot of the health system and drill down into any member, group of members, provider, or site that falls outside of established parameters. Through this, and working side-by-side with physician and clinical leadership, we gain an understanding of each member’s medical needs.

By providing clinical teams with succinct information about individual members in need or rising risk, prioritized by their need or intervention opportunity, it becomes manageable for them to come together to create realistic action plans and measureable outcomes.

A holistic picture of each member is necessary.

Until providers have a true 360-degree picture of the member in front of them, they will only have a fractional understanding of the member’s needs and ability to adhere to care plans. In other words, clinicians must see the whole person, not just the person that presents within the four walls of the exam room.

A true 360-degree view includes:

  • Interactions with all providers, including those out-of-network
  • All medications, regardless of prescriber (and if they were filled and/or refilled)
  • All lab and testing results, regardless of who ordered them
  • Availability of community services and which, if any, the member utilizes
  • Analytically-driven insights around the likelihood of disease
  • Financial situation with regards to health insurance, co-pay and deductible – no one likes to talk about money and healthcare, but these realities impact people’s ability to engage.

Bringing all these elements together provides invaluable insight into the way each person connects with the healthcare system and how they are likely to engage going forward. More importantly, these elements drive the understanding of why members engage or fail to engage with the healthcare system.

The clinical context in which insights are delivered is key.

Getting A holistic pictureTo say that clinicians are busy is a gross understatement. These dedicated individuals are on their feet, at the front lines, day in and day out. The demands of a busy practice schedule, documentation requirements and coordination of care efforts necessitate information to be presented in the most efficient and actionable manner.

With this in mind, population health consultants help health plans to deliver insights in ways that are meaningful to the clinician. When the analytical divisions of health plans simply give clinicians a spreadsheet, they are doing them and their members a great disservice. Insights must be delivered in a concise, usable fashion that makes sense within the clinical workflow.

When population health experts work together with physician and clinical leadership, the results speak to the clinician’s naturally scientific mind – the mind that wants to solve the puzzle of each member’s care.

Connecting the dots.

The goal of population health management is to facilitate outcome improvement across the health continuum for the populations served – to keep a member population as healthy as possible. Population health management strives to

  • Understand and engage those with rising risk
  • Engage those with chronic conditions to slow or halt disease progression
  • Coordinate care for the catastrophically ill or injured

These actions help to minimize the need for expensive interventions such as emergency department visits, hospitalizations, imaging tests and procedures. This approach not only lowers costs, but redefines healthcare as an activity that encompasses far more than sick care.

While population health focuses partly on the high-risk members who generate the majority of health costs, it systematically addresses the preventive and chronic care needs of every member.

Putting analytics into action and creating engagement strategies to positively impact the health of individuals and populations is challenging. It requires a new way of looking at healthcare. It requires innovative technologies and people who can boil it down, communicate it succinctly, and work collaboratively with physicians and their clinical teams to implement. Leading plans provide population health experts to lighten the load for providers and help them achieve success within their value-based arrangements.


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