Population Health Management

An illustration of the population health management matrix
Population health management requires healthcare networks to move away from a system of individual, siloed providers to a coordinated, team-based approach in order to create a holistic view of the patient population.

The first step in the process of population health management is acquiring and aggregating both clinical and financial data to create a holistic view of the patients within a healthcare network. This data allows the network to identify populations of patients whose conditions can be managed through evidence-based care plans that are coordinated across care settings.

For many organizations, obtaining population health data can be difficult because it must be collected and organized from many disparate sources. For example, while a diabetic's HbA1c result is discrete, easily collectible data, the results of the same patient's foot exam may only be found in text format within the clinical notes. Encouraging physician engagement around evidence-based care plans helps reduce healthcare provider variation, which in turn may result in more uniform collection of patient data.

Population health management data can help networks identify and close gaps in care that can drive improvements in care and reductions in cost. Patients enrolled in a robust outreach program are more likely to get care intervention before their problem escalates to the point of requiring expensive tests or a costly inpatient stay. This can be especially helpful when trying to manage a population's subset of high-cost patients.

Successful population health management requires healthcare providers to predict the care needs of a population in order to properly develop and assign appropriate care plans and determine how to best promote patient engagement in his or her care. Networks need to be aware of all care that each eligible patient receives both within the network and outside of it.

Explore how McKesson Population Manager can provide your organization with actionable insights about your patient populations to help care providers achieve better preventative care and disease management.

Next: Succeeding with value-based care models