A new paradigm for population health management

Over the last 10 years, most US payers and providers have implemented some form of Population Health Management (PHM) to address problems that contribute to poor health conditions in populations and communities. These pop health processes are designed to improve clinical health outcomes of a defined group of individuals through improved care coordination and patient engagement supported by appropriate financial and care models.

The problem with population health management is that there is a drastic and alarming range of success and failure. A study conducted by the NIH shows a net return on investment (ROI) range between $-244.65 and $1,592.48 PMPY.

How can a payer or provider establish a successful population health management program that yields net savings vs. net loss?

Interoperability enables population health management to fulfill the promise of value-based care. It involves payers enabling collaborative care management through the use of innovative technology integrations that aggregate and share electronic medical record data among all members of the extended care team. Anyone who interacts with that patient, from member services, payer case managers, primary care providers to specialists, has access to the longitudinal view of the patient by connecting data through a Health Information Exchange (HIE)—which enables health data exchange across provider and pharmacy networks—and displaying that information in one-screen views through integration with a platform CRM system, for example Salesforce® Health Cloud.