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Population Health: Great. Now, What Exactly Is It?

Population Health: Great. Now, What Exactly Is It?

A new inforMD by Privia blog series, “Population Health & You,” brought to you by Rick Foerster, VP, Population Health, Privia Health.

It’s time to set the record straight. The term “population health” gets thrown around a lot in the healthcare industry but is not universally understood, which is a shame because this approach is the backbone of the future of healthcare. Once fully embraced, population health can substantially decrease a physician’s daily administrative work, open doors to operationalizing value-based care and can be a real revenue generator if done right. So, how do you do it right?

Let’s start by defining population health. From a top-line perspective, population health is the proactive and comprehensive management of a group of patients. That’s simple in concept, but difficult to accomplish in reality. It requires a different way of thinking as an organization, from how you manage your day-to-day to how you reward performance. In population health, you need to be responsible for the totality of a patient’s care, regardless of whether they see you or not, where they get their care, or even whether they follow through with your recommendations. Congratulations, you are responsible for it all.

Population health must begin with the physician. Without engaged physicians as the foundation, it doesn’t matter how many capabilities you layer on top, population health can’t be successful. After the physician is committed and onboard, the following four categories come into play:

  1. Helping patients outside of the four walls of the practice to follow-up on their care plan, provide advice, and remain accessible.
  2. Coordinating care across the entire healthcare network and ecosystem  (i.e., specialists, pharmacies, hospitals, post-acute facilities, etc.) to manage the patient’s care when they’re outside of your office
  3. Developing and maintaining strong payer relationships – because as physicians transition into value-based care, they need a new set of expertise and tools (separate from those in the fee-for-service world) to be successful
  4. Implementing data and technology that allows you to comprehensively take care of all of your patients at once, with a “full picture” of their health stored in one accessible place

Equally important to defining population health, is defining what population health is NOT. Population health is not just a single thing you implement and then dust your hands of afterwards. It is NOT:

  • Just something that only a big health system can do
  • Just hiring a care manager
  • Just something for doctors and nurses
  • Just an app
  • Just an EHR system
  • A money-loser
  • Charity

Understanding what population health is not is just as important as understanding what it is. You can’t just implement one piece, and then assume you’re done.

The opposite is also true. When beginning, you should not over-complicate or over-engineer solutions. You will end up with too much cost, a complicated model, and confused physicians and patients. All it really requires is going back to the basics and using common sense. When you’re ready to begin your journey, start with these questions:

  1. Do you have data on your patients today?
  2. How are you rated on standard measures on quality of care?
  3. Where are you seeing the highest costs in your patient population (hint: probably hospitalizations)?
  4. Look at the data – what is in your control to improve?
  5. Create an action plan and return to the data next month to measure your progress

At it’s core, population health is about understanding your patients and then implementing action plans to improve their health one step at a time. It’s a mindset, philosophy, and way of doing business that aligns with healthcare’s value-based future.

As a way for the Population Health department at Privia to do our due diligence in being proactive, this is the start of a new blog series “Population Health & You,” where we’ll really dig into the topic and what it means for each group of people across the healthcare spectrum. Stay tuned next week for “Population Health & Primary Care Providers.”

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