In healthcare, population health management is an essential part of marshaling resources and deploying them in a smart, targeted way to efficiently improve patient outcomes. A crucial part of that hinges on “improved care coordination and patient engagement.”
There are numerous examples of population health and case management – whether it’s supporting an aging population in a specific metropolitan area, exploring what can be done to more effectively aid those suffering from opioid overuse, or caring for historically underserved communities.
But with such large patient groups, how do you appropriately manage the balance between broadly understanding the big universal needs of the group while triaging for the highest priority cases?
Visibility is essential
If you can’t see what’s going on, how could you possibly hope to fix it? Technology platforms make it possible to gather the relevant data on a critical population in a single place and automatically analyze it for trends. The ability to understand the big indicators of health – whether positive or negative – through a birds eye view is important for identifying and tracking trends. But it also underpins another essential component of this care type: the high priority cases that require extra attention and resources, perhaps immediately.
Companies are getting in on the population management bandwagon as a way to offer more effective healthcare services to their workforces while better controlling costs. The financial services firm Argus, for instance, has built the Thrive. population management program – and that visibility has allowed better support of those with chronic care needs and those who have recently been hospitalized and require care coordination.
Quickly surface truly ill patients for immediate support
In any population, there will be a certain number of patients who are very ill. These people typically can’t wait long for intervention – or the outcomes can be serious or even irreversible. A manual approach won’t cut it here. Technology can make it easier to surface people who meet specific criteria instantly. Imagine, for example, being alerted to a diabetes patient with an A1C of greater than 9. You could instantly assign them to a specialized program or connect them with the appropriate coach or educator for behavioral modification. Similarly, those who reach a particular score threshold for certain cancer screening assessments can also trigger an automatic alert. This is a better way to ensure that those who need the most hands-on care, get it.
Create better, more responsive communications pathways
Often population management means working with a particular group to provide education and care around a single issue or set of related issues. A technology platform can facilitate faster and more effective communication – for example, connecting a 24/7 advice line with a triage protocol that ensures patients who meet the right criteria are elevated to speak with clinicians or advised to head to the emergency room. Follow-up appointments are easy to book. Reminders to send educational materials or to connect patients with the right person for a personalized look at what education can be programmed in as part of the workflow for care teams.
Divide and conquer more effectively
A care team approach is best for population health and case management because no one person can do it all. And to be frank, no one person should do it all. A clinician shouldn’t spend time setting up appointments or issuing reminders just as a physician’s assistant isn’t the one to diagnose a problem. Technology can be helpful with a care team approach by putting all members on the same page as far as what’s happening with a patient or entire population. Even better: customized pathways can be built to give the right people the right information at the right time so they can do their jobs well.
Build specialized programs quickly
There’s a reason the saying “one size fits all” doesn’t really work in healthcare. People are unique. They might share a condition but it may manifest differently. They may have differing levels of adherence with a program. One person may react differently to a drug protocol than another. Technology can adjust for these differences by creating multiple programs that are customizable to a patient’s unique circumstances and needs.
Argus, for example, was able to do that with lifestyle case management, complex case management, care transition support, and a specialty drug program, all tailorable for patients’ particular journeys. Automation then supported each of these programs – for example, once enrolled in the specialty drug program, protocol requires follow-up in two business days, an example of a task that a platform can support by generating automatic reminders.
Technology has made life better in all areas of life – and healthcare is another example where it can function as a trusty sidekick, easing the way, making connections at an enviable speed, and charting a path to better patient outcomes. In population health and case management, those advantages net out to clear wins for care teams and the patients they serve.