Keep patients in focus with a digital population health solution — 4 technology pillars and 3 steps for success

In the U.S. the push for population health management is largely driven by rising healthcare costs and rates of chronic illness. Costs are growing at an unsustainable rate and do not correspond with care quality and outcomes on a national level. Additionally, the nation's population is aging and demand for healthcare services among chronically ill patients is on the rise.

"At its root, [population health] is about doing more with less and a desire to improve the quality of care, especially as we're living in this world of ever-changing payment models," said Michael Blackman, MD, medical director of population health at Allscripts.

To improve the health of patient populations, hospitals and health systems need to be able to engage with patients beyond the four walls of the hospital and support the streamlined internal communication of patient information, making technology an essential component of any successful population health strategy.  

During a Nov. 19 webinar sponsored by Allscripts and hosted by Becker's Hospital Review, Dr. Blackman described how hospitals and health systems can create "a smart healthcare community" — that is, one that is safe, effective, patient-centered, timely, efficient and equitable, per the World Health Organization's definition — by carefully selecting and deploying population health management software.

"Doing this creates value not only for patients but for the entire system," Dr. Blackman said.

4 pillars of a successful digital population health solution

To improve clinical care, do "more with less" and stay competitive in a changing payment environment, a population health solution should support four key "pillars," according to Dr. Blackman.

1. Aggregation/interoperability: The ideal solutions can combine and normalize data across multiple sources.

2. Analytics: That data is then leveraged to create information that deepens understanding of the patient population.

3. Care coordination: With analytics, healthcare organizations can identify those patients who need extra care or outreach and better manage high-risk and -cost patients.

4. Patient engagement: Finally, beyond driving improvements in costs and outcomes, a successful solution will also encourage patients to take a greater interest in their own care.

The most effective population health management tools will address those pillars while also fitting seamlessly into existing clinician workflows and "meeting patients where they are," Dr. Blackman said.

Furthermore, he added, "It's not just about the technology but, rather, what you can do with it. Because tools, frankly, are just that: tools. They don't solve issues by themselves, but they help improve processes and they help identify where to look."

3 steps for successful implementation

Once a solution is chosen, leaders must take several steps to ensure the implementation process is successful, drives value and delivers the desired results.

1. Define a strategy: The first and most important step is deploying and defining a strategy: determining whether the goals of the software lie in clinical improvement, financial or contract goals, or patient satisfaction.

"The fact of the matter is, it's never about one of these — it's about all of them, or some combination thereof, so you need to know what you want to measure and what the data source is, and bring that information from multiple places to save money and time," Dr. Blackman said.

2. Identify needs: With a strategy fully defined and a clear idea of how progress will be measured, it is crucial to identify data and process needs — including the entire team's expectations for the solution and a thorough understanding of how, exactly, the data will be used — well before implementation, "so there are no surprises later," Dr. Blackman said.

3. Ongoing review: Finally, after deploying the software, be prepared for ongoing reviews and near-constant adjustments. "It's important to remember this work is never done," Dr. Blackman said.

Conclusion: Keep patients in focus

Overall, he said, the most successful population health strategies are those that offer a holistic view of care, take advantage of every patient interaction to address gaps in care, think beyond the in-person visit to encompass telehealth and other virtual solutions, address the patients not currently being seen, and feature a robust analytics strategy to create insights and enable action.

"A successful population health strategy requires thinking broadly in a team approach," Dr. Blackman concluded. "There are numerous decisions that have to be made, and those decisions are affected by a number of factors, but in general, if you keep what is best for patients in focus, you're likely to make good choices."

View the full webinar here.

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