Understanding Population Health Management

The concept of population health management (PHM), targeted to a defined population such as an employer-sponsored group, is increasingly being viewed as a way to manage healthcare risk, control costs and improve health outcomes. In its most basic form, it is a systematic way of managing personal health behavior to improve the overall health of a population.

To accomplish this, some influencing entity such as an employer or provider group works with a population of individuals to help them make appropriate choices and decisions about their health and medical care – decisions that help them reduce unnecessary medical expenses and stay healthy. Population health management strategies such as lifestyle, demand, disease and large case management, provide the means by which the influencing entity attempts to change the behavior of the targeted group for the better.

Designed to Manage Risk

When population health management strategies are combined with a self-funded health plan, the employer, health plan or other entity at risk for the population’s health care costs, is dedicated to protecting and promoting the health of the defined population. As new entities such as Accountable Care Organizations (ACO) become more actively involved in the business of health care, they become more influential because of their concern and financial risk for the cost of medical care. Even when providers are not at risk financially, they are becoming increasingly aware of provider profiling and measurement of quality medical outcomes.

Promoting Access to Appropriate Care

Through health risk assessment, data analysis, behavioral expertise and coordinated care goals, population health management strategies can be individualized, yet coordinated for the defined population. Whether teaching individuals how to care for themselves or identifying physicians, nurses, educators, counselors or other care managers, the goal is to prevent chronic disease and disability and to avoid catastrophic claims and their associated costs.

When a self-funding plan is in place, employer groups have the flexibility to adapt the plan design to the needs of the covered population. By integrating health promotion with aspects of lifestyle management, preventive medicine, ongoing screening and proactive management of acute and chronic care, population health management strives to improve health and reduce costs from the perspectives of both providers and payers.

To view other articles from the SIP Winter Newsletter, please click here.

In cooperation with NAEBA

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