High-risk populations are a common target for population health management, care management and utilization management programs. Population health management tools support management of these populations by identifying high-risk populations, supporting interventions and documenting the activity of care managers.
Identification. In the management of high-risk populations, population health tools are first used to help organizations identify high-risk members. EHR clinical data, demographic data and claims data can be used to identify patients with multiple chronic conditions or specific conditions that are of high complexity; predict the future financial risk of individual patients based on their current diagnoses and demographics; and identify very specific diagnoses and utilization triggers for immediate intervention.
Intervention. After populations are identified, population health management tools are used to deliver lists of patients requiring interventions by care managers. These tools also provide support for care managers in their work by recommending specific interventions and outreach and identifying the needs of patients.
Documentation. After interventions are complete, population health management tools are also used to document the activity of care managers so that organizations can monitor the volume and effectiveness of interventions. In addition, population health management tools can facilitate the development and maintenance of care plans for high-risk patients.
Previously appeared in the November 2017 issue of Accountable Care News.