Population Health Management

Taking on the responsibility of caring for the health outcomes of a population of patients.

Deliver high quality and efficient care to a population of patients.

The process of a healthcare organization managing a population or group of patients is often called population health management. The advent of the Affordable Care Act, new healthcare reimbursement CPT codes that incent proactive and preventative care, combined with an increasing trend towards taking on risk-based contracts has created an environment where high quality, proactive care, at a reduced cost, is rewarded. Many healthcare providers are looking towards population health management as a way to succeed in this new environment.

Value-based reimbursement requires investment in population health.

In order for healthcare providers to get reimbursed for value-based services, they need a systematic way to track and manage patients – population health management systems provide just that. Population health management enables healthcare providers to serve a group of patients using processes, technology and people to treat patients both in person and remotely. The goal is to proactively track a group of patients and provide preventative care to increase quality and reduce higher cost services like emergency room visits and hospitalizations. Population health management includes systems that allow healthcare providers to remotely monitor patients. Patients with chronic diseases like hypertension, COPD, diabetes and asthma can benefit greatly from engaging with healthcare providers in between regular visits, to both monitor their health status, medications and lifestyle and to provide them support and answers to questions they might have about their care.

Risk stratification and analytics of diabetes patient populations with Glooko.

Monitor Pop Tracker v2

Glooko’s Unified Platform for Diabetes Management enables healthcare teams to proactively manage their population of diabetes patients. Healthcare organizations looking to provide high quality, proactive care that is both efficient and effective can change their cost structure and improve outcomes by having visibility and designed processes for engaging high risk and often high-cost patients. These patients can achieve better outcomes if they are managed carefully and proactively. Being able to segment patients into high-risk, low-risk and rising-risk, also known as risk stratification, is important to the success of population health management efforts. With Glooko, healthcare providers can view and analyze patient groups. As patients start to experience risky scenarios, they are automatically “flagged” in the Glooko Population Management view. Healthcare providers can set “custom flags” for both patient groups or for individual patients so that they are alerted to when patients need remote engagement to get back on track.