Population Health Management: Challenges Present Opportunities


Population health management (PHM) involves transforming organizational practices in the collection, analysis, and application of data for improving clinical and financial operational efficiency. Enabling infrastructure requirements include greater interoperability to support data exchange, as well as the standardization of metrics and measures for monitoring and reporting on PHM outcomes. Advances in informatics and Big Data science are key to promoting effective risk management capabilities, as well as automation to scale interventions.

The PHM software and services market is still relatively new, and continues to evolve from the perspective of business models, organizational practices, and technology solutions. The challenge with operating in such a market environment is being able to meet clients where they are in terms of their PHM strategic priorities and needs. With PHM technology solutions continually evolving and implementation practices remaining customized for now, Tractica’s Population Health Management Software and Services report identified a number of challenges that present opportunities for technology-enabled solutions:

  • PHM Continuously Evolves: To succeed financially under new payment models, healthcare providers will need to expand the data sets that they can bring into their analytical platforms if they are to favorably impact the health trajectory of populations and achieve the cost reductions and quality improvements for the populations that they manage.
  • Data Inconsistencies and Quality Issues Affect Data Management: Quality data enables better risk stratification and prediction, more engaged providers, and improved care coordination. When data is trusted, relevant, and complete, healthcare providers are empowered to deliver the right care, in the right place, and at the right time.
  • A Networked Healthcare Environment Requires Interoperability: Because patients increasingly receive care services from a variety of providers both within and across settings, patient care is transitioning to a more inter-networked collaborative and coordinated model of care management. Patient identification and matching methods are also key to effectively sharing and integrating data across systems.
  • Big Data and Analytics Required to Advance Risk Management: Advanced information management and analytical methods are necessary to manage the inherent heterogeneity and complexity of the data currently in use to stratify and select target populations and predict outcomes, as well as provide intelligence to drive continual improvement in care processes.
  • Workflow Integration Is Key to Actionable Clinical Decision Support: To be effective, care management relies heavily on the ability to provide clinicians with information-powered insights that support decisions and inform actions at the point of care. The demand for real-time insights and analytics in clinical workflow will drive innovation in the delivery of services, as well as effective patient engagement.
  • Patient Engagement Strategies Are Key to Realizing Value: A main driver in the realization of a total PHM solution will be the consumer patient. The patient engagement segment of the PHM market consists of patient-centered tools that support health education, self-care management, and behavior change that promotes compliance with care protocols.
  • Automation Will Drive Customized Virtual Care at Scale: For PHM to be successful, providers must find ways to customize care experiences at scale across their entire population. As PHM transitions from the care management of the most acute patients to the broader population, automation of processes will be key to optimizing limited workforce resources to manage care at a population level.
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