*Russell Olsen,  *Patrick Flynn
Phytel
Demo-Interactive Presentation – Business Track
Saturday, Sept 29, 2012: 4:20 PM – 4:33 PM – Demo Pavilion

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*Presenting Speakers

Background

All current industry trends – from patient-centered medical homes and meaningful use to the rise of accountable care organizations and the return of global capitation – point toward the need for population health management. However, many healthcare organizations today face a variety of challenges with managing the health of an entire population, especially tracking patients as they move across care settings and keeping track of those who rarely come in contact with the healthcare system. For example, a study in the New England Journal of Medicine revealed that patients receive only about 55 percent of recommended care.

Methods
The presenters will showcase how population health management approach can be used for organizations striving to engage patients for improved population health and quality outcomes. It will include a demonstration of next-generation, web-based applications and toolsets used by care teams at provider organizations like Prevea Health, and how they are coordinating care across patient populations through eHealth interventions, including:

  • Clinical dashboards and eHealth engagement tools to help care teams maximize patient visits and provide structured treatment plans
  • Automated aggregation and advanced stratification of population health data
  • Population benchmark reports to show trending for quality measures across the entire population or by physician
  • Patient summaries to show each patient’s preventive care status, top chronic conditions, HRA-based Lifestyle Score and risk factors
  • Chronic and preventive care management post-visit
  • Patient-specific health and wellness interventions

Results
The presenters will also discuss Prevea Health’s specific improvement outcomes resulting from the implementation and use of the eHealth and population health management tools. The results have showed:

  • Diabetes patients who were successfully contacted were significantly more likely to have both a chronic care-related visit and an HbA1c test than their counterparts who were not contacted.
  • Hypertension patients were significantly more likely to have both a chronic care-related visit and a systolic blood pressure reading recorded in an electronic medical record.

Conclusions
Success in population health management requires physicians and care teams to strengthen relationships with patients, optimize the services they provide before and during office visits, and extend their reach to remain in contact with patients outside of the office. Through the use of eHealth, social and mobile technologies, automation tools can help practices achieve these patient intervention goals, while reducing the administrative, clinical and outreach effort that population health management requires of physicians and care teams.

Automated population health management can have an important impact in helping healthcare organizations improve the quality of care by engaging noncompliant patients in patient-centered treatment plans and allowing earlier interventions—especially for chronic diseases like diabetes and asthma.