Industry Trends: What is Population Health Management?

The term “population health management” is a buzzword in healthcare right now. It can be defined as purposeful actions that are taken to improve the health outcomes of a specific group of people, both thru medical care and by understanding the socioeconomic factors that determine health (education, income, nutrition, etc.)

Population health management (PHM) is very different from public health, which is usually a government function and consists of preventing epidemics, managing environmental hazards, and promoting healthy lifestyles. It’s also a bit broader than disease management, because it encompasses everyone in a defined population, including those without a chronic condition.

PHM allows us to define a population in many different ways. Sometimes it can be a defined by a geographical area, as in a statewide initiative like the Vermont Blueprint for Health, which aims to improve the health of all state residents. It could also be an ethnic group, insurance plan members, or all the patients seen by an accountable care organization (ACO). The Affordable Care Act (ACA) can be seen as a PHM initiative, because it aimed to improve the population health of the entire nation, by expanding access to care (through Medicaid expansion, state and federal insurance exchanges, guaranteed access to preventive services without cost-sharing, the elimination of pre-existing conditions as a barrier to insurance, etc.)

Strategic measures to improve outcomes
Historically, our healthcare system has been reactive rather than proactive. It was designed to respond to acute episodes illness, with little emphasis on following up with patients or keep them healthy afterward. Now, we’re starting to shift to a more proactive system, one that anticipates the needs of patients by shaping patterns of care for specific populations.

Here’s an example of how this might work. Hospitals are under a mandate to reduce readmissions within 30 days. To do this, they must identify the population of patients that are at greatest risk of complications after discharge. Once they do so, they can implement a quality initiative that is customized to fit the needs of that group. It might be that better discharge instructions and follow-up calls from a nurse or pharmacist are needed. But it might also be another form of advocacy or outreach that will solve the problem. Maybe patients in a low-income community are missing medical appointments because they have no transportation. Or perhaps they are going without medicine or nutritious food during the last week of every month, while waiting for a pension check to arrive.

This is where PHM comes in, with its flexible and comprehensive approach to care. Under the PHM mindset, providers – and sometimes payers – will not only coordinate the medical aspects of care, but will address a broader range of factors that can have an impact on health. This includes any condition that might present a barrier to care, including access to transportation, safe housing, and nutritious food. PHM attempts to level the playing field a bit, preventing the disparities in health outcomes that are often seen by various types of disadvantaged populations.

What does this mean for nurses?
No matter which populations are served by your hospital, you’ll want to advocate for your patients whenever possible. If you notice environmental, behavioral, or economic deficits that are interfering with their care – or ability to live a health lifestyle – you may be able to do something about it. Increasingly, hospitals and private practices are including case managers or nurse navigators on their staff. If you’re a floor nurse, you can bring up your concerns to one of these professionals, who is very likely well poised to help the patient connect with the appropriate community resources.

As PHM shifts from theory into practice, hospitals and primary care practices will have to provide better follow-up care and work harder to keep patients well. This is likely to increase job opportunities for nurses specializing in case management, who can connect the dots and formulate care plans. Online nursing degrees like American Sentinel’s MSN with a case management specialization can make you attractive to employers, provide you with case management knowledge and skills, and give you the academic background you’ll need to pass the credentialing exam.

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