Population health management (PHM) combines data analytics, technology, and engagement tactics to deliver targeted health care services in support of population health efforts.
PHM is the foundational capability that is enabling the transition from fee-for-service to alternate payment arrangements. In this evolving alternate payment landscape, where health systems are expected to take on the responsibilities for pre-defined populations, having an effective PHM capability is going to be critical to maintaining profitability.
This new model of providing care requires health systems to understand who is the population that they are caring for, identify who is most at risk and then engage them through the appropriate channels to provide the educations and services necessary to improve health outcomes.
For example, a hospital with a population health goal to increase vaccination rates must properly identify, target, and connect with a non-vaccinated population. With the help of an HCRM, healthcare organizations identify vulnerable populations, find those most likely to not have received vaccinations, and develop personalized outreach to specific patients.
Here’s how healthcare organizations can leverage the HCRM’s capabilities, including real-time data, technology, and 360-degree patient views to more effectively implement population health management.
Population Health & HCRM
Every person serviced by a healthcare organization travels through both a patient and a customer journey. The patient journey includes check-in, clinical procedure, recovery, communication, and discharge. The customer journey, on the other hand, includes research and preparation, appointment scheduling, recovery & rehabilitation, and follow-up.
Every one of these steps relies on a specific kind of technology to get relevant information in the right place at the right time. The “BIG 5” software products in the healthcare industry – healthcare CRM, marketing automation, content management, a call center, and an EMR/EHR – support both the patient and customer journey.
The HCRM is the centralized database and analytics engine that brings it all together and can play a key role in the success of population health management.
Let’s take a closer look at how healthcare organizations can use the HCRM for population health management to find targeted audiences, guide patients through their journey, and keep patients for life.
1. Attracting Target Populations
With the help of an HCRM, healthcare organizations identify target populations and execute outreach to build awareness of both the healthcare organization, physicians and treatments/services relevant to the patient. While the goal of population health is to improve community wellness, not all population health initiatives are applicable across a healthcare system’s customer and patient base.
That’s why a first step is to define a specific audience where the message is most relevant. For example, a health system may want to help patients effectively manage chronic health conditions, like Type-2 diabetes. This type of initiative is only applicable to certain members of the community. Narrowing the audience is the first step to a more effective campaign.
Here are three ways HCRM helps healthcare organizations develop target audiences:
Building Customer Profiles—The HCRM allows healthcare organizations to compile patient data from multiple vetted sources, create a centralized location for all patient and customer information, and establish 360-degree patient views throughout their organization.
Propensity Models—The HCRM uses predictive analytics to identify patients who need and would benefit from outreach and targeted engagement efforts. Leveraging the analytics engine of the HCRM, hospitals, and physicians are able to better organize data, identify patterns, and develop actionable insights to determine the best next action for the patients.
Data Analytics (Segmentation) —With ample patient information to work with, healthcare organizations use the HCRM to categorize patients by illness, demographics, frequency of visits, and more.
2. Managing & Supporting Patients
Next, the HCRM helps healthcare organizations educate, guide and motivate patients toward population health initiatives with personalized support. With the help of a healthcare call center, the HCRM manages patient recovery far beyond the hospital.
HCRM and the engagement center, an HCRM-enabled call center, help healthcare organizations keep patients engaged with population health initiatives by reaching patients directly with information relevant to their health and healthcare journey.
For example, a patient with diabetes entered into an email nurture program will first receive messaging corresponding to the lifestyle the HCRM assigns him or her. The patient later receives messaging about specific clinical gaps identified by the HCRM, such as a kidney screening. The email program can continue to engage with customized messages educating the patient on preventative measures, such as a heart screening.
If the HCRM is effectively integrated into the customer and patient journeys, healthcare organizations gain visibility into patient well-being after they leave the hospital. Let’s take a closer look at the role of the HCRM in stages of both the customer and patient journeys:
Customer Journey: Appointment scheduling & Clinical Encounters—The HCRM works with the engagement center and marketing automation to engage customers over the phone, add them to email nurture streams, and send a post-appointment email from their physician.
Patient Journey: Clinical Procedures, Recovery, & Communication—The HCRM works with marketing automation and content management to send patients personalized education text programs, family reminders, and patient discharge prep text programs.
3. Driving Value to Improve Outcomes
Last, the HCRM helps healthcare organizations improve quality and efficiency in order to deliver more value to customers and improve health outcomes. For example, through HCRM-enabled call center, healthcare organizations can help prevent readmissions by making sure patients adhere to care plans and utilize any available resources.
Here’s how call center agents can leverage HCRM insights to drive value in both the customer and patient journeys:
Customer Journey: Recovery & Follow-up—With visibility into detailed customer profiles, agents can not only deliver relevant information to their health (i.e. post-operative reminders) but also identify opportunities to engage them in other relevant services (e.g. comorbid conditions).
Patient Journey: Discharge—Call center agents administer and record patient assessments. All information is recorded in the HCRM. Engaging with patients and understanding what they’re going through after discharge gives healthcare organizations visibility into patient health beyond the hospital. This can reduce readmissions and increase patient loyalty.
The HCRM allows healthcare organizations to stay with patients for their entire journey while providing useful information along the way.
With the HCRM, healthcare organizations are able to support population health initiatives by putting the right information in front of customers and patients when they need it. By leveraging the data and analytics engine of an HCRM, teams are able to create audiences, determine personalized and relevant outreach, and attempt to optimize every interaction with patients.
As technology advances, so will the amount of data available to healthcare organizations. Innovations such as wearable technology can help improve patient outcomes and inform population health initiatives by making patient health metrics such as heart rate, activity level, and sleep patterns easily accessible, but analytics are necessary to fully realize the data’s potential.
To drive success in population health initiatives, an HCRM provides the foundation to show they know and understand their target audience. With a strong understanding of customers, marketers deliver personalized, relevant messages that resonate with patients and nudge them to be proactive about their health. These efforts ultimately drive conversions, improve overall health within the community, and reduce long-term healthcare costs.