Provider-Led Population Health Management

Provider-Led Population Health Management

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Provider-Led Population Health Management draws connections among the new care-delivery models, the components of population health management, and the types of health IT that are required to support those components. The key concept that ties all of this together is that PHM requires a high degree of automation to reach everyone in a population, engage those patients in self-care, and maximize the chance that they will receive the proper preventive, chronic, and acute care. In the course of explaining how to do this, we describe how health-care organizations are transforming themselves to manage population health and prepare for value-based reimbursement. The ACO, PCMH, and CIN models are discussed, and the advent of bundled payments will also have a major impact on hospital and post-acute care. But at its core, the transition to accountable care centers on care teams that take responsibility for managing and coordinating the services provided to individual patients. These care teams must also engage patients in caring for themselves and improving their health behavior. As care teams become more sophisticated, many of them will use Lean thinking to continuously improve their own work processes. The book is laid out in three sections that progress from the general to the particular aspects of population health management. Section 1, entitled qNew Delivery Models, q first explains what PHM is and why it's important. Ensuing chapters cover ACOs and patient-centered medical homes, which are the favored vehicles for PHM. Section 2, qHow to Get There, q discusses some fundamentals of the new delivery models, starting with the impact of Meaningful Use on the IT infrastructure that provider organizations must build to operationalize PHM. Other chapters in this section address clinical integration, predictive-modeling applications, and the return on investment in IT solutions that help organizations take advantage of value-based payments. Section 3, qImplementing Change, q describes how organizations can use health IT to manage population health. This begins with the basics of care coordination and moves on to advanced methods of care management that utilize Lean thinking. Following a chapter on overall methods of patient engagement, we finish up with a discussion of post-discharge automation, which is another way to involve patients in their own care. Finally, in a brief concluding chapter, we suggest some next steps for organizations heading down the road to population health management. While this book is intended for health-care executives and policy experts, anyone who is interested in health care can learn something from its exploration of the major issues that are stirring health care today. In the end, the momentous changes going on in health care will affect all of us. See what others are saying about Provider-Led Population Health Management: This book is one of the best primers available on the rapidly evolving technologies that help healthcare providers manage population health. The automation of care management through information technology, as the book astutely notes, enables medical homes to execute the manifold tasks of population health management cost effectively and without overburdening care teams. Paul Grundy, MD, MPH - IBM's Global Director of Healthcare Transformation President, Patient-Centered Primary Care Collaborative Dr. Richard Hodach's book addresses the most critical elements for providers as they transform themselves to provide population health management. His review of new delivery models, and his discussion of what is needed to deliver population health are right on point. There is even a road map on how to implement the changes necessary to deliver population health. What makes the book most interesting is the way in which Richard draws the connections among the new delivery models, the components of population health management, and the role of health information technology necessary to support population health management. These connections are critically important and explained such that any health care executive or policy expert has the guidance they need to transform themselves to manage population health and value-based reimbursement. Lastly, the case Richard makes for the effective use of information technology is well done and critical as we strive to move from a fragmented system of health care delivery to a fully integrated patient centered population health management system. This book is a must read for anyone interested in population health. Don Fisher, PhD AMGA, President and CEO This book is a real gem! Health care transformation to improve health, quality, and cost (the Triple Aim) requires new payment for value, new delivery systems founded on patient centered medical homes, and new information systems to support care of populations. Dr. Hodach provides spot-on vision of how all three must work together, along with a detailed roadmap for success. Michael K. Magill, MD - Professor and Chairman, Family and Preventive Medicine Executive Medical Director, University of Utah Health Plans University of Utah School of Medicine Dr. Hodach brings a wealth of knowledge and experience in the field of population health management to this new book. His keen insights into U.S healthcare transformation underscores the need for each healthcare system to have a well thought out and deliberate population health strategy. The building blocks for healthcare transformation are described in a way that guides the reader step-by-step. As Richard discusses, without a robust population health IT infrastructure, these new care delivery models are nearly impossible to implement successfully. Our healthcare system, like many others, began this transformation while flying the proverbial plane. It wasn't until we implemented automated outreach and care coordination the we began to see measurable results. In addition, a multifaceted approach to health system realignment is detailed in a way the simplifies this sometimes intimidating task. The author describes many disruptive innovations that will be necessary to shift the paradigm from sick care to a more proactive care for an entire population. This book provides a virtual tool kit for the reader to build a population health strategy. The term must read is used frequently to describe important works, but for those healthcare leaders who are embarking on the population health path, and for those who are neck deep in the waters of transformation, this book will help you refocus your efforts and set your team on a clear path. Jeffrey Galles, DO - Chief Medical Officer Hillcrest / Utica Park ClinicsThis book is a must read for anyone interested in population health. Don Fisher, PhD AMGA, President and CEO This book is a real gem!

Title:Provider-Led Population Health Management
Author: Richard Hodach, MD, MPH, PhD
Publisher:Author House - 2014-11-05

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