Population Health Management

Population Health Management (PHM) programs are increasingly relying on integration between payers and providers to achieve scale and effectiveness.

By applying technology to population health strategies, payers and providers will drive better outcomes and decrease overall cost, as demanded by new payment incentives focused on value.

PHM1 savings for disease management

By 2023, improving prevention could save the US over $1 trillion2 in costs

Average savings of $250 PMPY3 in Regional Blue ACO collaboration with Hospital Group

…whole new set of disruptive changes that include broadened access, significant payment reductions, new care settings, advances in information technology and an evolving 'revolutionary' model of population health.

Assemble longitudinal patient records (LPR) across provider settings

Help providers identify and prioritize high-value interventions

Continuously monitor populations for critical indicators of patient health

Monitor populations to detect changes in member and provider behavior

Share LPR including intervention opportunity with practitioners for care coordination and transitions in care

Enable practitioners to create their own areas of opportunity for intervention

Measure, aggregate and report cost, utilization and quality information across practitioners and network settings

Key Implementation Capabilities

Integrated Member Record

Target Populations

Stratify at-risk populations assigned to providers. Identify partners with requisite quality, skills and patient access. Assess claims history to identify past payment trends.

Learn how Edifecs Population Payment Modeler can help.

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Design Contracts

Develop baseline budgets and incentives to reward successful population health management partnerships. Identify metrics and measures that correlate to quality and cost control. Identify incentives and payment terms.

Learn how Edifecs Population Payment Modeler can help.

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Assembled Integrated Patient Records

Access an “integrated member record” that combines administrative, financial and clinical data for sharing complete longitudinal views of patient care.

Learn how Edifecs Population Dimensions can help.

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Coordinate Care

Access to shared workflows across care teams to increase efficiency and improve patient experience.

Learn how Edifecs Population Dimensions can help.

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Target Interventions

Focus care management actions on patients with the highest opportunity for impact.

Learn how Edifecs Intervention Gateway can help.

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Monitor for Compliance

Gather insights to detect changes in morbidity, health risk, patient behavior and compliance to protocols

Learn how Edifecs Intervention Gateway can help.

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Measure Outcome

Match reported encounters, claims and payments to expected quality outcomes. Identify partners and populations at risk that could impact risk sharing/gain sharing payments. Identify best practices as a model for future programs.

Learn how Edifecs Population Payment Administrator can help.

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Pay for Value

Ensure partners receive quality and program payments according to contract terms. Apportion shared savings across the care community.

Learn how Edifecs Population Payment Administrator can help.

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Population Health Maturity Model

Have you been successful in operationalizing a blueprint that can optimize your population health management program across all partnership programs?

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  • WB


    A Perfect Match: Power Clinical & Business Outcomes Through Payer-Provider Engagement

    Collaboration is critical to success in today’s environment. Yet, providers continue to face daunting challenges in breaking down barriers between systems and processes. Watch this on-demand webinar to learn a new approach.

    View Webinar

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1. Study models yielded an estimated savings of $60.65 per wellness participant per month and $214.66 per disease management participant per month. Program savings were combined to yield an integrated return-on-investment of $3 in savings for every dollar invested. Source: NCBI

2. Milken Institute researchers determined that by 2023 the nation could avoid 40 million cases of chronic disease and reduce the economic impact of chronic disease by 27 percent, or $1.1 trillion annually. Source: Fight Chronic Disease

3. Source: Health Affairs