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Population Health

How can payers and providers identify best practices and implement population health strategies to achieve shared goals of quality improvement and cost management?

Traditional methods of risk stratification of populations limit our ability to drive effective outcomes. The key to successful population management is to have an infrastructure that allows partners to align care delivery and prevention resources with member health conditions.

The Edifecs Population Health Solution includes the Intervention Gateway and Population Dimensions products to provide clinicians with a set of tools that enable design and definition of health risk criteria that are used to establish “intervention thresholds” at multiple levels.

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Solution Spotlight

  • Intervention Gateway

    Intervention Gateway interrogates data in motion at the edge of the enterprise to dynamically deliver critical new insights and prescriptive actions to population health managers. Condition-specific learning engines increase population health management effectiveness with greater precision for early detection of changes in health risks, morbidity, network and services utilization, provider and patient behavior.

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  • Population Dimensions

    Population Dimensions works with the Edifecs Intervention Gateway to provide the industry’s first disruptive population health management solution. By continuous acquisition, normalization and correlation of member data, Population Dimensions presents a clinician-friendly shared view of the member health record across payer and provider settings at convenient points in the clinical workflow.

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Capabilities

Intervention Gateway provides real-time, configurable population classifications and alerts to focus program partnerships on high-value patient-level insights and interventions. A concept and rule modeler allows stakeholders to standardize definitions of clinical conditions, treatments and health economic values to create semantic interoperability of healthcare data from all sources.

Edge of the Enterprise Technology

Observe inbound member clinical and claims data at the edge of the enterprise

  • Eliminate the latency effect from dated claims data and static data warehouse reports
  • Trigger insights about individual patients and population segments in near real-time
  • Catalyze care coordination and timely transitions of care from real-time alerts embedded in the care team’s workflow and native applications

Configurable Intervention Platform

Intervention Gateway supports collaborative population health management programs design by payers and providers

  • Jointly define key clinical concepts and rules to incorporate into the population health management framework
  • Design clinical thresholds to detect progression of complex clinical conditions in a resource-intensive population segment
  • Apply intervention thresholds to trigger intervention notifications when thresholds are breached
  • Set triggers to flag members and services that are non-network and assist caregivers with timely care transition decision making

Prioritize Population Health Interventions

Configure and refine thresholds for population health conditions to incorporate different levels of intervention from primary care to complex chronic care management programs

  • Gain insights to identify members within population segments who require attention
  • Identify members “flying under the radar” and provide early indicators of clinical risk in an otherwise healthy population
  • Align appropriate clinical intervention resources to address population health needs by intervention level
  • Configure intervention levels based on clinical thresholds and risk strata for patients and populations

Flexible, On-demand Data Sharing

Provide information to clinicians at appropriate points in their workflow to catalyze decision making and action

  • Initiate workflow to automate critical intervention tasks across the care team
  • Incorporate critical data from care management systems, including care plans, care alerts, care gaps and HRA information
  • Document and view historical notes from the cross-enterprise care team

Extend Partnerships to Communities

Define, test and share best practices for early detection and intervention classification with the entire multi-payer/provider community

  • Create a searchable library of best practice concepts
  • Incorporate and curate business rules and intervention thresholds to identify those producing the best outcomes
  • Share clinical insights with population health management partnerships within the community

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