Population Health Management

Population Health Management

Population Health Management (PHM) is one of the key strategies moving the payers and providers towards closer alignment. Working together as a team, payers and providers are able to exchange information, identify opportunities in care, provide timely interventions, and improve care coordination.  This approach has especially benefited chronically ill population through increased adherence to evidence-based care practices, optimized utilization of healthcare resources, healthier outcomes, and overall better patient experience.

Value-Based, Patient-Centric Care

A coordinated, patient-centered approach enables patients to partner with their physicians and care teams to detect, prevent, and treat chronic conditions and diseases. Care management activities begin with identifying members that need support and coordinating the care with the best available resources. Payers utilize various methods and technologies (groupers) to stratify their members into risk and episodic treatment groups to analyze resource utilization, variation in treatment, preventable episodes of care, etc. Leveraging internal data sources such as member enrollment and adjudicated claims data, payers are starting to understand the member behavior and clinical encounter patterns. However, lack of depth of information such as lab results or vital signs and lag in claims processing can limit the insight gained from analysis of claims data alone.  This has led to increased payer focus on integrating patient outcomes data and emphasis on creating a transparent system with a 360 view of clinical encounters in the continuum of care, including, physician practices, hospitals, home health, and other care delivery settings.

Cohort Builder and Analyzer

At the heart of Population Health Management is Cohort Analysis, which breaks up an entire population into smaller groups that share similar characteristics. The goal is to identify trends and make informed decisions for better outcomes. Depending on the key objectives of a healthcare organization, they may choose to focus on cohorts of high-risk or at-risk patients, patients with chronic conditions or those in need of appropriate screenings and primary care interventions. Omni-HealthData’s Cohort Builder allows payers to create meaningful cohorts by dividing their member population into groups by attributes such as cost, condition or risk. Users with little or no coding experience can execute complex queries against member demographic, financial, and clinical data.

Statisticians can analyze these cohorts using metric views to identify trends such as top diagnosis or procedures, cost distribution by chronic condition, ER admission rates, and more.

Insights gained from cohort analysis can be used to design wellness campaigns, assign members to care management plans, or predict outcomes. The member engagement teams can run targeted member outreach campaigns such as member incentive programs for completing annual wellness screenings. Research analysts can utilize Omni-HealthData Metrics Views to perform predictive analytics, identifying and stratifying members with emphasis on understanding their clinical needs and future risks.

Population Metrics and Performance Scorecards

Metrics views form an important part of Omni-HealthData’s BI and Analytics capabilities. These views are built off the core Omni-HealthData repository and utilize industry code values sets such as VSAC and others to support regulatory reporting metrics, risk scores and other predictive models. One such example is the CMS STAR Scorecard for Payers serving Medicare Advantage population. The executive dashboard provides monthly scorecards on clinical quality measures (Part C and D) while highlighting focus areas that need immediate attention or significantly impact the overall plan rating. Users can do a “What If” analysis to identify areas of improvement that can provide the greatest return and move the quality needle in the right direction.


Healthcare payers that have a mature PHM strategy are able to provide safe, reliable, quality care and service for their members. By leveraging technology, health plans are becoming more data driven and focusing on aggregating data from disparate data sources across continuum of care. Omni-HealthData platform can help health plans leverage their disparate clinical and financial data sources, both internal and external, to empower their care providers and care givers with a holistic view of their at-risk, high risk and chronic patient population leading to timely interventions, better utilization of preventative care and unprecedented savings in overall healthcare resource utilization.