Population Health

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What is population health?

There’s an effort underway to improve the health of populations, and to understand the causes of chronic illnesses by analyzing large quantities of patient data. It starts at the practice level.

Identify patients

Learn which patients are most in need of care to improve outcomes and minimize costs.

Manage care

Identify gaps in care. For a diabetic patient, this could be a foot exam or an eye exam.

Engage patients

Create and follow up on care plans to improve healthcare delivery and outcomes for patients.

4 steps to population health management

Identify

Risk stratification
Disease registries
Cohorts
High utilizers/high costs
Open care gaps

Assign

Empanelment
Coordinate care
Close care gaps
Team-based care
Care plan creation

Engage

Build relationships
Educate and activate
Collect patient-reported data
Ongoing care management
Annual wellness visits

Measure

Baseline metrics
Set goals
Monitor
Assess results
Improve

You have the opportunity to provide better care

The big picture of population health

Greenway Community shows the big picture of a practice’s patient population, including the segments that incur the greatest costs. Drawing on clinical data — and its access to claims data — the solution provides information in user-friendly visual formats.

Analytic insights at the point of care

Plan accordingly for when care gaps emerge. Greenway Community makes data available, freeing you from the burden of tracking information manually. It makes you aware of patients’ progress through care plans, and when they are due for treatment.