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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

  • Risk stratification
  • Disease registries
  • Cohorts
  • High utilizers/high costs
  • Open care gaps
Medical team united for population health management.
  • Empanelment
  • Coordinate care
  • Close care gaps
  • Team-based care
  • Care plan creation
Medical team united for population health management.
  • Build relationships
  • Educate and activate
  • Collect patient-reported data
  • Ongoing care management
  • Annual wellness visits
Medical team united for population health management.
  • Baseline metrics
  • Set goals
  • Monitor
  • Assess results
  • Improve
Medical team united for population health management.
Medical team united for population health management.

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. 

“Having quality measures to show providers is a huge advantage. Once you have the data, you can show them what’s happening.”

Brittani Anderson, care coordinator
North Ottawa Community Health System

Embrace the benefits of population health management.