Proactive population health management
Impact the outcomes of high-risk populations with data.
The ability to proactively identify, prioritize and manage care for high-risk populations depends on having the appropriate data analytics and advanced tools. Acting on data that identifies these populations and areas of high utilization can help you engage members with additional care resources to impact outcomes and lower health care costs.
When considering a strategic approach to improve patient care and population health, it's important to be proactive. Providers need to address issues early, from high cost and utilization, to high-risk patients who need extra resources, so they don't continue to impact cost and quality goals. Let's explore the proactive approach Optum takes to population health management, through three different lenses: CMO, patient, and physician.
Let's start with our CMO, Joseph. As chief medical officer, Joseph uses Optum Performance Analytics to monitor the clinical outcomes and costs of his patient populations, to understand where care improvements can be made. Optum Performance Analytics is an electronic health record agnostic platform, that surfaces opportunities to improve clinical and financial performance, while improving the health of patient populations. It gives Joseph insights in four key areas, so he can optimize care management, improve clinical quality, reduce care variation, and manage financial risk.
Say Joseph wants to understand which patients are driving up costs through resource utilization. He can easily review the High-Risk Patient Registry Dashboard in Optum Performance Analytics to understand that population. The interface is simple and easy to navigate. Joseph can switch between reports, and find what he needs quickly. All the reports are dynamic, letting Joseph dig into the data behind the results. The summary bar shows the number of high-risk patients, average age, amount paid per patient, and average hierarchical condition category, or HCC score. Joseph can monitor the total amount paid each month, identify spikes, and drill into outliers to see what's driving up costs, and a heat map of chronic conditions within the high-risk population helps Joseph direct more resources to patients in these categories.
Optum Performance Analytics allows Joseph to be proactive at the CMO level, but let's see how the Optum approach works at the patient level. This is Steve, a 64 year old with COPD and pancreatic cancer. These multiple chronic conditions make Steve a high-risk patient, so he has a care manager through the Optum Care Coordination platform. By using the online patient portal, Steve can easily connect with his care manager from a computer, tablet, or smartphone anytime he needs to, without waiting for an appointment, and the care manager can send Steve medication reminders, upcoming appointment information, or educational materials. Steve's primary physician, Dr. Dawn, benefits from this proactive support. She knows his care manager is managing his chronic conditions through the Care Coordination platform. So instead of spending time tracking and managing Steve's plan, she gets to focus on providing the best care possible to Steve and her other patients.
Let's take a closer look at the care coordination platform. It takes in clinical, claims, social, environmental, behavioral, demographic, and patient data to create smart workflows. Easy navigation lets care managers move seamlessly between patients and care plans, seeing each patient's goals and progress. The Care Coordination platform is designed to work with multiple care plans and allows quick navigation between them, and sort and filter options allow care managers to group tasks by goal, urgency, or issue, depending on their needs. These tools can help a care team improve the health of high-risk populations. From CMO, to patient, to physician, Optum provides technology and expertise to make population health easier to manage.
Learn how advanced population health analytics from Optum can help drive proactive strategies aimed at improving patient care and population health.