Navigating population health management challenges

Feb. 27, 2018
Population health management is recognized as a means of improving care quality, clinical outcomes, efficiency, and even financial outcomes. Because it offers so many benefits, population health management seems poised to become a practice that is widely adopted by healthcare providers. But, transitioning to a population health model is not without challenges, and many healthcare teams run into obstacles ranging from staffing to strategy development. Fortunately, smart use of the patient engagement technology that most teams already have in place can make implementing a population health program less of a struggle.
Allison Hart
Vice President of Marketing,
TeleVox Solutions at West

Will there be staffing challenges?

A popular belief among healthcare providers is that population health management programs either put significant strain on staff or require additional hires. In fact, a West survey revealed that 44% of providers expect that adopting a population health program will create staffing issues. It is not surprising that healthcare teams feel population health management requires staffing adjustments. A well-executed program involves analyzing clinical data, stratifying patients by risk and disease, developing personalized outreach campaigns for subpopulations of patients, regularly communicating with patients, monitoring patients between visits, and taking steps to proactively help patients avoid adverse health issues. These responsibilities are not part of the normal routine for a lot of healthcare teams. As a result, most providers do not believe their current staff can support these efforts. In reality, many of the tasks associated with population health management can be automated and done very efficiently. The task of patient outreach is a prime example.

As an example, it is not realistic for a physician to manually contact 500 patients on a routine basis to see how well they are managing their blood pressure. But, staff can easily automate this outreach and send targeted messages to a group of patients that have elevated or high blood pressure. Patients might receive a text message reminding them to fill their blood pressure medication and take it as directed. They could be sent a voice message that prompts them to complete a survey about their lifestyle and symptoms. Or, patients may get an email with tips for reducing their sodium intake. Messages like these, that are relevant to a group of patients, can be sent on a one-to-many basis. This type of patient communication has a large reach, but it requires minimal staff time to execute. The point is, the repetitive outreach that benefits groups of patients with similar health conditions and needs can be performed automatically—so the strain on clinical staff is limited. Staffing becomes much less of a problem when teams rely on automated technology-enabled communications to handle portions of the population health management process.

Developing a strategy

More than one-third of healthcare teams are uncertain of how to develop a population health strategy. West’s survey revealed that 38% of providers feel there is a lack of population health management best practices, which makes designing a population health strategy challenging.

Healthcare teams can gain the insights they need for developing their population health strategy by examining their own clinical data. Information from electronic health records is useful for identifying what groups make up a larger population, and from that information, the types of support and communication needed. Practices will typically want to design a set of communications to engage and support patients with common chronic conditions. That could mean creating a campaign geared toward managing obesity, and another campaign aimed at managing diabetes.

When designing patient outreach campaigns, healthcare teams don’t need to reinvent the wheel. They simply need to craft messages that will engage patients and encourage them to do things to manage their specific conditions. A clinic’s diabetic patients can be assigned a series of automated communications that alert them when they are due for an A1c draw, prompt them to schedule routine foot or eye exams or report their glucose levels to their care manager. If providers consider the ideal behaviors and actions they want to see from patients, and build their engagement communication strategy around those things, they will be on the right track.

Most providers will want to dedicate a lot of effort to chronic-disease management, and rightfully so. However, one tip teams should remember when building their population health program is to focus on preventing issues across all patients under their care. That includes prevention for “healthy” patients, too. Teams can develop outreach campaigns that engage all patients within their population, so patients who do not have chronic conditions can maintain their good health.


Despite the obstacles, population health management provides many benefits for patients and providers. Healthcare teams that want to pursue a population health management program can minimize challenges by starting to use technology to automate key processes, and engage and support patients.

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