Earlier this week, we stumbled across an article suggesting that perhaps population health does not dive deep enough to be meaningful on an individual level. This sparked an introspective look into the role population health management plays, and how, in fact, the principles that guide this approach are firmly centered around the individual patient. Population health management has evolved over the years to continuously create new innovations and develop measures to improve the health status of individuals across various populations. There are many definitions, but to me, population health management is about the collective actions of a group of providers to care for a defined population with the goal of helping each member of that population achieve the best health possible. The goal is about individuals, not populations.

What principals guide a population health management approach?

  1. Patient-led care. Patients can, and will, take greater responsibility for their own health when given the tools and support. It is these tools and support that we provide. Understand that the only sustainable path to long-term health improvement is with the patient in charge, and the key to realizing that improvement is the relationship between the patient and a trusted healthcare provider.
  2. Use the right tools and approach. When operating within a system of population health management, healthcare providers use tools such as motivational interviewing, readiness to change, appreciative inquiry, and small step rapid cycle improvement to help patients move along a continuum of health behavior changes.
  3. There is value in data and analytics. Providers use data and analytics to see patterns and opportunities to identify and help people with underlying risk factors or underlying chronic conditions. By doing this, they can provide “actionable insights” and are able to work together to remediate risk and improve health.
  4. Guide patients through education. Providers work with their patients to help them know their numbers, experiment with strategies to improve it, monitor progress, adjust strategy, and celebrate wins along the way.

Providers working within a system of population health management move the needle one patient at a time. The result is the collective improvement of health and lower cost across the entire population.

Healthcare providers working with this approach to care know that digging in and taking the time allows you to really get to know your patient. To engage them. To empower them to take greater responsibility for their own health. Learn about the achievements our patients have had this past year through a population health management approach in our recent blog post.

  1. Minemyer, P. (2021, January 5). Cambia’s Ganz: Why population health isn’t the “virtuous” approach. FierceHealthcare.

About the Author: Dave Demers, MPH

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Consultant, Population Health Management
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