Bill FeraThe concept of population health management (PHM) is gaining significant momentum among healthcare organizations. An increasing number of healthcare entities are implementing PHM strategies to drive down costs and improve outcomes in the newly evolving, value-based care system. The newest trend is for payers to engage proactively with providers and partner in providing PHM rather than doing it separately.

To create an effective patnership, healthcare organizations would do well to keep in mind a simple mantra as they reconfigure their approach to managing patients: “Right patient. Right intervention. Right time.” Focusing on this three-part equation can help organizations to streamline the way they manage patient populations, with an emphasis on both improving quality of life and enhancing health outcomes. Healthcare organizations that adopt this approach can target members using rules and models that emphasize high sensitivity and specificity; provide patients with holistic, seamless, and coordinated care on the patient’s terms; and deliver care when it is most effective in producing the best outcomes.

A key factor in implementing a successful PHM program is for payers and providers to integrate each other’s assets to produce actionable information and customized care interventions. These assets include the collection and analysis of data from claims systems, electronic health records (EHRs), and even personal health record data, such as patient-collected information. Through collaboration beyond the pay-for-performance models of the past, many payers are finding success in sharing results from their predictive analytics with providers to assist them in identifying specific patients who could benefit most from certain care interventions, which is a central theme of PHM.

Once payers and providers have their “right patient, right intervention, right time” strategy in place, the next critical steps will be to focus attention on setting, measuring, and monitoring program outcomes and on developing the technology infrastructure required for information sharing, data analytics, and reporting.

The need for such collaboration today is clear: Integrating payer and provider functions brings together the traditional strengths of each to build the foundation of a strong PHM program.


Bill Fera, MD, is a principal and the clinical transformation leader, Health Care Advisory Services practice, Ernst & Young LLP.

The views expressed herein are those of the author and do not necessarily reflect the views of Ernst & Young LLP.

Publication Date: Monday, June 03, 2013