The Science of Population Health

From Research to Delivery

By Lizza Miller

Population Health Management is defined as “the aggregation of patient data across multiple health information technology resources, the analysis of that data into a single, actionable patient record, and the actions through which care providers can improve both clinical and financial outcomes.”

In other words – understanding your population and individual patients, and improving their health, is a process. One which will require that you acquire the right data on what matters most to patients and use this to make informed decisions, which in turn will result in better outcomes, which is what really matters at the end of the day.

At the end of the day, it’s all research; the very thing we’ve been enabling our customers to do for decades. Historically, researchers have worked to understand what truly matters in health – from the causes to the treatments to the preventions thereof. Their innovations in data collection, participant management, analysis, and other parts of the process resulted in great insights for the health of their participants.

There is a lot to be learned from health researchers around population health management, especially how to ask the right questions, measure the right outcomes, and tailor the findings to the right people at the right time.

A Stepped Process

It typically starts with a question focused on a specific population. Next, the proper outcomes needed to find answers to that question are identified. Data are then collected around those outcomes. The fun part of analysis begins once all, or enough, data are collected to draw significant insights. Finally, a conclusion is drawn.

Repeatedly performing these fundamental steps helps them understand trends within the studied population. They use these insights to implement interventions with a goal of improving health and proving the value of their work.

This scientific process is nothing new but it’s application to population health within the healthcare setting is in the infant stages.  Therefore, the steps are slightly different but the goal is the same: gain insights into the most effective ways to improve population health. Here are the five steps to the Science of Population Health.

Ask the Right Questions

What do you want to learn? What is your goal? Knowing the right questions to ask your patient population is the first step to understanding them and improving their outcomes.

Track Outcomes Over Time

To truly facilitate change, start measuring outcomes. Continuously tracking them over time will help you identify important trends among individuals and populations.

Share Feedback

Providing information back to your patients will empower them to make informed decisions based on information tailored to their particular situation and empower them to become partners in their health.

Deliver Interventions

Using insights to personalize care and interventions to the individual patient’s needs and preferences will help improve adherence and success.

Evaluate, Learn, Improve

Use data to identify what worked and what needs improvement. It can also help benchmark the success of various interventions, allowing you to identify those that provide the best value. Refine the process. Repeat.

Population health is a big, yet important, task to tackle. However, a manageable first step is identifying and measuring the outcomes that matter most to a patient’s health and quality of life. After that, following the process that has driven results within health research will allow you to be successful.