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How Does Population Health Impact Hospital Quality Scores?

Created 20 days ago by Lippincott Solutions
  • quality scores
  • SDOH
  • patient outcomes
  • hospital ratings
  • Center for Medicare and Medicaid Services
  • Star Ratings
  • social determinants of health
  • healthy people 2020
  • population health
  • CMS

The population health concept represents a change in focus from individual-level outcomes to improving the health of an entire population group. It also seeks to complement the classic efforts of public health agencies by addressing a broader range of factors shown to impact the health of different populations.

Population health is an approach that holds three common components: 1) health outcomes, 2) patterns of health determinants, and 3) policies and interventions.

An important priority in achieving population health is to reduce health inequities or disparities among different population groups due to the social determinants of health (SDOH). The SDOH include the social, environmental, cultural, and physical factors the different populations are born into, grow up with, and function with throughout their lifetimes. These factors potentially have a measurable impact on the health of human populations.

What is Population Health Management?

Population Health Management (PHM) is 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.

Population Health Management seeks to improve the health outcomes of a group by monitoring and identifying individual patients within that group. Typically, PHM programs use a business intelligence tool to aggregate data and provide a comprehensive clinical picture of each patient. Using that data, providers can track, and hopefully improve, clinical outcomes while lowering costs.

The best PHM programs bring clinical, financial, and operational data together from across the continuum of care and provide actionable analytics for providers to improve efficiency and patient care.

A successful PHM program will give real-time insights to both clinicians and administrators and allow them to identify and address care gaps within the patient population. A well-developed care management program is the key to better outcomes and cost savings, especially in populations with chronic disease.

Advantages to PHM

Focusing on improving health outcomes for entire populations will result in several advantages to healthcare systems.

  • Better health outcomes. The ultimate goal of PHM is simple: improving the quality of care while reducing costs.
  • Disease management. PHM improves the care outcomes of those with chronic and costly disease by using IT solutions that track and manage their care.
  • Closing care gaps. A fully-integrated business intelligence tool helps close gaps in care by allowing organizations and physicians to have real-time access to track and address patient needs. Laboratory, billing, electronic health record and prescription data is all incorporated and providers can easily pinpoint unmet needs and gaps in data or service delivery.
  • Cost savings for providers. As with all advances in healthcare management, population health management is a win-win. By leveraging data analytics, PHM improves clinical outcomes while reducing costs.
  • Improved patient decision making. Care management is a critical component of PHM, and while the objectives of care management can vary from organization to organization, they center around improving patient self-management.

Improving Hospital Scores

Improving population health and public reporting of health care quality data allows consumers, payers, and health care providers to access information about how clinicians, hospitals, long-term care, and other facilities perform on health care quality measures. Report cards, reporting websites, or similar tools enable consumers to compare provider performance on measures of health care quality.

These tools can also help providers assess their own practices and consider the performance of other providers. Health care quality data is often provided by regional collaboratives, but can also be shared by health insurance plans, state, local, or federal government agencies.

The Overall Hospital Quality Star Rating program classifies hospitals on a 1 to 5 star scale based on reported quality measures. The Center for Medicare & Medicaid Services’ (CMS) stated goal is to facilitate informed choices for all consumers based on available hospital quality data.

For more information, see Healthy People 2020, an initiative and website sponsored by the US Department of Health and Human Services.

What initiatives have helped your facility improve quality scores?