Population Health Management – Helping Members Achieve Better Health

Population Health Management (PHM) involves identifying and helping individuals achieve the highest quality of life possible. Health is influenced by a variety of factors, ranging from behavioral and psychological to medical and genetic, as well as social, financial, and cultural issues.

To improve the quadruple aim — better health care, better patient experience, lower health care costs, and higher clinician satisfaction — it is necessary to perform measurement, monitoring, analysis, and interpretation about the health status of populations and subpopulations, including the impact of social determinants on health.

Improving Patient Health

PHM services are offered to Highmark Blue Cross Blue Shield and Highmark Blue Shield members as part of their health insurance plan.

Through a series of clinically supervised interventions, PHM targets health care needs or conditions to help patients and caregivers:

  • Optimize care
  • Prevent future complications
  • Maximize opportunities for wellness at all points along a member’s personal health care journey.

Who Can Benefit from PHM?

PHM programs use clinical, utilization and predictive modeling indicators to help identify members who could benefit from such services. Indicators include, but are not limited to, the following:

  • High-risk diagnoses
  • Complex disease processes (including HIV)
  • Catastrophic medical events
  • High-cost cases
  • Quality of care
  • Situational and discharge planning needs
  • Psycho-social issues
  • Financial issues
  • Complex care coordination needs
  • Multiple admissions and readmissions
  • Multiple emergency department (ED) visits and lack of care coordination
  • Medication adherence issues
  • Health risk assessment screenings


These programs focus on whole person health — addressing medical, behavioral, emotional, and economic needs. Through outreach and education, patients receive help implementing care plans and goals, and have access to behavioral health and social services support through community partnerships.

If you feel a patient would benefit from Population Health Management, please call us at 800-950-0051.


 

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