5 steps to a successful population health framework

Pop health expert Michael Dulin of the University of North Carolina offers his views on how healthcare organizations can frame, implement and evaluate an effort that succeeds.
By Bill Siwicki
09:42 AM

How should population health look and work? There's a five-step process to getting there, said Michael Dulin, MD, director of the academy for population health innovation at the University of North Carolina at Charlotte. Dulin is a nationally recognized leader in the field of health information technology and applying analytics and outcomes research to improve care.

"The first component is understanding what you are trying to do with your population health framework, from the standpoint of the health system, and using data to identify and understand the opportunities to be gained, the resources already in place, and your overall strategy of healthcare delivery," Dulin said. "And then there are four more steps that come underneath this first step."

Step two, Dulin said, is preparing to implement a population health strategy, which includes preparing the requisite data and visualizations, identifying key stakeholders, and creating multidisciplinary teams that can implement a strategy.

 Learn more at the Pop Health Forum 2016 in Chicago September 12-13.

"The third step is to engage the population health stakeholders and start the implementation of the process or enhance a process if one is already more or less in place," Dulin said. "For example, if you have a care management team or nurses on call lines, understand who they are and make sure you engage them with the tools they need to implement the population health framework."

Actual implementation of a population health framework is step four.

"You have your care model, then you use data to reflect back very rapidly what is happening," Dulin explained. "You need decision support tools at the point of care, planning reports from the data for what you need, and information for the care team, which involves things like segmentation and understanding risk and then sending information back to the care team. This includes implementation of population health reports and customer relationship management systems, understanding when someone is not in a health system and when to engage them when they are not in the clinical system."

And the final component, step five, revolves around evaluation of the population health framework and getting feedback from evaluations quickly back to caregivers, Dulin said.

"You have to be ready to evaluate your efforts to see what is effective and what is not effective, and then report very rapidly back to clinical teams," he said. "So in an outpatient setting, for instance, take flu shots. Yesterday a patient came in and left without getting a flu shot. How did that error occur, and how do we change the care delivery process to remedy the situation?"

As part of this evaluation step, healthcare executives in charge of population health also must get feedback from patients on the patient experience, which is not something that today is done very effectively, Dulin added.

"See if patients are willing to share information from their Fitbits or through surveys, conduct focus groups or interview key patient stakeholders in the community," he suggested. "Then feed the information you glean back rapidly to care teams so they can quickly understand if there were errors made. And when during evaluations of any kind you find that outcomes have been positively impacted, to keep care teams engaged, share with them what it was that they did that made an impact. They will remain engaged and change the way they provide healthcare moving forward."

Related articles with Pop Health Forum 2016 speakers:

Prescription for ER overuse: Engage patients in EHR data and health information exchange

Centura Health fuels population health with mobile app and medical concierges

Population health's biggest challenges - understanding data, structuring services, engaging patients and evolving mindsets

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

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