Population health management (PHM) is an increasingly popular term in today’s health care vernacular, but a quick review of the literature reveals that the term is not defined consistently by health care executives and health IT providers. PHM’s meaning seems to morph based on who is speaking and who is listening. However, a few core concepts around PHM seem to be emerging. The most salient point is that PHM involves efficiently managing the provision of health and health services across the care continuum, for a specified group or population. The focus is on care coordination, quality and the cost/risk equation.

This is especially true for chronic conditions, where the opportunity and potential for value and cost savings are the greatest. One thing is certain: Successful PHM requires solid data and trusted information from a variety of sources for decision-making at the clinical and the business level. Reliable information helps to identify health issues, prevent new and recurring health problems and effectively manage the health and health services of the patient population. Essential information for population health management includes:

• Patient outcomes: This means both individual outcomes and those aggregated for the population. Since patients don’t typically receive all care from one source, this almost always means information from other providers.

• Cost: Today the delivery of care is episodic and the organization likely can account for the cost of services it provides. However, real value will only be recognized when cost data is aggregated from multiple sources that give the full picture of the cost to care for an individual or population, in order to better understand real cost and value. In other words, how costs impact the whole system and the value that particular services or approaches have.

• External determinants of health: Frequently outside the reach of traditional collection/ capture methods, this means data and information about lifestyle, education, socioeconomic status, family support, community, environment and other factors that impact disparities in populations and health
This data and information come from a variety of sources both within and outside of the typical organizational sources. Health care professionals may wonder: Can it be trusted? Does it have consistent meaning regardless of the source? Is it valid? These questions, among others, are important and must be able to be answered with confidence. However, due to the inability of some organizations to consistently and accurately identify individual patients (due to a lack of the right information or information processes), the answers to these questions are not always easy.

The stakes could not be higher, because the health of individuals and the health of the organization depend on it. While many believe they can address the data and information risks with IT investment, an effective strategy involves much more than just the technology. A successful strategy is based on the understanding that enterprise information is an organizational asset that needs to be used optimally to benefit the organization and, specifically in this case, PHM. Approaching enterprise information in this way implies that it is necessary to have oversight or governance that includes coordination, integration and prioritization.

Driven by clinical and business stakeholders at all levels, an effective information governance (IG) strategy will assure that the information needs of clinical and business decision- makers are identified, prioritized and met. Foremost among these needs is analytics capability. Analytics are necessary to address care gaps, predict resource needs, describe outcomes and manage the ongoing financial risks associated with PHM. The data on clinical and business decision-making are what drive these analytics. But without appropriate policies, processes and education that enable data standardization, definitions, and metrics, analytics are not possible.

An IG program provides the framework for supporting the analytics necessary for PHM. In addition to enterprise information of all types and from all sources, its scope will include data and information that must be procured, captured or curated from external sources. An IG program also requires strong leadership and the development of organizational capabilities that will enable it to demonstrate value. The American Health Information Management Association’s (AHIMA) Information Governance Adoption Model (IGAM) helps organizations develop these capabilities so that they can be successful with PHM as well as any other initiative that requires robust, trustworthy data and information.

About the author: Lydia Mays Washington, MS, RHIA, CPHIMS, is senior director of Information Governance (IG) at AHIMA, where she consults, provides industry analysis, identifies best practices and serves as an educator on information governance in health care.