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by Jagwant Grewal
Published on 24 May 2017

In the first post of a two-part series, Jag Grewal from the population health team outlines challenges faced by the NHS and how population health management can provide the solutions they need.

The NHS Five Year Forward View sets out clear plans to pursue the ‘triple aim’ – improved health and wellbeing, transformed quality of care delivery, and sustainable finances – and advocates that health and care services be planned around populations rather than around individual institutions.

To achieve these aims, it’s imperative that organisations across the continuum of care work together to connect information, integrate systems, transform the workforce, and fundamentally change the way people engage in their care.

With many information systems spread across the health economy, providers and patients are often left with fragmented workflows based on inconsistent information – damaging efficiency and quality of care.

Connecting the health system and its different solutions enables every member of the care team to have full context and pertinent information available to them, ensuring coordination of care across the entire care team, with all working from a single source of truth.

‘Information’ versus informed care

To truly transform health and care, the breadth of big data across the economy must be turned from simple disconnected, linear information into knowledge and actionable insight. A layer of intelligence applied across your health system can create a unified informatics architecture. Only then will the data be able to truly inform clinical decisions and commissioning models – allowing the shift from reactive care and recording, to proactive health and planning.

The NHS, along with health systems in other countries, are embarking on the journey towards outcomes-based reimbursement models. Hospital managers and clinicians are already talking with local partners about how to transform health systems to deliver efficient, affordable and safe care for today, and for future generations.

Evolving technology and data has revolutionised the world, yet healthcare lags behind. As the NHS and partners work on the visions laid out in digital road maps and STPs to deliver the Five Year Forward View, population health management will become the gold-standard of healthcare.

While a Health Information Exchange is a solid foundation for connected care, it’s fundamentally reactive and only those who actively seek care benefit. However, by including an intelligence platform for population health management, entire communities can move towards proactive health and care:

Health Information Exchange (HIE)

  • Improvement to existing delivery model through shared data;
  • Used at the point of care regardless of venue;
  • Broadly reactive in nature, organisational based;
  • Volume-based service, focussed on acute care;
  • Collaborator in an integrated care network.

Population Health Management

  • Radical shift in service scope and redesign of delivery model;
  • Standardised evidence-based care pathways to manage risk and reduce variance;
  • Population health analytics for anticipatory, proactive care;
  • Outcomes-based capitated model sharing incentives across all
  • providers in network;
  • Clinically integrated care network.

In the second part of this blog, I’ll explain more about how to implement a strategy for population health management and discuss how it truly is the platform of the future.

Want to discover more about population health management? Discuss it with Jag today via

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