Population Health Management (PHM) involves identifying and helping individuals achieve the highest quality of life possible. Health is influenced by behavioral, medical, psychological, genetic, social, environmental, financial, cultural, and developmental factors.

To improve the quadruple aim (better health care, better patient experience, lower health care costs, and higher clinician satisfaction), it is necessary to perform regular population assessment framework that includes measurement, monitoring, analysis, and interpretation about the health status of populations and subpopulations, including the social determinants of health.

Optimizing Care

Highmark Blue Shield of Northeastern New York (BSNENY) PHM services are offered to members as part of the health insurance plan.

PHM is a collection of clinically supervised interventions implemented for populations defined by a health care need or condition that help patients and caregivers optimize care, prevent future complications, and maximize opportunities for wellness at all points along a member’s personal health care journey.

Who Can Benefit from PHM?

The programs use clinical, utilization, and predictive modeling indicators to help identify members who could benefit from PHM. 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 ED visits and lack of care coordination
  • Medication adherence issues
  • Health risk assessment screening

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 877-878-8785, option 2.

 

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