Population health management (PHM) gives providers the ability to make informed care decisions based on their entire patient population at-a-glance and in near real-time. Learn about how PHM is disrupting healthcare and how it benefits both patients and providers.

1. What is Population Health Management?

2. Healthcare is more than medicine, it’s a
goal — we want the best possible health
for ourselves and those around us.
2

3. “Today the average doctor in the U.S.
manages more than 2,000 patients whose
health information is locked in a paper record.”
3
- Ryan Howard, founder and CEO, Practice Fusion
*http://www.annfammed.org/content/10/5/396.full

4. 4
It’s estimated that a doctor with 2,000 patients would have to spend more
than 17 hours a day providing all of the recommended care.
*http://www.annfammed.org/content/10/5/396.full

5. 5
With so many patients and only so many
hours in the day, it can become an
overwhelming task to try and keep track
of things like ‘who is up-to-date on their
vacancies’ or the latest clinical
recommendations.

6. Typically, there’s no way to look across the patient population
to see which diabetics are at goal, or who is due for a vaccine.
6

7. Over 45% of diabetics are not at goal.
7
Every year, over 40,000 people die from
vaccine-preventable diseases.

8. 8
Population health management is making it more efficient to
identify and help these patients.

9. What is Population Health Management
9
Management?
Population Health Management
is a systematic approach to optimizing
the health of populations and preventing
people from getting sick or sicker
“
Yesterday
Care coordinators combing over thousands of charts
and calling patients to provide support or schedule
HCP visits
Information Week, Healthcare Edition. 11/2013.
”
Today
Leverage Health IT and point-of-care messaging
to empower providers with actionable information
to improve patients’ health

10. Population health management uses data
and technology to drive better health
outcomes for patients by giving providers
the ability to monitor their entire patient
population at-a-glance and in real-time.
10

11. Core Components of Population Health Management
Population health management dashboard
Deliv
er
CDS

12. Step 1: Identify the Appropriate Patients
+ Patients are identified by demographics and
chart values (i.e. labs, diagnosis) and
applicable clinical quality measures which are
evidence-based, clinical guidelines
Sample Diabetes Quality Measures
NQF# Measure Description
0059
Diabetes: Hemoglobin A1c Poor
Control
Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the
measurement period
0055 Diabetes: Eye Exam
Percentage of patients 18 through 75 years of age with a diagnosis of diabetes (type 1 and type 2) who
had a retinal or dilated eye exam in the measurement period or a negative retinal or dilated eye exam
(negative for retinopathy) in the year prior to the measurement period
0056 Diabetes: Foot Exam
Percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the
measurement period

13. + Provide Clinical
Decision Support,
which is an actionable
message to the
provider during the
office visit
Step 2: Provide Clinical Decision Support at Point-of-Care
Not an actual patient

14. Step 3: Measure Outcomes of the Patient Population
+ Compares provider to peers
+ Provides guidance on performance
+ Engage patients through clinical
email outreach pre and post visit
Populat Dashboard ion management
PHM detail dashboard | Diabetes
Above median Median Below median
76%
68%
76%
68%
76%
50%
40%
68%
90%
68%
44%
40%
Reporting Period Full year
You
Practice Fusion providers
% of diabetic patients with certain
other disease complications and
A1c ≥ 8%
You
Practice Fusion providers
You
Practice Fusion providers
% of diabetic patients who have
had an eye exam
% of diabetic patients with
A1c ≥ 7.0%
Measurement period
You
Practice Fusion providers
You
Practice Fusion providers
You
Practice Fusion providers
% of diabetic patients with
A1c ≥ 9.0%
% of diabetic patients with A1c
tested in the last 6 months
% of diabetic patients who have had
a food exam
Diabetic patients confirmed by ICD9
with and A1c test in the last 6 months
(245/602)
Click here to engage your patients via email

15. 15
With population health management,
patients get the care they need when they
need it, providers see better outcomes,
and by reducing preventable critical care,
population health management lowers
costs and save lives.

16. Resources
16
+ For more information about Practice Fusion’s population
health management offering, please visit:
 http://www.practicefusion.com/pharma/
+ For a quick, video overview of population health
management:
 https://www.youtube.com/watch?v=C0w68xbDwEs
+ Set up a completely free, web-based EHR from Practice
Fusion in less than 5 minutes:
 https://www.practicefusion.com/signup/