Insight to action: using automation to manage population health
Population Health Management (PHM) is an increasingly popular way of improving outcomes and reducing the costs associated with readmissions and chronic care. But have providers got the right software tools to deliver an integrated, actionable strategy?
Effective PHM requires the ability to segment your population based on risk profile and proactively manage patient journeys across the care continuum. High-risk individuals receive focused, coordinated attention and all patients are encouraged to self-manage beyond the four walls of the hospital setting.
The problem is that a lot of software won’t allow providers to easily exchange data, or track patients beyond each clinic or hospital. Once your population health software has segmented patients into cohorts, how do you put manageable plans and protocols into action?
Lumeon Care Pathway Manager is a cloud-based platform that provides a single, real-time point of reference across the care continuum, integrating data from patients, remote health monitoring devices, EMRs and EHRs and telemedicine software throughout clinical settings.
We work with providers to help them understand the people, process and technology that needs to be coordinated in order to use automation as a tool for PHM. Providers can then create their own pathways and formulas to manage integrated care processes for each cohort.
Effective care coordination
Create workflows that automate activities or send event-based tasks to the right people at the right time. Staff have a complete view of the patient care journey including which events should happen next and the current patient risk status.
Single view of patient journey across the care continuum
Care Pathway Manager can integrate clinical, financial and administrative data onto one platform, for a consolidated real-time view of the patient journey. We use HL7 and FHIR to help integrate with existing software.
Advanced risk management
Our approach allows you to integrate population health software into your pathways, so once patient cohorts are identified you can rapidly create risk management plans and protocols for each segment.
Engage patients with dynamically personalized wellbeing plans
Patients can be allocated to high, medium and low risk automated pathways that vary the frequency of interaction, sensitivity of thresholds or intervals between follow-up. They can also be set personal goals (e.g. lowering BMI by certain levels) and sent automatically tailored activities and resources.
Close the gap between insight and action
Controlling your outpatient pathways through a single master mechanism (with near real-time reporting) allows you to collate integrated data, analyze this across different patient cohorts then rapidly update your automation rules to see rapid results.
Consolidated and individual view of outcomes data
Care Pathway Manager allows users to pinpoint individual progress or analyze data across entire geographies and cohorts in near real-time. Our Analytics module also lets you compare performance by practitioner or type of digital wellness plan.
Get in touch/request a demo
If you would like to find out more about Lumeon Care Pathway Manager, please get in touch.