A Brief Overview on Population Health Management

As a pharma marketer, you are either already being pulled into discussions about Population Health Management (abbreviated as PHM for the rest of this column), or you likely will be in the near future. If the topic is unfamiliar to you, or still a bit murky, here’s a practical and simplified view on the subject with an emphasis on ways that pharma can support PHM.

What PHM Seeks To Accomplish

While there is no universally accepted definition of “population health,” we think it can best be defined by what it seeks to accomplish. An article published last year noted that the goal of PHM is: “To keep a patient population as healthy as possible and reduce the need for expensive interventions like tests, emergency department visits, hospitalizations and procedures.”1 That’s a great goal, and it’s right in line with what pharma marketers are often trying to do with their products.

And what is a “population?” An easy and workable definition is, “Any group under the care of a healthcare provider.” And that definition can be applied whether the “provider” is an individual physician, a group practice, or an entire health system. If you are under a provider’s care, you become automatically part of that provider’s patient population, and to some degree, each provider you see bears some responsibility for helping you stay healthy while also controlling the resources used to achieve that goal. And that, in turn, brings us to the two things that must be considered as part of any PHM program: The clinical needs of the patient; and the resources needed to provide care.

Balancing Clinical and Financial Goals

As every pharma marketer understands, controlling healthcare costs is a big part of healthcare today. Higher co-pays, restrictive formularies and prior authorizations are the most commonly employed tactics used to control pharmacy costs specifically. PHM is concerned with controlling costs, but it also considers the clinical needs of the patient population along with measures to control cost. Thus, we can say that a key element of PHM is to balance the clinical and financial aspects of care so that increasingly scarce resources are used to prevent disease and treat known health conditions at a cost that the patient population (or those paying for their care) can sustain over time.

How You Can Be Involved in PHM

Electronic Health Records (EHRs) are important in PHM because they can both collect information needed for PHM programs and deliver information to providers and patients. There isn’t enough space in this column to discuss the role of EHRs in data collection and management, but that’s not where pharma marketers are going to be most active anyway. Pharma marketers are likely to be most involved in communicating with providers and patients in ways that support PHM, often via EHRs.

For example, we regularly work with our EHR partners when a particular intervention or educational message to a patient is warranted. These messages might, for example, call out the need for diagnostic testing for patients fitting certain criteria, or they may help to educate a patient recently diagnosed with a particular condition. Programs that encourage adherence to therapy can also be supportive of larger PHM efforts, and pharma marketers can play a role in PHM by supporting these programs.

Speaking to the Provider

Pharma does have a more specific role to play in supporting PHM through programs that speak to the provider. PHM is often “empowered” through Clinical Decision Support (a future column topic) that alerts a provider to the need for a particular action such as ordering a certain test, calling out a recommended action based on a particular lab value, or reminding the provider that a new treatment guideline is now in effect.

Pharmaceutical companies can often support PHM efforts by sponsoring these types of alerts within the prescriber’s workflow. This is likely to become a more common method of participation for pharma in PHM efforts. If pharmaceutical marketers believe they have a product that can help to prevent or effectively treat a healthcare problem, it is worth considering the role that product might play in the PHM efforts of their customers. Sponsoring appropriate messages to providers can be helpful to all parties in the larger PHM effort.

Finally, it is important to remember that changing patient behavior is often the most difficult aspect in managing the health of a patient population. Sponsored programs that address the need for diet, exercise and other patient behaviors can be an important part of changing the behavior of patients—and what better time and place is there to deliver this type of information than in the provider’s office or pharmacy. Here, the role of both pharmaceutical intervention and lifestyle modification can be discussed with the provider—who may be very happy that additional resources are available to help educate and motivate the patient.

A great role for pharma also exists within PHM for brands to support programs that encourage first fill of a prescription and also make additional resources available to the patient through point-of-care messaging that directs patients to other resources, such as digital programs available online.

Pharma’s Role Will Continue to Expand

Pharma will play an increasingly greater role as a sponsor for programs and activities that help to alert providers and educate and motivate patients about healthier, sustainable actions. And pharmaceuticals, when properly used, can offer an excellent opportunity to balance the clinical and financial needs of a patient population due to their proven ability to lower the overall cost of healthcare while preventing and lessening the impact of disease and illness on patients. Pharma marketers can play an important role in this effort—and in a variety of ways.

References:

1. Cassidy, Bonnie S. “The Next HIM Frontier: Population Health Information Management Presents a New Opportunity for HIM.” Journal of AHIMA, Vol. 84, No. 8 (August 2013): 40-46.

  • Mark Heinold

    Mark Heinold is CEO of PDR, the largest EMR and digital communications network. PDR connects prescribers, pharmacists and patients to improve health outcomes through targeted communications, and is the publisher of the renowned Physicians Desk Reference. PDR delivers health information designed to positively improve health behaviors through a variety of digital, office-based and pharmacy-based channels.

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