Exploring the Principles of Population Health Management

Exploring the Principles of Population Health Management

The nationwide pandemic response has brought to the forefront the need for a data-driven approach to decision-making; the need to work together across organisational boundaries to deliver transformation; and the importance of focusing on good health and the underlying determinants that constitute health.

These same three themes sit at the heart of Population Health Management (PHM) – an approach to understanding current, and predicting future health and care needs with a view to designing and adapting services accordingly.

Similarly, these same underlying principles are highlighted in the NHS Clinical Commissioners report focused on Advancing Population Health Management. Through ten local stories the report demonstrates the progress and outcomes being derived from a Population Health approach. More importantly, it identifies a number of key learnings that need to be addressed as we look to embed PHM systems in 2021.

Together for Health Takeaways from this report include:

  • Finding a common definition for Population Health Management is a challenge, however, what is clearly important is that PHM is an approach to planning services based on the health needs of a population – even when that goes beyond the boundaries of traditional health and care systems.
  • A commonality across the stories is the importance of data and in particular, getting access to shared data and the associated information governance challenges.
  • Arming clinicians with the insights from this data and getting the right people from a range of stakeholder organisations around the table to talk about the needs of a particular cohort – that’s when radical transformation can really happen.
  • Transitioning to a local approach offers the opportunity to deliver meaningful and sustainable change – local teams understand their populations, and they’re very committed to the changes because they own them.
  • Clinical commissioners sit at the heart of Population Health Management as the bridge between primary and secondary care organisations, facilitating the right conversations and breaking down traditional silos

It is encouraging that whilst many describe themselves as being only at the beginning of their PHM journey, we can see that it is making a real difference to health outcomes.

Read the full report to gain insights from the following case studies:

  • Getting a grip on the data in North West London
  • Improving diabetes care for people in West Berkshire
  • Workforce empowerment in Dorset
  • Collaboration to improve mental healthcare in Sheffield
  • Building coalitions to provide even more targeted care in Leeds
  • Targeting need in Lewisham
  • The start of a journey in Suffolk
  • Clinical commissioners help to create the right conditions for PHM approaches in Lancashire
  • Encountering information governance challenges in Birmingham and Solihull
  • Merging towards strategic commissioning and population health management

Find out more about Population Health and Population Health Management here.


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