HealthTexas has begun tracking and monitoring the health status of their entire patient population. Traditional disease management programs seek to address the needs of complex patients, some of whom have five or more conditions (e.g., diabetes, heart disease, obesity, hypertension, and lipidemia). These patients may be seeing different physicians and taking one or more drugs for each condition, potentially causing adverse interactions. But by just focusing on this group, which typically constitutes about 2% to 5% of a population, the care team is missing the opportunity to prevent other patients from developing advanced disease. Because health status is fluid, the real challenge is managing and coordinating the care of every patient in a population across the spectrum of health.
To effectively manage population health, HealthTexas is reengineering the practice workflow and adopting health IT automation tools that will enable our physicians to reach out to patients who need services, and keep track of these patient populations more efficiently. HealthTexas is committed to population health improvement by raising the quality of care, improving health outcomes and reducing preventable health care costs for those individuals with chronic conditions at the highest level of risk.
Currently working with several corporations in the DFW area that promote population health improvement among their employees, HealthTexas utilizes robust care teams to deliver care continuum services such as health and wellness promotion, disease management, and care coordination. Aligning financial incentives for the physician to improve health outcomes for these patients creates a win-win for our patients and physicians.