Q&A: Categorizing population health models

Q: How do I categorize population health models for my facility? 

A: Population health models are strong and prevalent in hospitals, especially academic medical centers that have decentralized service lines, because they are clustered around physicians. However, population models often do not have a case manager who is exclusively assigned to this function or involved in data analysis, quality improvement, educational offerings, or other population-defined practices. An exception would be if the case manager were a clinical specialist or nurse practitioner who could be free to cross boundaries and would have a UR and discharge planner possibly assigned to the case manager. In this situation, the population model starts to look like the clinical resource model described in point five, which states that case managers have a collaborative relationship with attending physicians or hospitalists (and may manage the UR and discharge planning function/personnel) to “move the patient through the acute care continuum”. These models include disease management models for highrisk patients and outcome models in which “clinical inquiry” and data are used.

For more information, see Case Management Models: Best Practices for Health Systems and ACOs, 2nd edition.

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