Managing Population Health with Integrated Registries and Effective Patient Touchpoints

A patient might expect a reminder about a missed colonoscopy during a primary care visit, but during a trip to the dermatologist? Providing health plan members with “consistent and ubiquitous reminders” via multiple touchpoints in their healthcare journey is one of Kaiser Permanente’s key population health management strategies, reports Jim Bellows, PhD, senior director of evaluation and analytics for Kaiser Permanente.

Another is the vigorous use of registries — more than 50 in all, at last count — even for relatively rare diseases. Dr. Bellows defines the criteria for registry creation, expands on the choice and availability of patient touchpoints and explains the evolution of other Web-based PHM tools in use by Kaiser Permanente.

Dr. Bellows shared his organization’s approach to population care and population health management during a July 31, 2013 webinar, Managing Population Health with Integrated Registries and Effective Patient Touchpoints.


Length: 12:25 minutes

Performance Quality Measurement and Reporting for Accountable Care

When tracked within its electronic medical record, key interventions like transitional care coaching and an expanded Patient Health Questionnaire not only improve the care provided to John C. Lincoln ACO’s population but provide a clearer picture of the accountable care organization’s performance, note Karen Furbush, business consultant, and Heather Jelonek, chief operating officer of the John C. Lincoln Network ACO.

Additionally, the ACO’s Physician Advisory Network, made up of its leading physicians, tracks patterns and trends within the ACO and helps the care team to adhere to best practices in evidence-based medicine. Monthly webinars with the physician advisory network and its EMR specialists provide opportunities for evaluation and training in these best practices.
Karen Furbush and Heather Jelonek shared how the John C. Lincoln Network ACO has modified its reporting process, from workflow changes to customizations within its EMR to improve performance results during a July 17, 2013 webinar, Performance Quality Measurement and Reporting for Accountable Care, a 45-minute program sponsored by The Healthcare Intelligence Network.

Karen Furbush and Heather Jelonek



Length: 8:40 minutes