5 Population Health Tactics That Open the Door to Care Access

Tuesday, March 18th, 2014
This post was written by Patricia Donovan

remote patient monitoring

Remote patient monitoring is a phone call away.

Remote monitoring of patients, one of five Adventist Health approaches to improve access to care, can be as basic as a follow-up phone call or as high-tech as sensors placed around the home to monitor activities of daily living (ADL). Here, Elizabeth Miller, VP of care management at White Memorial Medical Center (part of Adventist Health), offers a set of population-based ideas to improve access to care.

First, consider embedding care professionals into the patient-centered medical home (PCMH). We do that for our highest risk patients. We embedded a nurse practitioner/social worker so that as the patients were on site, we talked to the primary care in the medical foundation to schedule their high-risk patients, the ones that we are going to population health-manage. We will embed our staff and come to you two days a week.

Second, consider home visits for homebound patients, although those are very intensive. I’ve done home visits; it takes about an hour and a half per patient.

Another option to consider is group settings; you may be able to reach out in your community and have group settings for the purpose of population health management. Also, consider going to a physician’s office for group settings.

There is also telehealth and monitoring from a distance. I can tell you that it doesn’t always go as well as face-to-face visits because sometimes some things are lost without the face-to-face. It is my personal preference to meet face-to-face, but we do monitor from a distance. A lot of this is just telephone calling to follow up.

We also send reminders. We phone to remind them of appointments; you can also send them letters or employ text messaging. It depends on your population and how savvy they are with social media and tools.

Excerpted from Population Health Framework: 27 Strategies to Drive Engagement, Access and Risk Stratification.

Readers, what do you think? Could remote monitoring extend care for the population you serve? Share your comments here, or Tweet questions @H_I_N and we’ll try to get them answered during this week’s webinar on Humana’s remote patient monitoring with telephonic case management to improve care coordination.


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