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    Case Study: One health system's population health journey

    To consistently achieve high-quality, cost-effective care, healthcare organizations are shifting their attention away from acute, episodic-care delivery toward chronic-disease management through preventive medicine. This is no small feat, especially among those organizations providing the bulk of their services to uninsured and underserved populations.

    Methodist Healthcare Ministries of South Texas, Inc. (MHM)—a private, faith-based not-for-profit organization and the half-owner of the Methodist Healthcare System—is pursuing a multifaceted approach to managing the health of a large population, relying on data to identify the most effective ways to proactively engage patients and leveraging technology to share information between facilities and programs.

    MHM provides medical, dental, and health-related human services to low-income families and the uninsured through clinics it owns and operates, and it provides funding to other agencies that are successfully delivering healthcare and social services to this population in their respective communities throughout south Texas.

    Leveraging Data to Understand Population Needs

    To make meaningful improvements in population health, MHM first focuses on understanding its patient population and their diverse care needs, analyzing data to assess the landscape and drive interventions.

    For example, before it determines where to provide services, build clinics or develop infrastructure, it commissions and studies detailed epidemiology reports which look at demographics and the types of conditions a population faces. The organization serves a substantial diabetes population as well as a large number of patients dealing with hypertension; so many of the interventions MHM supports address these particular conditions.

    MHM also relies on data to reveal patients in need of proactive health management. Once an individual is identified as having a certain chronic condition like diabetes, there are many care interventions that can occur, depending on the patient's ability to comply with prescribed treatments. For instance, MHM has certified diabetes health educators that work with patients, educating them on how to keep their illness in check and make positive life choices.

    Next: Technology Enables Robust Information Gathering

     

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