Population Health Management Solutions

Population health management is implementing steps to improve the health of a targeted group of people based on insights derived from their location, race, ethnicity, gender, or demographic data. Population health management software is a digital system that aggregates healthcare data from multiple sources to enable providers and public health experts to use it to improve the medical outcomes of the targeted people. Population health management solutions are used to study the health of many people fitting certain criteria and undertaking steps to improve it.  

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Explore Population Health Management

Data aggregation means gathering a vast amount of data and presenting it into a pre-defined summarized format for better and detailed analysis and insights gathering. Every public health system generates tonnes of data through various data sources such as EHR, EMR, and more. Leveraging this public health data for population health management and public health app-building requires advanced data aggregation strategies. For the highly accurate and quick process of population health management analysis, it is essential to aggregate, process, and normalize health and demographic data of patients.    

    We have experience in engineering customized population health management systems for your needs that help to find the key statistics such as gender breakdown, age distribution, illness burden, health status, and care utilization often must be collected from disparate sources. We understand that population data aggregation is tied to data warehousing, and we ensure to build a population health management system as per your requirement that offers better data aggregation. Having a clean, complete, perfectly reconciled, usable, and highly interoperable public health data is essential to deploy for population health analytics. We ensure to help you collect population health data across multiple EHRs and data sources to reliably aggregate data from across the care continuum.

A population health management relies on PHM data that helps to identify the populations and the demands for care, to assess the medical care provided to these populations, and to deliver the best care to the right people. Clinical data and other data such as socioeconomic data, health risk assessment, patient-reported data, and biometric data, and more. Population health management analysis helps to aggregate data from multiple resources that require regular and effective communication. Care organizations can rely on healthcare cloud based population health management that offers best-in-class healthcare analytics to scale patients by risk using collected longitudinal public data, for developing personalized disease management programs and coordinating care delivery.

    OSP has successfully customized a population health management analysis solution for an INC 5000 company in Iowa. We have the experience to build advanced clinical data analytics to define the distinct population segments. We customize population health management in such a way that patients with a chronic disease, patients under the care of a particular set of providers, or any other grouping can be created, monitored, and analyzed using population health analytics. We help population health organizations to stratify risks of patients with high risks for better Healthcare management through coordination. Risk stratification is a clinical exercise to help understand which members have a chronic disease and need better care management. Generating the right measures, trends, graphs, work lists require analytics and robust reporting to enhance the accuracy of care management for enhanced population health informatics.

Data visualization and smart reporting modules help population data to reach the right care decision-maker at the right time and in the right format. Health organizations rely on population health management strategies that use advanced data segmentation and highly interactive data visualization to gather insights about the populations. Many modern data visualization based population health strategies provide a deeper outlook into the complex models for risk stratification at both at a discrete patient level and an aggregate population level. The public health data is also used from EHR systems to visualize disease registries to monitor and track performance metrics.

    OSP can customize population health management tools to your needs that help you highlight the key concepts that ensure that important information is seen and utilized appropriately. Population health companies first focus on identifying the segments in the given population treated by a specific provider. The types of clinical risks drive the population health data segmentation. Even after the population is defined, the size, composition, and disease get modified for the old patients with new patients in the system. Population groups’ dynamic nature requires continuous monitoring and real-time analysis for population health informatics optimum results through visualization. OSP can tailor a system for population health management with interactive dashboards and visualization to make sense of every data inch.

Care management is the method of operating in a well-coordinated way with community partners (hospitals, counselors, pharmacies, and others) to support the complete range of health needs for high-risk patients. A well-made care coordination system for population health management includes identifying the high-risk patients, sharing the data with other healthcare stakeholders, and managing the patient’s use of care to prevent unnecessary services. Once the care gaps are identified, they should be quickly resolved to forestall preventable acute events. For population health management strategies and CDSS, care management and care coordination strategies are integral components.

    We can understand your needs and build a customized population health informatics with integrated healthcare management solutions for better care deliveries. Advanced and integrated population health management tools can improve participation from a broad spectrum of healthcare stakeholders, including patients, healthcare providers, clinics, hospitals. Our team builds solutions that help aggregate, maintain, and make available longitudinal patient health records. With secure communication and automated alerts, care coordination is made full proof of offering qualitative care delivery models for population health management. We understand that for high-cost and high-risk populations suffering from chronic health diseases, personalized care through streamlined care management plays a crucial role. We build our population health management strategy to create and deploy comprehensive care plans for individuals with chronic diseases and other complex needs.

Health literacy is the capability to understand and use healthcare data to make the right care decisions and manage patient’s health. For a population health group of chronic disease patients, health literacy to self-administer their medicine and monitor their blood glucose levels is needed. Healthcare providers can reach key populations through patient outreach and patient engagement. For population health management’s success, connecting with the segmented groups and delivering meaningful, consistent information can produce the quality of consumer experience needed to drive engagement. Patient engagement and education features in a PHM application help boost outcomes by encouraging and tracking care plans’ adherence.

    We have experience in helping health organizations on their population health strategies with customized patient engagement modules. This type of value focuses on improved population health and disease reduction due to improved surveillance/screening, immunizations, and increased patient engagement due to enhanced patient education and access to information. We at OSP can help with tailored population health management solutions with patient engagement for precise targeting and communication channels by reaching key populations and getting them to engage and respond quickly. Connecting with segmented groups of population data and delivering meaningful, consistent health information can provide the quality of consumer experience required to drive engagement.

Healthcare interoperability is one of the biggest challenges faced by digital health systems across the US. The enormous amounts of patient data are yet to be put to use, but it is stuck in data silos. Enhancing the accessibility and interoperability for this data is one of the fundamental needs of population health management. Health information systems must be interoperable to help clinicians and care teams deliver well-informed, coordinated, patient-centered care, especially for population health management. Patient-generated health information and other types of exogenous data are needed to supplement clinical and claim data. We help healthcare provider organizations such as clinics, FQHCs, and hospital management systems to provide good and optimum care with easy access to patient PHM data regardless of the origin of that information, in a format appropriate to their workflow.

We believe Patient-generated population health data from multiple sources must be included in the mix, and patients should participate in the HIPAA compliant information exchange. With modernization in PHM solutions, the care organizations strive to deliver comprehensive, personalized, and timely interventions made possible only through the better interoperability of the population health management solutions. We have experience streamlining the EHR data through simplified interfacing with other care systems, clinical decision support, patient portals for patient engagement, reporting, and enhanced user experience. Our team can engineer custom-build population health management with advanced interoperability to aggregate and analyze data from multiple sources in near-real-time. We can build a custom intuitive platform that uses a flexible data lake model to standardize, store, and report patient population data.


Most chronic diseases cannot be cured but are only managed with medication, diets, and a healthy lifestyle. They cost several billion dollars to the healthcare industry and require continual medical attention, unlike regular diseases that are cured with a finite round of treatments. OSP’s can design population health solutions to consolidate the health information of a large group of people and offer actionable insights to public health experts on the best course of treatment/management.

Since population health management analyzes the health data of many people, it enables doctors to identify individuals at higher risk of disease. Using a population health management platform that we can build enables providers and population health experts to identify people more likely to contract certain diseases and undertake preventive measures. This approach benefits the patients, providers, and payers regarding the cost of care.

OSP can design a custom population health management system to offer valuable and actionable insights into the health situation of a large number of people. This insight enables providers to identify patterns and correlations that cost-effectively highlight the best approach to treatments. Additionally, our population health management solution empowers providers to take a preventive approach to care instead of a reactive one. This goes on to reduce healthcare costs.

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Population Health Management Software Development Services


Design of a Population Health Management Platform

  • Aggregation of data from multiple data points into one dashboard
  • Analytics to harness actionable insights about population health and diseases
  • Enhanced data visualization tools to gain perspective on the information compiled
  • Identification of at-risk individuals or groups through advanced population health solutions
  • Features for improved chronic care management

Development of Population Health Management Solutions

  • Analytics function to identify factors that are determinants of health
  • Integration of EMR and other medical software for more data points
  • A consolidated dashboard for viewing key markers for population health
  • A secure, centralized repository for data storage along with backups
  • Implementation of access controls and audit trails to prevent unauthorized access to the data

Design and Development of Population Health Management Software

  • Inclusion of custom features to suit unique requirements – chronic diseases, behavioral health disorders, etc.
  • Data-driven analytics to determine care gaps which to highlight multiple factors
  • Identification of major causes of re-admissions and worsening of diseases
  • Data from multiple data points are aggregated into one dashboard, providing a comprehensive view
  • Insights on factors like health plans, diet, ethnicity, and demographics on population health

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Frequently Asked Questions

Population health management comprises all the activities and processes involved in improving the medical outcomes for a targeted group of people through various data-driven techniques. It involves the analysis of data obtained from multiple sources to identify care gaps and act upon those to implement better care models.  

A good example of population health management would be the medical community’s efforts during the recent Covid-19 pandemic. Doctors around the globe were accumulating clinical data on people infected with the coronavirus. All the patient’s symptoms, timelines, bloodwork, vitals, medical histories, and other demographic information was analyzed in depth to identify the nature of the disease and formulate measures to contain the spread of the virus.   

The accumulated data is also known to have helped accelerate the discovery of the vaccine, which played a major role in saving lives. This is one of the most well-known examples of population health management.  

  • Improving Population Health  

This is the main purpose of population health management. The whole idea of obtaining clinical and demographic data of patients is to identify if some groups of people are more vulnerable or face greater risk. Subsequently, the insights derived from this are used to formulate clinical interventions for improving population health, controlling epidemics, and supporting research.  

  • Improving Patient Experience  

Patient experience is a vital part of the whole healthcare journey. It indicates how the patients feel about the provider and the care and if they are likely ever to visit the provider again. Population health management analyzes the care journey and identifies gaps that need to be filled for improved patient experience.  

  • Reduction in Cost of Care  

The growing costs of care are a major concern in the United States. The more it grows, the harder it will get for people to access care. One of the most important goals of population health management is identifying the major causes of growing costs and addressing the problem, which will enable more people to access care in the long run.  

Medical Outcomes: This indicates patients’ recovery level after undergoing treatment for a disease. It is a major indicator of the quality of care provided.   

Patterns of Health Determinants: Several factors, like family history, diet, lifestyle, genetic predisposition, nature of the job, and housing, are determinants of a person’s health. The spread of certain diseases has been directly linked to these determinants, which shed light on how best to prevent or treat them. The patterns derived from people who suffer from diseases and their determinants enable clinicians to make informed treatment decisions.  

Policies and Interventions: This refers to the government’s protocols and rules after comprehensive data-driven research into population health management. Policies and interventions outline methods in which positive medical outcomes and better determinants of health need to be achieved. It helps providers formulate strategies to tackle widespread diseases and treat patients suffering from them, not to mention educating them to live healthier lives and avoid contracting the disease.

Population health management tools enable clinicians to accumulate medical data to generate a complete picture of a patient’s health. The information and insights from these tools help doctors understand the causes of disease, the spread, and better ways to treat and contain them. Moreover, by understanding how certain people contract diseases, doctors are better able to treat them.  

Population health management software is a digital platform that enables medical professionals to aggregate clinical information about patients and analyzes the same for insights. Analysis of this data would highlight patterns about the nature of diseases, how they spread, who might be more vulnerable, symptoms, and so forth. This broadens the understanding of the diseases studied and enables clinicians to formulate ways to treat and prevent them effectively. Knowledge of disease helps protect the population against it.  

  • Electronic health records to be used for harnessing patients’ data  
  • A software platform is used to aggregate this data and offer an analysis.  
  • Data visualization tools help clinicians and researchers make sense of the data.  
  • A secure database to store all the medical data and insights and their backups.   
  • The database can either be cloud-based or maintained on-premises at the facility researching population health management.  

     1. Identify the Population  

The first step towards population health management is identifying the target population whose health needs to be studied. This could include all the people in a geographic area, people of a certain ethnic group or gender, or individuals involved in a certain profession that makes them follow a lifestyle. By categorizing a set of people into a group, experts can then begin observing the health metrics of that group to improve their medical outcomes.  

     2. Formulate a Continuum of Care  

It is important to provide care services to the target population that encompasses everything from diagnosis, treatment, post-treatment care, and analysis. The care provided must be data-driven and include all the insights derived from analyzing the clinical information of the people in the group. Doing so helps physicians identify who might be at higher risk, the impact of the disease on the group, and the outcomes derived from the treatment.  

     3. Formulate Payment Modes  

Payments are one of the biggest factors affecting the level of care available in the United States. Clinicians must shift towards value-based care that rewards medical outcomes instead of the number of services provided. In the absence of such a payment system, a significant part of the population won’twon’t have access to the care needed.  

     4. Utilize the Insights  

The continuum of care provided to the targeted population will hold insights about why some people are more likely to contract a disease, how best to prevent it, viable treatments, and so on. The goal of population health management is to understand diseases better and how they affect the population or parts of it. This knowledge will help clinicians treat patients better.  

Population health management is improving the medical outcomes of a select group of people using care models derived through data-driven methods. Population health management enables medical researchers as well as providers to understand diseases and their impact in a more nuanced way. Regarding medical care, several factors determine the varying outcomes for different people. These factors include income, lifestyle, diet, food, jobs, ethnicity, gender, family history, and even location of residence. By analyzing these factors against diseases and medical outcomes, clinicians can obtain important insights into how the healthcare system neglects some people and other systemic inequities which need to be addressed.  

Taking such a data-driven analytical approach helps medical researchers know why some parts of the population suffer more fatalities from a disease or why others don’tdon’t suffer as much as others. The factors mentioned above play a major role in determining long-term health, access to care, and overall clinical outcomes for parts of the population. This then highlights the gaps in the healthcare system and how they came to be.  

Subsequently, the insights garnered from population health management will help policymakers and doctors address inadequacies and ensure that underserved people get the care they need.  

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