Population-based managed care (PBMC) is a management technique designed to provide patients with the best care cost-effectively through better monitoring of patient needs based on populations of similar conditions. Curtin (1996) states that health care workers should be careful lest the person gets lost in the population. Population consists of individual people and individual health professionals care for individual people. Curtin suggests that even if you may be responsible for all the people in the particular unit, you should care for them one at a time.
Tumulty (2001) noted that health care in
The objective of this program is to ensure that a health care system can be given with high quality care to every individual of the subgroups in a particular population selected in
Population-based managed care is a systematic, planned approach to caring for patients who have common, predictable health care needs.
Subgroups of patients with similar conditions, such as diabetics, pregnant women and smokers, are identified using various sources of information from healthcare usage and their services and service delivery are tracked to determine efficiency through clinical outcomes. The data allows for fact-based medical practice guidelines and better service delivery. The subgroups help identify the special set of services needed. The subpopulation selected should account for a significant proportion of the organization's practice workload and/or cost. Population data are culled from a number of sources. Membership and billing services are used to produce information about age and gender. Other data sources include information from the pharmacy system, laboratory system, the hospital information system, or from outpatient visit diagnostic codes.
After identifying and refining the population, next is identifying services and planning service delivery to the subpopulation. First, establish expected health outcomes. These outcomes help determine whether interventions are preventing or slowing the progress of the disease, reducing or preventing complications, improving functional status, and prolonging life. Scientific literature can provide evidence-based practice guidelines which outline state-of-the science health care services for each population. Other tools, such as clinical pathways and self-management/patient education strategies, also can improve care for specific populations. A consistent, evidence-based, mutually agreed upon treatment plan is the goal for each patient in the population.
After identifying the appropriate services, they must re-examine the way they work and their various skills and competencies and negotiate new roles that are efficient, effective, and satisfying. This work requires a new mental model for practice. It demands that the team look at their practice from the subpopulation's perspective, that is, from the patient's perspective. It requires that the health care team shift from planning care for individuals, one at a time, to planning care for groups of patients with common conditions or problems and predictable health care needs.
Population-based managed care requires that teams meet together to collaborate and to accomplish this work. Each team can learn what works best for them, as long as the entire team is engaged in planning, implementing, and evaluating the care processes and outcomes to improve care.
A Health Care Team is to be established which links the synergy among base agencies to promote help-seeking behavior and integrate prevention programs. The team addresses risk factors through a collaborative, integrated, customer-focused prevention effort designed to offer programs such as stress and anger management, personal financial management, and effective parenting. These programs support readiness by reducing risk factors and building the performance-enhancing life skills of our community members.
The concepts of a healthy community involve more than just medical interventions. They include local environmental quality and hazards; quality of housing, education, and transportation; spiritual, cultural and recreational opportunities; social support services; diversity and stability of employment opportunities; and effective local government.
In connection with this program, patients can be able to access the best possible resources for improving their overall health and to become educated, responsible consumers.