Population Health Management Tools & Solutions

Address population health challenges

Many people face barriers to healthcare because of where they live, their race or ethnicity, their education level, and many other factors. In fact, a person’s ZIP code is often more important than their genetic code, with as much as 80% of a person’s health impacted by non-clinical and socio-economic factors — something that directly affects overall population health outcomes.

Capture SDOH at scale and connect patients to the resources they need

Beginning in 2024, CMS and many states will require hospitals to implement social determinants of health (SDOH) screenings for all patients 18 years or older. The Joint Commission and NCQA have also created requirements or reimbursement incentives to screen and support social needs.

We can help

Leveraging GetWell InPatient and GetWell Navigators, we now offer a new suite of features and services that help automate the screening of SDOH and navigate patients to appropriate resources:

Use existing tools to collect SDOH data: Through Get Well’s interactive TVs, client partners can allow patients and caregivers to confidentially complete social needs surveys.
Add additional channels for scale: Patients can now also complete SDOH surveys on their phone via text messaging, tablets, or mobile devices, or during tech-enabled staff rounding with GetWell Rounds+.
Seamless integration into existing EHR: Directly embedded SDOH screening data into Epic, Oracle Cerner, and other EHRs ensures coordination of data and workflows.
Escalate and triage social needs: Care teams can monitor patients in real-time, pinpointing intervention opportunities, and triaging needs to appropriate care teams.
Navigation of patients to the social resources they need: GetWell Navigators — virtual, and digitally enabled by the Get Well platform — can guide patients to local resources via texting or phone, reducing the workload for overburdened care teams and closing the loop on community referrals. The “high-tech, high-touch” combination sets the GetWell SDOH solution apart.

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Improve overall health outcomes

Understanding the health — and health risks — of a population is vital to ensuring successful population health management. The ability to predict patient behavior or anticipate health decline, build and maintain lifelong relationships with your patient population, and gain real-time insights into the health and healthcare experience is invaluable to providers, health systems, and health plans.

But it’s also challenging. Inefficient, outdated, and expensive tools often result in inaccurate information, which leads to poor outcomes and high costs for organizations.

Get Well’s digital engagement platform helps healthcare organizations better support both clinical and non clinical needs of the populations they serve. Our solutions:

Improve outcomes by guiding patients through complex, high-cost procedures
Reactivate dormant patients
Engage underserved populations in routine clinical care to help address care gaps
Improve documentation of SDOH risk via longitudinal SDOH assessments
Increase referral and conversion of highest impact patients via smart referrals to SDOH programs
Reduce out-of-network patient leakage and ensure smooth handoffs of care following procedures or ED visits

Spotlight on health equity

Health equity is when everyone has the same opportunity to be as healthy as possible, regardless of their social position in a community or other social determinants. Social determinants are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health.

Health inequities arise when there are differences in health status or distribution of health services among or between populations that are avoidable and that lead to unfairness and injustice in healthcare. Differences in quality of life, access to healthcare, rates of disease or death, and length of life between groups of people reflect health inequities.

Learn more about how hospitals and health systems can use technology to improve care quality and access for all in this on-demand webinar.