Best Population Health Management (PHM) Software for Nonprofit

Over 25 years ago, one of our founders was working as the IT Director of a large behavioural health and residential services agency in New York. Sensing a need for a better way to track and report on their services, he developed a case management system for his agency. Over time, two other agencies joined in and helped expand the software so that it could serve the needs of virtually any human services agency in the country. Today, Foothold’s team and our software support hundreds of agencies across the nation, in Guam, and in Puerto Rico. With our technology expertise and roots in human services, we continue to empower agencies to focus on their missions.

Although clinical health is essential, better outcomes require a higher level of care. HELIOS provides a 360deg view that encompasses all aspects of a member’s health. The care team can collaborate to determine the best interventions and reduce avoidable readmissions by using a holistic view of the member. VirtualHealth's HELIOS platform allows for unparalleled collaboration and coordination between the member and their care team. It also provides visibility across the entire healthcare organization. Our clients can achieve more than traditional care management by connecting their entire care team to one integrated ecosystem. This allows them to drive greater efficiency, transparency and cost reduction.

AssureCare, a privately-held healthcare technology company, provides innovative care management solutions for commercial and health and human service providers. AssureCare's flagship platform, MedCompass is used by healthcare providers across the United States to provide end-to-end care management for millions. MedCompass transforms healthcare management through streamlining workflows and automating processes. This allows care professionals to make better decisions and achieve lower costs and a significantly improved quality of care. AssureCare is a leader in the development of modular, seamless solutions that improve patient outcomes and reduce unnecessary costs associated with population health management.

Humhealth supports group of Medicare programs including Chronic Care Management, Remote Patient Monitoring and other programs. Humhealth software promotes the Practices to the next level of patient care.

Harris CareTracker stands out as a premier healthcare software solution, providing medical practices and clinics with state-of-the-art tools and technologies. Our comprehensive platform includes essential features such as Electronic Health Records (EHR), Practice Management, Revenue Cycle Management, Electronic Prescriptions, Patient Portal, and Telemedicine. Designed with user-friendliness and continuous improvement in mind, Harris CareTracker streamlines practice operations, enhances patient care, and maximizes overall efficiency.

CareManager is a versatile population health management platform that operates independently of any specific electronic health record (EHR) systems, offering features such as care coordination, interoperability, analytics, outcomes measurement, and risk stratification. Leveraging cloud technology, this solution effectively minimizes the risk of patient readmission while maintaining high standards of care quality. Providers involved in the program can collaborate using a unified care plan, transfer patient information seamlessly, monitor clinical quality metrics, and handle authorizations and claims throughout their network. By consolidating data, CareManager reveals patterns and outcomes, enabling data-driven decisions in healthcare. With real-time access to up-to-date information, CareManager provides a holistic overview of each patient’s health records, enhancing understanding and transparency regarding activities across the entire care continuum. Additionally, it facilitates the management of patient assignments among various agencies and teams, ensuring coordinated and effective care delivery. This comprehensive approach aims to optimize health outcomes for communities while streamlining processes for healthcare providers.

Medbridge’s award-winning suite of online solutions for healthcare organizations and individual practitioners is paving the way for the future of healthcare, allowing organizations to meet the needs of every patient at every stage along the care continuum with exactly the right level of care at the right time. With education and engagement resources for practitioners and patients, reporting tools for organizations, and an integrated, all-in-one online platform to simplify access, Medbridge is uniquely positioned to improve population health on a global scale.

Finally, an Electronic Health Record system that can be used in hospitals, clinics, and other healthcare facilities. It is easy to set up and maintain, but it doesn't cost much. The iCare Enterprise cloud EHR is a fully integrated system that includes a range of administrative, clinical, and revenue cycle management capabilities. iCare offers a complete solution for billing, clinical, and administrative functionality at a fraction the cost of legacy software. The web-based user interface allows your users to access iCare from any device. It also allows workflows to be customized to fit the needs of clinicians. Legacy EHR systems were built on outdated client/server systems that are expensive, inflexible, slow to innovate, and closed. iCare was designed with the future in view. iCare is the industry's most advanced architecture, intuitive user interfaces and rock-solid performance - there is no other EHR that comes close to it.

Meeting the objectives of care coordination at a reduced cost is essential for enhancing patient satisfaction and fostering loyalty. However, these objectives are intricate. Your organization requires a population health software solution that offers a collaborative care plan, seamlessly integrated across all healthcare environments, without disrupting users' workflows. It’s vital to utilize automated outreach tools for patients, allowing care coordinators to focus on more strategic responsibilities. Now is the moment to consider Care Director. By implementing Care Director, your team can streamline the coordination of outpatient services, categorize patients into healthy and at-risk groups, and obtain care recommendations driven by actionable clinical insights, leading to timely interventions and better overall population health. Care Director empowers healthcare providers to view a comprehensive care plan directly within their existing workflows, facilitating easy access to information and enabling efficient communication back to care navigators with just a few clicks, ultimately transforming the care delivery process. With this approach, your organization can enhance operational efficiency and deliver a higher standard of care.

The Innovaccer Health Cloud will accelerate your transformation. You can unify patient data, create comprehensive financial and clinical insights, and innovate faster. We help providers integrate disparate patient information to provide actionable insights at point of care, collaborate across care teams and achieve better outcomes. We facilitate connectivity and collaboration among payers, providers, members, and members to manage risk and compliance as well as rising member expectations. We assist medtech and biopharma companies to build digital solutions at the intersection of healthcare and better use real-world data throughout the value chain. Transform from silos to an open platform that unifies healthcare data into one longitudinal patient record that allows for whole-person care.

Address the complexities of value-based care regardless of your existing EHR system. Gain a comprehensive understanding of your patient demographics through consolidated data from various sources, presented in an intuitive visual format. Leverage data-driven insights to enhance the management of chronic diseases and facilitate smoother transitions in care, while also working to prevent illnesses, reduce costs, and enhance care management initiatives. Promote effective care coordination through tools designed for a proactive mindset, including a pre-visit dashboard, risk assessment capabilities, and automated monitoring of admission, discharge, and transfer activities. Activate care management strategies to broaden the reach of healthcare providers. Encourage essential patient interactions and ensure meaningful follow-up between visits. Utilize the Johns Hopkins ACG system for risk stratification to pinpoint patients most at risk for high-cost healthcare utilization. Efficiently allocate resources to areas where they are most urgently needed. Aim to elevate performance metrics related to quality care. Engage successfully in value-based payment initiatives and maximize reimbursement opportunities as you navigate this evolving landscape. By implementing these strategies, healthcare organizations can improve patient outcomes and foster a more sustainable care environment.

Our extensive and adaptable range of solutions and services is built upon a strategic framework aimed at empowering organizations to understand and forecast trends within populations, actively involve individuals, their families, and care teams in proactive measures, and effectively oversee health outcomes for improved well-being. Unlike traditional medicine, which typically concentrates on the individual and equates "health" with the absence of disease, population health management broadens the scope by enhancing initiatives across whole groups and prioritizing the management and prevention of chronic conditions. To successfully oversee the outcomes of population health, it is crucial to address the underlying causes of health issues, allowing for the anticipation, prevention, and management of such challenges before they arise. By integrating clinical data with social determinants of health (SDoH), healthcare providers can gain valuable insights that not only improve individual care but also foster collaborations with communities to promote overall health and wellness. Ultimately, this holistic approach aims to create healthier populations and more effective healthcare systems.

IBM Phytel offers automated solutions for patient engagement that enhance your resources and effectively boost patient outcomes. These tools help identify gaps in care, prioritize patient engagement, and track progress over time. By increasing the number of appointments made and attended, along with annual wellness checks and telehealth sessions, practices can see notable improvements. The system also aids in enhancing performance on essential quality metrics pertinent to MIPS, PCMH, MSSP, and others. In doing so, it allows staff to dedicate their efforts to other pressing care needs while ensuring patients receive timely and relevant information for optimal care. Compatible with any electronic health record (EHR), IBM Phytel’s solutions facilitate collaboration among patients, providers, and care teams to drive better health outcomes. Through evidence-based communication strategies, the platform aims to promote improved health for high-priority patients. Additionally, it enables the implementation of personalized management campaigns for chronic and preventive care, ensuring proactive patient engagement. By utilizing automated, multi-channel appointment reminders, practices can significantly lower the rate of no-shows, ultimately contributing to more efficient healthcare delivery.

Driven by a passion for enhancing health outcomes, we aim to develop cutting-edge solutions and services in population health that elevate care management and enrich the consumer experience. At i2i, we are committed to the belief that superior care translates to a better quality of life for every community. By focusing on innovation, we strive to make a meaningful impact on public health.

Over 70% of healthcare information is contained within clinical documents, including reports, patient charts, clinician notes, and discharge summaries, allowing our specialized Natural Language Processing and AI Engine to extract essential concepts, attributes, and contextual information that drive business insights, enhance billing processes, assess and categorize patient risks, calculate quality metrics, and gather patient sentiment and outcome data. By tapping into difficult-to-access or previously unused data sources, you can significantly improve your clinical research or business intelligence efforts. Our extensive database features thousands of clinical concepts, including genomic biomarkers, symptoms, side effects, and medications, enabling the identification of disease characteristics and risk factors from clinical documents to better stratify patients and elevate the standard of care. Moreover, we ensure the protection of data subjects' identities while preserving the usefulness of the data through effective document de-identification strategies. This approach not only safeguards privacy but also empowers healthcare organizations to make informed decisions based on the most comprehensive data available.

Through the utilization of sophisticated analytics on extensive claims and consumer data, Trilliant delivers valuable insights that revolutionize the methods by which health systems enhance their revenue growth strategies. Furthermore, this transformative approach enables organizations to make informed decisions that drive financial success.

The 3M™ Ambulatory Potentially Preventable Complications (AM-PPCs) Grouping Software is specifically crafted to detect complications that could be avoided following elective outpatient procedures. Utilizing advanced grouping algorithms, this software allows healthcare professionals to scrutinize procedure encounters along with their related complications through multiple lenses, such as particular procedures, medical conditions, service lines, healthcare providers, and facilities. This comprehensive examination provides valuable insights that can guide focused interventions aimed at improving patient safety and the quality of care delivered in outpatient environments. Ultimately, the implementation of this software could lead to significant enhancements in overall patient outcomes.

Premier empowers health systems to concentrate on their core competencies by lowering expenses and delivering unparalleled clinical insights. HealFirst. The PHMC methodology streamlines the learning process for organizations aiming to enhance care delivery, elevate quality and efficiency, improve patient experiences, increase profit margins, and foster better alignment between hospitals and clinicians, all while progressing towards successful population health management. Organizations gain the ability to visualize the costs and medical usage of their ACO populations across essential service categories in comparison to national averages and well-managed benchmarks. This capability enables them to implement changes more rapidly within their ACO at both the facility and beneficiary levels. Moreover, the platform facilitates the rapid classification of opportunities and assessment of ROI, ensuring that organizations can prioritize efforts in areas that promise the highest potential returns, thus driving overall improvement in healthcare outcomes. By harnessing these insights, health systems can ultimately advance their mission of delivering quality care to their communities.

The advanced features of the Inovalon ONE® Platform enable our clients and collaborators to thrive by utilizing extensive industry connections, vast primary-source real-world data, advanced analytics, and robust cloud-based technologies to enhance healthcare outcomes and economics. Central to modern healthcare is the necessity to consolidate and scrutinize vast amounts of varied data, extract valuable insights from these analyses, and apply this knowledge to effect significant improvements in patient outcomes, operational performance, and healthcare economics. With analytics and capabilities employed by over 20,000 clients, we draw upon the primary source data from more than 69.5 billion medical events, encompassing one million healthcare professionals, 611,000 clinical environments, and 350 million distinct patients. This extensive network of data and analytics is crucial for driving innovation and efficiency in the healthcare sector, fostering an environment where informed decisions lead to substantial advancements.

MEDITECH’s Cloud Platform empowers organizations of all sizes to enhance their Expanse EHR by integrating various specialties, enabling connections to remote locations, and safeguarding patient information. Communication with your community remains seamless and accessible through Expanse Virtual Care and the Patient and Consumer Health Portal, even when physically apart. Additionally, providers can access essential data during unexpected outages thanks to High Availability SnapShot. Clarity is paramount for care teams addressing population health, and with MEDITECH Expanse Population Health, you will be equipped with the necessary tools to gain a comprehensive understanding of your patient demographics — their histories and future pathways. Furthermore, this platform offers capabilities to assist individual patients in managing their health risks throughout different life stages, ensuring that their care journey is well-supported regardless of the circumstances. Ultimately, this comprehensive approach not only enhances patient care but also strengthens the overall healthcare system.

Data possesses the incredible capability to protect lives during disasters and strengthen the resilience of communities. Geospiza SWIFT™, our innovative web-based software for workflow and decision support, ensures that high-quality data is both accessible and actionable for communities of all sizes and financial backgrounds. This platform seamlessly integrates over 1,000 different datasets and models to deliver clear, actionable insights that enable informed decision-making while also facilitating the assessment of effectiveness over time. With Geospiza SWIFT™, organizations focused on public safety, disaster response, and homeland security can accelerate their evidence-based decision-making processes. By utilizing a broad array of mapped data sources alongside comprehensive population vulnerability models, users can effectively navigate their communities, optimize scarce resources, establish success metrics, and monitor return on investment over time. Designed for everyday application, our tool helps users identify the most vulnerable members of their community and understand the reasons behind their vulnerabilities, ultimately fostering a more secure environment for everyone. This approach not only enhances preparedness but also promotes a proactive stance in community resilience planning.

The Amadeus Digital Care Record (DCR) offers a thorough solution that aims to give healthcare professionals a consolidated perspective of patient data right when it is needed. By merging information from various healthcare systems into a Health Information Exchange, the platform generates a comprehensive, up-to-date profile for every patient. This efficient methodology enhances clinical decision-making and boosts productivity, while also alleviating clinician fatigue by minimizing redundant tasks. Furthermore, the Amadeus DCR incorporates analytical tools and care coordination features, which play a crucial role in promoting improved patient outcomes by detecting risks at an early stage and facilitating effective care throughout the entire patient journey. Ultimately, this integrated system not only optimizes workflow but also fosters a more patient-centered approach in healthcare delivery.

There is a more secure approach to handling risk management. Our population health service enables you to effectively coordinate care and engage with patients, allowing for the seamless management of population groups of varying sizes across different electronic health records (EHRs). The newest advancements in healthcare extend beyond traditional medicine: population health management tools assist large medical practices in maintaining connections and engaging with patients, facilitating the management of populations—regardless of size—across various EHR systems. Ensure you remain linked to the essential data necessary to oversee your patient demographics. By utilizing over 140 pre-designed reports or generating custom reports with our data visualization tools, you can reveal cost and utilization patterns within your population and pinpoint actionable insights to tackle them. Care managers can leverage adjustable, evidence-based resources to develop the appropriate care plan for each patient more efficiently. Additionally, automated outreach services empower you to connect with a larger number of patients and successfully address more care gaps with reduced effort, ultimately enhancing overall patient engagement.

Greenway aims to transform healthcare by providing top-notch solutions tailored for practices, patients, and communities alike. Their comprehensive, interoperable software platform is designed to meet the diverse needs of ambulatory care specialties while ensuring a superior client service experience. A dedicated team composed of clinical, financial, and technological experts is committed to offering solutions that empower clients to thrive in the dynamic healthcare environment. By prioritizing emerging client needs and integrating direct feedback, they continuously enhance provider experiences with innovative products and services. Their medical software for ambulatory practices is both reliable and user-friendly, promoting efficiency and ease of use. Adopting a client-centered approach, they offer a versatile suite of data-driven EHR, practice management, and revenue cycle solutions to help practices navigate industry shifts effectively. Greenway's commitment to integrating end-to-end EHR, practice management, and medical billing systems further establishes them as a leader in the healthcare technology sector. This holistic approach ensures that practices not only keep pace with changes but also excel in providing quality care.

When individuals are dealing with a common cold or managing long-term illnesses such as diabetes or heart disease, they frequently have inquiries and concerns that require attention, as well as guidance to help ensure they comprehend and stick to their treatment plans. Health Dialog presents a collection of tailored population health solutions designed to tackle these challenges, empowering your members to enhance their overall health while simultaneously decreasing costs. Our team of healthcare professionals provides personalized health coaching through targeted outreach to assist members in better managing chronic conditions, including asthma, diabetes, and heart disease. We pinpoint members who may be at risk of not following their treatment plans, identify the most effective ways to engage them, and offer education to promote consistent medication adherence. Additionally, your members can benefit from round-the-clock access to a live registered nurse who is available to deliver clinical advice, refer them to necessary services, teach vital skills, and provide pertinent educational resources to support their health journey. This comprehensive approach not only enhances member engagement but also fosters a more informed and health-conscious community.