Conducting population health management is challenging for most health care entities. Doing it during the COVID-19 pandemic makes it exponentially more difficult.

Provider support of chronic care patients has been achieved via telehealth more over the past year than ever before. This is an exciting improvement, but it comes at a price – screenings for both adults and children have declined steeply due to the pandemic. According to the Epic Health Research Network, EHR data showed an abrupt drop of between 86 and 94 percent in preventive cancer screenings performed across the United States in spring 2020 compared to 2017-2019 historical averages.

Developing a New Approach to Population Health

Being able to manage a population during a pandemic takes, at the very least, a new strategy. That’s due to the fact that there’s new data available about the impact on health care of social determinants of health (SDOH). As realized during the COVID-19 pandemic, poor communities suffer more than their more affluent counterparts during a pandemic.

Discussions of population health management often focus on the analytics or interventions needed to carry it out. Although those are certainly relevant, there are three additional components that must be considered to successfully operationalize a population health strategy.


It’s no secret that the health care landscape can be fragmented and confusing for patients to navigate. A population health approach restructures that landscape by proactively engaging and managing patients. It anticipates needs from the patient perspective and addresses them in a timely manner.

In this approach, a patient is asking what they need to do and how it should be done. Without the proper support during difficult times, though, patients can become overwhelmed and abandon their better choices. That’s why effective navigation is not only key to successful patient outcomes but also positively impacts the patient experience by reducing anxiety.


It’s human nature to ask why something should matter to us. Therefore, patient education can be a long and difficult process. Being succinct in patient communication mitigates the possibility of a message getting lost in the noise. Similarly, education that is motivational and occurs at consistent intervals – not only during an in-office doctor’s appointment – is most consumable.

Behavioral Economics

This principle is centered on the study of psychology as it relates to the economic decision-making processes of individuals and institutions. By anticipating needs patients experience along the health care continuum, providers can proactively address those needs and build trust in the process.

Providers developing a population health strategy in the pandemic era should ask three key questions:

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