Population Health

Gain deep insight into your patients to understand and plan for population health interventions, including health equity and payment risk, by using the following products and solutions.


Community Health Profiles

Community Health Profiles support hospitals and their partners in the community health needs assessment process.  

  • Track summarized demographic and socioeconomic characteristics as well as hospital utilization based on the service area as defined by the hospital.  The variation in population demographics impacts the demand for services, as well as the preferences and available places for regular care.  
  • Use data that will assist hospitals and partnering agencies in describing the health of the local population, highlighting the major risk factors and causes of ill health for the population, and identifying priority areas for focus and community interventions.    


ChimeMaps uses advanced mapping techniques to provide analytic insights based on hospital, health, and population data.  

  • Hospitals use ChimeMaps for service line analysis, market assessment, intervention planning, and community health needs evaluation.
  • ChimeMaps is a primary tool in conducting community health needs assessments, as it provides timely, relevant data that illustrates the true burden of health issues in the community.  This empowers hospitals to target health outreach and interventions that result in reduced avoidable readmissions and a measurable improvement in community health.


Gaps in Care

As part of managing the health of a population, this solution allows hospitals to pinpoint areas for improvement across the continuum of services.  
Leveraging advanced analytics and methodologies, including predictive modeling, this solution encompasses condition-specific algorithms.   
To optimize care delivery, this solution can be used to identify potential gaps in care that combine a patient’s chronic disease profile with:

  • Excessive utilization to streamline appropriate primary or preventive care.
  • Prevention Quality Indicators, which can be used to identify ambulatory care-sensitive conditions.
  • Population summaries and comparisons are included in this tool as well as patient-specific data to support the deployment of highly targeted, disease-specific, informed outreach.

Risk Stratification

Risk Stratification is a patient-centric solution that assigns risk scores to individual patients based on the number and types of diagnoses they exhibit.

Hospitals can:

  • Understand healthcare utilization within the population, identify trends, and compare to benchmarks.
  • Assess opportunities for risk mitigation and gain sharing.
  • Define target caseloads and provide insights to help with the allocation of resources for care coordination.