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Resource Details


How to Use Population Health Tools to Stratify Your Population for Care Management

Year Developed: 2024

Resource Type: Archived Webinar.

Primary Audience: Administrative Staff C-Suite (CEOs, CFOs, CIO, COOs, CMOs, etc.) Clinicians PCAs
Secondary Audience: Enabling Staff

Language(s): English

Developed by: Renaye James Healthcare Advisors (RJHA) (See other resources developed by this organization).

Resource Summary: This webinar demonstrates how to use population health electronic tools to identify patients with chronic illnesses with an obesity (or elevated BMI) comorbidity. Having this information allows health centers to identify the patients who would benefit from care management, additional resources, and care coordination services.

Resource Details: The objectives of the training are to: 1) describe how to use a population health platform to identify elevated Body Mass Index (BMI) for at risk patients; 2) discuss stratification of care management patients based on comorbidities connected to elevated BMI; 3) determine how to use a population health tool to identify the appropriate care management level based on the risk stratification score; 4) recognize how to use a population health platform to communicate with care management patients for engagement; and 5) identify how to effectively measure and evaluate a care management program using a population health platform for data.

Resource Topic: Quality, Value-Based Health Care Transformation

Resource Subtopic: Quality Improvement, Patient-Centered Health Outcomes.

Keywords: Care Coordination, Chronic Diseases and Care, Data Collection, Management, and Analytics, Patient Education, Health Systems, Integrated Care, Non-Clinical Services, Obesity, Policies and Procedures, Screening, Team-Based Care.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,625,000 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit