Population Health Management

Manage all aspects of health from wellness to complex care.

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Scaling Population Health Management using Automation

To better manage all aspects of health from wellness to complex care, healthcare delivery organizations are increasing their focus on raising the quality of care, improving care coordination across all care settings, and applying this approach over a much longer period than that of a single episode of care. The population health management (PHM) model goes beyond treating only those patients in need of immediate care; instead it helps physicians assess their entire population and stratify it into various stages across the spectrum of health:

  • Those who are well need to stay well by getting preventive tests completed
  • Those who have health risks need to change their health behaviors so they don’t develop the conditions they’re at risk for
  • Those who have chronic conditions need to prevent further complications by closing care gaps and also working on health behaviors

Technology can be very helpful in assessing and stratifying patients and targeting interventions to the right people. Automation provides a more efficient and effective way to do population health management and performs much of the routine, time- and labor-intensive work in the background for physicians and their staffs.

  • Outreach - combines an electronic registry and evidence-based guidelines with an automated method of communicating with patients who are overdue for preventive and/or chronic care services.
  • Care Coordination – Generates actionable reports that help care teams identify gaps in care, better manage chronic conditions and optimize pre- and post-visits.
  • Quality Reporting – Uses a sophisticated rules engine that can incorporate disparate types of data with evidence-based guidelines, generating reports that provide many different views of the entire patient population that can be filtered by payer, activity center, provider, health condition, and care gaps.
  • Patient EducationProvides digital educational materials tailored to patients’ conditions and directs them to appropriate self-help programs.

How Phytel’s Solutions Support Population Health  

Phytel offers an integrated suite of services that strengthens the vital connection between patients and providers, increasing the efficiency of healthcare delivery and improving outcomes. Our solutions allow physicians to follow each patient throughout the entire continuum of care by supporting powerful, coordinated healthcare teams that can engage, motivate and treat every patient at the highest level possible.

Phytel Outreach™

Phytel Outreach

Phytel Outreach™ is an automated service that determines the need for recommended care and communicates to patients according to evidence-based guidelines.


  • Identify patients due for recommended care
  • Automatically notify patients through automated messaging
  • Track patient response and monitor compliance

Phytel Coordinate™

Phytel Coordinate

Phytel Coordinate™ automates your care management process empowering your care team to take action 


  • Identify care gaps and implement the most appropriate intervention
  • Produce worklists to track and manage quality measures and initiatives
  • Generate pre-visit reporting to identify care opportunities before each encounter

Phytel Insight™

Phytel Insight

Phytel Insight™ provides a quality lens, delivering metrics that let you evaluate your organization’s effectiveness


  • Displays an integrated quality dashboard
  • Enables oversight of chronic and preventive care conditions
  • Lets you gauge practice effectiveness across facilities and providers

Phytel Engage™

Phytel Engage

Phytel Engage™ is a patient-centric suite of solutions that empowers patients to take control their own health — based on proven behavioral science principles.


  • Best-in-class tools and services actively engage patients in healthcare management
  • A seamless continuum of care supported by a connection between these patient-facing tools and the care team
  • A way to capture and compile self-reported patient information