Population Health
Monitor a patient’s care and take action with precise engagement to keep patients healthy or improve chronic conditions – no matter where the patient receives care
Sharing & Aggregating Data Across Your Network
Close care gaps and eliminate duplicate testing with a wide spectrum of data from labs, risk scores, paid claims, and external systems at your fingertips.
Sharing & Aggregating Data Across Your Network
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Understanding Contract Performance and Opportunities
How many care gaps do I need to close to hit my goals? Which service categories have the biggest opportunity for cost reduction? Use analytics to track and intervene on target metrics for your contracts.
Understanding Contract Performance and Opportunities
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Care Management Across the Continuum
Promote patient wellness with integrated health and social care tools. Assess patient needs, connect them to resources, and track their outcomes.
Care Management Across the Continuum
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Primary Care Visit Optimization
Prompt providers to review conditions and close gaps at the point of care to ensure conditions are well-managed and to accurately capture a patient's risk. Bring support staff and providers together in a morning huddle to provide collaborate on patient care and prepare for the day.
Primary Care Visit Optimization
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Social Drivers of Health
Help lower or remove barriers to health by addressing social drivers. Suggest programs and services provided by your organization or use a community resource directory to connect patients directly with community-based organizations.
Social Drivers of Health
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A critical success factor in improving the health of our patients is to identify those who need care the most. This is done by integrating claims data from payers with Epic. This approach allows us to risk-stratify populations and focus on high-needs patients, rising-risk patients, and patients who need basic wellness and prevention care (e.g., annual visits), or preventive care measures such as health screenings and flu shots. In addition, any care provided by Essentia is captured nightly to inform outreach through our care coordination platform, Healthy Planet.
—Debbie Welle-Powell, Chief Population Health Officer, Essentia Health
Drawing Meaning from Data: Making the Case for Population Health Analytics
Corewell Health won a HIMSS Davies Award of Excellence in 2024 for outcomes including decreasing ED visits and improving chronic disease management in a clinic that cares for a high-risk, medically underserved population.
Read the full article on EpicShare →
Helping People Stay Healthy and Housed with Whole-Person Care
The San Francisco Department of Public Health improved care coordination to provide a stronger safety net for people experiencing homelessness.
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From Food Deserts to Healthy Futures: The Case for “Food As Medicine” Programs in Disease Prevention
"Many of the patients we care for at Eskenazi Health live in food deserts with limited access to affordable, nutritious food due to a lack of nearby grocery stores. To help address this issue and other challenges affecting access to nutritious food for our patients, we established a comprehensive “food as medicine” program across the neighborhoods we serve. This program includes vouchers for our onsite and mobile food pantries, cooking classes, and counseling services to assist with SNAP benefits and nutrition education. In 2024, more than 10,0000 grocery vouchers were redeemed at our pantries, amounting to about $300,000 in assistance."
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Resources
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UserWeb Resources
Take a deeper dive into implementation and support documentation, education and training resources, and more on the UserWeb.
Roadmaps
See a high-level view of what Epic can do now, which new features are coming soon, and what the future holds.
