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Population Health

Population Health Management

VNSNY is a leader in Population Health Management and
is committed to clinical quality and innovation. Our approach
uses analytics and predictive modeling to focus on proactive,
person-centered care that reduces rehospitalizations.
This approach includes:
• Clinical Utilization Management
• Gaps in Care Management
• Chronic Disease Management
• Transitional Care Coordination
• Remote Patient Monitoring

Population Health is comprised of an interdisciplinary care
team including registered nurses who are trained
as certified Population Care Coordinators. They focus on:
• Engaging individuals in their own health through
education and coaching
• Providing longitudinal rather than episodic care to
manage disease-specific interventions and necessary
lifestyle changes
• Using EMRs and other technologies to promote more
timely reporting and sharing of data
• Coordinating care between and across providers
and settings
• Identifying community linkages

Service area: All five boroughs of New York City, Nassau,
Suffolk and Westchester counties
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