Population Health

The SWHR approach achieves quality outcomes and lowers the total cost of care through innovative care models

Innovations in quality and care coordination

Our leading population health management approach helps deliver value by ensuring that patients have access to the right care at the right time and in the right setting. SWHR identifies what drives up costs across the healthcare continuum, then creates innovative solutions to standardize care, increase efficiencies and achieve quality outcomes. We use technology, predictive analytics and evidence-based care models to enable providers in our network to deliver optimal care. Designing healthcare for the future requires a focus on preventive care and appropriate utilization, which ultimately, reduces high costs or unnecessary expenditures — benefiting patients, providers, health plans and employers. 

The SWHR difference

"Using information and resources from our population health services, individual physicians and physician groups are supported in improving quality and safety, as well as reducing the total cost of care. This supports opportunities to build improvements of individual providers and groups, as well as the overall performance of the physician network."

— Jason Fish, MD, Chief Medical Officer

Case Studies

How SWHR creates value for patients, providers, health plans and employers 

By aligning provider incentives and mindsets, integrating data-driven insights and scaling evidence-based improvements, SWHR creates value in population health management. Our innovations range from partnering directly with employers to offering higher-value healthcare solutions to helping physicians respond to their patients’ needs in crisis. Here are five ways in which our approach succeeds:



News and stories

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How we deliver value by connecting care

Patient Navigation

Dedicated patient navigation teams help ensure patients are seen by the right provider. We have more than 200 employees in primary care practices and central call centers to ensure appropriate care transitions occur in a timely manner. This also ensures clinical information is transmitted in an efficient manner.

These programs work closely with hospital care transition teams and care management teams to ensure patient needs are met, and to support physicians and their care teams.

Care Management

Individual patients are not only members of multiple populations, but move among different cohorts as circumstances change. Because of this, we need both the close-up view of individuals and the wide-angle perspective of entire populations to see and manage these cohorts clearly and effectively. This provides added services to patients with highly complex conditions, chronic diagnoses, multiple comorbidities and those that may need help adhering to treatments.

Care Coordination

Our Care Coordination team includes skilled care managers, social workers, and pharmacists, who help identify patients with complex and chronic conditions. These experts collaborate to fill gaps between primary care services and patients’ care, offering resources related to coordination among multiple doctors, access to resources, long-term support, and remote monitoring.

Post-Acute Care

Post-acute care is a major factor in our costs and outcomes which is why we’ve established processes to mitigate/reduce the total cost of care for these patients. 

We offer a care model with providers selected to deliver care that even includes robust home health care services. This enables us to deliver the right level of care for the right reasons to patients both in and out of the hospital.