Population Health Management

Building Healthier Communities with Clinical AI

Population health depends on the ability of providers, payers and other stakeholders to understand the clinical and socioeconomic factors influencing and driving risks across individuals and the communities in which they live. Social determinants of health (SDOH), such as patients’ income level or access to food and transportation, have been estimated to account for up to 80% of a patient’s health outcome.1 The Jvion CORETM turns socioeconomic, environmental and behavioral data into real clinical value that drives higher engagement, more tailored interventions and greater alignment between community need and risk.

Jvion’s Population Health solutions enable:

  • Alignment of community needs to available resources
  • Understanding of hidden clinical risks driving avoidable adverse individual and community health outcomes
  • Action plans based on prioritized evidence-based recommendations
  • Improvement of quality and cost efforts
  • Analysis of community and patient population needs down to the US Census tract level

Transformative for care models, Jvion enhances their ability to effectively address underserved populations and healthcare inequities as well as improve community resource strategies, allocation and impact.


Key products for Population Health Management include

  • Avoidable ED Visit: All Cause
  • Avoidable ED Visit: CHF
  • Avoidable Admission: 30/60/90 days
  • Sepsis
  • Avoidable Admission: Diabetes

1. Modern Healthcare, “Social Determinants of Health: The Impact on Members, Health Outcomes and the Bottom Line.” modernhealthcare.com, 03/2019. Available: https://www.modernhealthcare.com/patient-care/social-determinants-health-impact-members-health-outcomes-and-bottom-line.

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Featured Product

Community Acquired Sepsis

According to the CDC each year in America, 1.7 million adults develop sepsis and 270,000 die as a result. Sepsis is a medical emergency that requires prompt treatment. Jvion’s Community Acquired Sepsis product predicts which patients in the ambulatory setting are at a high-risk to be admitted to a hospital related to sepsis in the next 12 months. Insights, delivered to clinicians and case managers within their workflow, can be used to identify and treat patients early, bolster their infection prevention and vaccine practices, and inform community campaigns to help educate the general population on the dangers of Sepsis.

Who We Help

Patient Impact Story

Addressing Socioeconomic Determinants Improves Overall Health

A 65-year-old male has lived his entire life in downtown Atlanta. He struggles with obesity, high blood pressure and diabetes, and can’t get around like he used to anymore. The closest grocery store is 2 bus rides away and it’s difficult for him to make the trip, so his only option is the corner mart 2 blocks from his house. Most days he eats a hot dog because they are 3 for $1 and some boiled peanuts because he can snack on them through the afternoon. Most dinners are frozen meals that can be quickly heated in the microwave. He has no idea he lives in what is called a “food desert” in the middle of a major city — until he gets a call from his doctors office saying he has been identified as eligible for a new fresh and healthy food program being offered from a Food is Medicine program by his local hospital.

His provider was able to identify him by using the Jvion CORE. Now, he gets a box of fresh and healthy food delivered each week, with recipes included. He has enjoyed cooking new things and has lost weight. He now feels better and can take the bus to go to the grocery store and to other places around town. He is thankful for the program.

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  • 470-427-2900, 3965 Johns Creek Court, Suite 100, Suwanee, GA 30024
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