Module 9 · Population Health Intelligence · 9.1
Population Command Center
Portfolio origination — the population at a glance and where the next riyal of value-based contracting should go. Every tile deep-links into the stratification, segmentation, care-gap, outcomes, and opportunity screens.
Refresh cycle as-of 5 Oct 2027DISCOVER
2Opportunities
→ ORIGINATE2Contracts originated
→ VERIFY2Verifications running
Prospective Risk (RS-1) · 96,000 in-scope beneficiaries
Low 59,520Moderate 23,040Rising 8,640High 4,800
Rising-risk headline
1,340
members moved Low → Moderate over two quarters
New cardiometabolic diagnoses41%
Medication additions27%
ED utilization onset19%
Lab deterioration13%
Condition prevalence · severity strata (RS-2) — click for catchment splits
Type 2 Diabetes11,904
HbA1c <7.0 3,8107.0–8.0 3,1668.0–9.0 2,238>9.0 2,690
Eligible 3,240 → CT-2027-002
Hypertension20,736
Uncontrolled pool: 10,991
Controlled 9,745Stage 1 6,428Stage 2 3,525Crisis history 1,038
Eligible 5,860 → CT-2027-003
Depression & Anxiety9,408
Moderate+ pool: 4,798
Minimal–mild 4,610Moderate 2,916Moderate-severe 1,317Severe 565
Eligible 4,120 → CT-2027-004
MSK (OA 6,912 · LBP 16,224)23,136
Function bands 21,264Surgical-candidate-adjacent 1,872
Eligible 2,780 → CT-2027-005
Pregnancy (annual episodes)2,140
Standard risk 1,755High risk (18%) 385
Eligible 385 → CT-2027-007
Care-gap summary · 12,416 open high-yield instances — click to open the ledger
3,809
Diabetic retinal screening overdue
ADA 2024
2,140
Statin indicated, not prescribed
ADA 2024
1,905
HbA1c measurement overdue
ADA 2024
4,562
BP recheck overdue after elevated reading
ISH 2024
Pipeline-pending (Stage F)41%
PHQ-2 screening gap in primary care
APA 2023
—
Influenza vaccination due
Population screening standards