Authors: Ahmed Shawky , Feda Ahmad Abdullah Almazawdeh . , Sami Alhasan Yousif

Abstract

Background: Chronic diseases represent a major burden, considering the associated cost, low quality of life, and high mortality rates. Thus, early screening and management are essential to reduce their burden. There is limited evidence on the implementation and scalability of integrated Population Health Management (PHM) models—particularly those combining risk stratification, telehealth, and community outreach—in Saudi Arabia’s private healthcare sector.

Objectives: To investigate the effect of implementing an integrated population-based health program in the private sector of Saudi Arabia.

Methods: The study was conducted at CARE Medical Al Rawabi (CMR) in Saudi Arabia in 2024.

 CMR employed a phased framework:
- Initiation and Preparation: Strategic goal-setting, resource allocation, stakeholder alignment.
- Execution: Clinical programs, outreach strategies, digital platforms.
- Evaluation: Ongoing measurement of clinical and operational outcomes.
Foundational pillars included feasibility through telehealth, partnerships, and scalability via adaptable care models for diverse chronic conditions.

Results: The accuracy of the risk stratification model was 85%. The cancer screening trend increased by 59% in the second half of the year. Hospital admission rates were reduced from 2.5% in Q1 to 1.7% in Q4. 68% of the patients had their HbA1c levels below 7%, while 70% of the patients had their BP levels < 140/90 mmHg. The program saved 2 million Saudi Arabian Riyals.

Conclusion:

Through advanced data analytics, targeted preventive care programs, integrated digital health tools, and robust community outreach, CMR demonstrates improved health outcomes, reduced hospitalizations, and cost-effective chronic disease management. The CMR case demonstrates that private sector entities can lead in advancing national health priorities through innovative PHM models.

Keywords: Transforming, Strategic Innovation, Chronic Disease, Management, Private Healthcare.