Are You Leveraging Population Health Management Correctly to Mitigate Claims Risk?

Steps in Constructing a Comprehensive Population Health Management Strategy

Often employers may take steps to uncover and proactively identify current and potential health risk (step 1), but then they don’t take the necessary next steps to better manage those risk in a more meaningful way. So, what do you do with that data to achieve better population health?

1. 1. IDENTIFY RISK: Before we get into the next steps, let’s review the first step mentioned above, which is gathering data from each covered employee. Health screenings provide significant benefits for employees and plan sponsors alike.

There are two options when performing health screenings and it’s important to be informed of the pros and cons of each before you make your decision on a biometric vendor.

• Carrier Directed: The first option is insurance carrier directed, which still provides a screening and often can be subsidized by the carrier. However, the carrier typically only shares aggregate data with the employer, making it impossible to analyze member specific risk within their employee population.
• Direct Vendor Contract: Option 2, an employer enters a direct contract with a laboratory testing facility which provides comprehensive reporting and allows a third party to analyze member specific data to identify risk within the employer population. By having member specific data, it allows the employer to work with their wellness vendor to create a more comprehensive population health program when layered with claims data and predictive risk analytics. Typically, this option is not subsidized and is a direct cost to the employer.

Privacy laws such as HIPPA block employers from directly accessing medical information about specific risks for specific people, therefore partnering with an independent population health vendor is required.

2. 2. ANALYSIS. Many times, data comes from different sources such as your claims data, health risk assessment surveys and biometric screenings. An analytical company uses technology resources that combine population health data to better identify gaps in care and predict future risk and costs. These efforts identify whether employees are at low, medium, or high risk for chronic conditions such as heart disease and diabetes.
   
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3. 3. DEVELOP A PROGRAM: Your next step will be developing your population health program that will consist of communication, resources, incentives, and outreach. Of course, not one size fits all and your specific program can be customized to fit in with your company’s culture and objectives.

• Communication: Once the risks within a population are identified it is important to begin addressing the chronic conditions that are impacting the health plan and more importantly your employees and their families. Employers should begin by creating a communication strategy to provide general communication to employees. Communication campaigns such as these should span over a calendar year and themed based on the time of year.
• Create a resource toolbox: In addition to educating your employees begin to evaluate resources and tools to aid them on their path to better health.
• Incentives: Unfortunately, we live in a world that demands people’s attention everywhere they are via social media platforms, text messages, family commitments, work, etc. Incentives can help direct your employee’s attention back to their health and mindfulness. The design of an employer’s wellness plan will often determine which federal law will apply.  It is important to consult a trusted advisor when designing a wellness plan.
• Outreach: Using the risk analysis data and communication strategy, your third-party population health coaches will do targeted reach out to your high-risk employees with the goal of scheduling 1:1 health coaching session. Their Health Coaches will work with them to identify attainable goals, review possible gaps in care, and develop a roadmap for success.

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5. 4. TRACK PROGRESS. A population health approach establishes a solid baseline for analyzing each member’s current status and for evaluating progress towards reducing those risks. Once the initial analysis establishes a starting point, ongoing reviews track progress towards health goals and indicate changes. For example, tracking the number of employees with diabetes not meeting their compliance metrics such as annual eye/foot exam, medication adherence and routine testing of their A1c.