Posts Tagged ‘Health Risk Assessment’

Infographic: The Impact of Social Determinants on Health

July 6th, 2016 by Melanie Matthews

A range of personal, social, economic and environmental factors contribute to individual and population health, according to a new infographic by Healthy People 2020.

The infographic examines high school graduation rates by ethnicity/race and the impact of a quality education on health.

When success in a fee-for-value reimbursement framework calls for a care coordination vision focused on the highest-risk, highest-cost patients, an organization must be able to identify this critical population.

2016 Healthcare Benchmarks: Stratifying High-Risk Patients captures the latest tools and practices employed by healthcare organizations across the care continuum as they risk-stratify patients and health plan members in preparation for care management.

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2016 Population Health Management Snapshot: Most Interventions Telephonic and 9 More PHM Trends

May 19th, 2016 by Patricia Donovan

Most population health management interventions are conducted telephonically, according to HIN's latest PHM metrics.

The majority of outreach in the burgeoning field of population health management is delivered telephonically, according to 84 percent of respondents to an April 2016 Population Health Management (PHM) survey by the Healthcare Intelligence Network.

This third comprehensive PHM assessment also determined that data analytics use in population health management continues to rise, though more slowly than it did from 2012 to 2014, when EHR and registry use tripled.

Additionally, the survey found that 70 percent of respondents have committed to population health management, up from 56 percent in 2012. At the same time, many lament payor reluctance to cover essential PHM services like health coaching and group visits they see as critical to PHM success.

To accrue clinical and financial gains from PHM’s data-driven, risk-stratified care coordination approach, 90 percent provide chronic care management (CCM) services, a strategy that results in PHM ROI between 2:1 and 3:1 for 12 percent of these CCM adopters.

In condition-specific PHM metrics new for 2016, diabetes tops the list of health targets for PHM interventions, say 88 percent.

A health risk assessment (HRA) remains the primary instrument for identifying individuals for PHM interventions, say 70 percent, up from 64 percent in 2014.

Also paramount to PHM success under value-based healthcare reimbursement is strategic oversight of the ‘rising risk’— individuals with two or more unmanaged health conditions. One quarter of 2016 respondents focus PHM attention on their ‘rising risk’ populations, the April 2016 survey determined.

In recent years, population health management (PHM) has ranked as the healthcare space richest with opportunity, according to HIN’s annual industry trends snapshots.

Download an executive summary of 2016 Population Health Management survey results.

Community ‘Feet on the Street,’ HRAs Improve Dual Eligibles’ Health

January 14th, 2014 by Jessica Fornarotto

A local approach — the integration of public health with managed care — is what a lot of states and CMS are starting to look for, explains Pamme Taylor, vice president of advocacy and community-based programs for WellCare Health Plans.

In HIN’s special report, Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes, Taylor describes some of WellCare’s efforts to connect its dually eligible population to health services, including making contact, identifying services for each member and assessing health status via health risk assessments (HRAs) that are part of these community services.

Question: What is WellCare’s strategy and practice for contacting dual eligible members and ensuring follow-through with recommended referrals to community support services?

Response: This question is two-fold; first, how do we reach the members and get them engaged? And second, how do we verify that services were rendered? For members, we have street teams that go out into the community investments. We also have community health workers on our interdisciplinary team. It’s their job to connect with our members on a face-to-face basis while also connecting them to community supports. It’s through that model that we heavily rely on engagement and connectivity, etc.

Our first line of outreach is through the phone; our second line is through the community health workers and the individuals that are ‘feet on the street.’ And then, how do we verify that services were rendered, and how is that data collected? We have a command center, which is the warehouse of all that information, and then the social service electronic health record (EHR), which bolts onto the member’s medical record. That process produces a provider roster that we then put into the hands of our field teams, who use that as part of relationship management, much like a provider relations representative would use in their engagement with the primary care physician (PCP). We meet with them on a regular basis to confirm that services were rendered, and review the successes.

The secondary piece to that is our case managers also reach out to the members that they have referred to services and activities. They verify through the members they received it and their level of satisfaction. So there’s two points of feedback: one from the provider themselves and one from the member.

Question: How do you identify community services to meet members’ needs?

Response: It’s similar to the United Way 2-1-1 directory. We did community health needs assessments, which identified a number of different needs. And using epidemiological information, we come at it in terms of identifying the need, and then determining the service model. Then we took it a step further and asked, ‘How do we define the services so it’s a blend between public health, social supports and managed care terminology?’

We use about 67 different categories of social supports. We turn that into research. We go ‘feet on the street’ to canvas the neighborhoods to make sure that we have all of the organizations represented. Then that’s put into a ‘pend’ status in our databases and it is vetted on a secondary level of review by our team of liaisons. Once it’s vetted and confirmed, it’s then put into the final database, which is used for searching by our case managers. It’s a combination of public health practice using both public health and managed care terminology.

There is no magic number of categories or organizations. No one’s ever systematically inventoried or catalogued the network of social services. That’s what we’re hoping to do — explain and quantify what organizations exist, then identify their service area, their reach, their service portfolio, and the volume of connectivity that the health plans have with these organizations for specific services. It’s an exciting time.

Question: What other components of the comprehensive health assessment are administered to the duals as they come on board?

Response: A number of different factors go into the HRA that’s completed. There are health factors, socioeconomic factors, living environment, and activities of daily living (ADL). What are their social needs, what are their social supports, etc.? There’s a whole number of different tiers of questions that we ask as part of the HRA. We use very specific tools that are either state-dictated or guidelines produced by the state or in partnership with CMS. It depends on which side of the equation that we’re being contracted for, and it depends on what’s already in existence.

HINfographic: Risk-y Business – HRAs Take Temperature of Population Health

December 2nd, 2013 by Jackie Lyons

Seventy percent of healthcare organizations use health risk assessments (HRAs) to measure health risk factors, according to a recent 2013 HIN survey.

The individuals most eligible to take HRAs include employee and health plan members, spouses and dependents over 18, according to a new infographic from the Healthcare Intelligence Network. This infographic also provides metrics on HRA completion rates, target populations, HRA formats and contents, and HRA inputs and outputs.

Risk-y Business - HRAs Take Temperature of Population Health

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You may also be interested in this related resource: 2013 Healthcare Benchmarks: Health Risk Assessments.

Risk Assessment, Case Management Help to Improve Dual Eligibles’ Health

April 30th, 2013 by Jessica Fornarotto

“When you look at some of the characteristics of the dual eligibles, in the under 65 population, 66 percent have only a chronic condition and have no functional impairments. But as you move up to the older ages, there’s fewer frailty and a bit more of the chronic conditions,” according to Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. SCAN has a strategic approach to serving the dual eligible market, and Dr. Schwab recently discussed how they get this population to complete health assessments as well as the role of case managers in deciding who needs nursing home services. He also discusses how case managers work with the most extreme health condition cases.

Question: SCAN-risk stratifies individuals to determine those at highest risk, using HRAs, claims data and other assessment tools. How does SCAN encourage or incent completion of HRAs and other assessments in what can sometimes be a transient or hard-to-reach population?

Response: Getting completion of the HRA instrument is a challenge in any population, but more so in a very diverse population like the dually eligible. We initially mail our HRA to all new members. Then we follow up with reminder postcards. If we still don’t receive a response, we have a shortened risk assessment form that we ask them to complete through telephonic interactive voice response (IVR). Even with that, we still probably have a 30 percent failure rate to get the HRA done in a timely fashion.

We try to supplement that with information from our physicians. On the first visit to the physician, we can gather information and ultimately supplement it with our claims data on both the medical side and importantly the pharmacy side. We get a lot of valuable information, which makes up for people who don’t complete the HRA.

There are two groups that usually don’t complete it. The first is the group in long term institutions, like nursing homes. There’s a low response rate there. We also have a lower response rate in populations with mild dementia who are living on their own. But we also have a fairly low response rate from very healthy individuals. It’s important to recognize in the dual population that there are a group of duals that are relatively healthy. The only reason they’re a dual is because of financial conditions qualifying them for that. They could be out and about and just not concerned about completing the HRA.

We do not currently provide incentives for the general population to complete the HRA. We have tried some minor incentives with subsets of the population; for example, years ago with our diabetic population we offered a small gift of a foot care program if they completed a mini risk assessment. But in general, we haven’t found it effective.

Question: What percentage of your dual eligibles require disability support and what particular challenges would a case manager working with this subset of beneficiaries encounter?

Response: For our over 65 dual population, about 40 percent are what we classify as nursing facility level of care, or individuals who live in the community but have deficiencies in usually three or more activities of daily living (ADLs). They are frequently getting services for some of those deficiencies and are at high risk of ending up in a nursing home for long-term care, unless interventions are placed.

Of that 40 percent, probably about half are getting some sort of home-based services that are non-Medicare covered; things like personal care, homemaking, bathing assistance, and transportation assistance. For our case managers to make these assessments, do the in-home visits, and develop a care plan, we focus on hiring social workers, geriatric social workers and geriatric nurse practitioners. We spend a lot of time training them, both in how to identify the needs in the home, and how to identify the needs when talking with the caregiver, who is frequently an important part of this conversation.

We also offer on the job training for working with the rest of the team when they present these cases at our team meetings and the interdisciplinary care team meetings.

Question: How can care managers work with the most extreme cases that have multiple physical health and behavioral health, chronic and acute conditions?

Response: Those are the tough ones to work with. The first step is to find the right care manager for that individual. For example, if the primary issue is behavioral health, choose a care manager that excels in behavioral healthcare. That care manager then works with others to resolve the other issues. These people will require more time. You may also need to engage the help of the personal care workers or those in the home, so that they become both the physician and the care manager’s eyes and ears there. Teach them ways to pick up very subtle changes or differences in that person so that you can quickly provide new interventions if the person starts to show signs of deterioration. It’s a classic example of ‘one size doesn’t fit all;’ if your model says we will contact an individual monthly, some may need weekly and some may need daily contact. You may need to figure out ways to get that contact in an easy, efficient way for that individual.

Power of Extrinsic Incentives Sometimes Elusive

April 23rd, 2013 by Jessica Fornarotto

Webinar Replay: Health and Wellness Incentives: Positioning for Outcome-Based Rewards

“It’s important for companies to keep their options open when offering incentives, especially since the impact incentives can have on people could be a mystery,” explains John Riedel, president of Riedel & Associates Consultants, Inc. “Sometimes it’s the value of the incentive that can affect an individual’s engagement in a health and wellness program.”

HIN spoke with Riedel prior to his presentation during the webinar, Health and Wellness Incentives: Positioning for Outcome-Based Rewards. Riedel discussed how the rise in the cap on how much employees can receive in 2014 will impact program participation, how to address those older employees who could have difficulty with outcome-based incentives, and if companies should move toward programs with only outcomes-based rewards.

HIN: The cap on how much employees can either receive as a reward or be penalized is set at 20 percent of the total healthcare premium, or about $1,120 for the average employee. When this limit is raised to 30 percent in 2014, how might this affect participation and adherence, and on the structure of incentive plans overall?

(John Riedel): It’s 20 percent now, going to 30 percent. And for smoking cessation programs it’s going to be at 50 percent. An increase from 20 to 30 percent is not going to make a big difference. Employers are going to have more leverage with their total dollars that they can offer for either incentives or disincentives on the extrinsic side of incentives and disincentives. Certainly, innovative companies are going to find ways to use the additional dollars in creative and unique ways. On the whole, I don’t think it’s going to make a big difference with participation — getting people into programs and keeping them engaged. But I do think it’s important.

One of the issues that we have to contend with is incentives, and extrinsic incentives are important. Keep in mind though that we don’t know much about the same power that extrinsic incentives provide. We know that incentives can get people engaged in programming. They typically do well when you’re trying to get someone involved in a discrete program, like completing a health risk assessment (HRA). Though, we don’t know if incentives have a strong impact on people who are now engaging in healthy behaviors. It’s a complicated relationship and we have to be somewhat cautious in how we look at that.

Also, be careful when talking about outcome-based extrinsic incentives. There are going to be some employees who are typically older and maybe less educated. There could be employees who are higher risk who may have a harder time getting to those incentives, and perceive the incentives in an unfair way. We want to be careful that we don’t alienate people. The whole point is to motivate people.

The amount of the reward is not always a predictor of healthy change. Kevin G Volpp conducted some research on smoking and found that a $750 incentive doubled the number of people in the incentive group in terms of quitting smoking, and that’s a great outcome. But 36 percent relapsed over the longer term, which is significantly higher than usual relapse rates. That’s something we need to take into account. The interesting thing in that research is that they asked the people who actually quit smoking if they would have quit for less money. Eighty-seven percent of the quitters said they would have.

So yes, I think that raising the limit is helpful. The larger incentives you have, the more creative you can get. But at the same time, we don’t know enough about extrinsic incentives to know how that’s going to play out down the road.

HIN: Should companies be moving toward a program of only outcomes-based rewards?

My notion is that it should be built into an overall incentives offering. I know that there are companies who are moving toward outcomes-based rewards and that makes sense. But again, we still don’t know much about the impact of incentives, especially on the moderate to longer term behavior change component. It’s a complex issue and it’s important for companies to keep their options open.

With outcome-only rewards, you may have more of an issue regarding those people who have a harder time getting that outcome. You don’t want to create a non-compliance issue on the part of people who feel that they can’t get where they need to be. Find a way to make the incentive program fair to all. Be creative with using incentives for basic participation and for progressed-based incentives as well as outcomes-based. Create a package; each has advantages. We know that small rewards can be very powerful and have an impact on individuals. So it’s important to keep options open. A good approach when talking about outcome incentives, is to say, “If you do this,” and we lay out the criteria, “this is what you’re going to get in return,” and that makes sense. People want to know what it means for them and what they can do in order to get a certain incentive.

At the same time, in the field of behavioral economics, it’s very interesting. They suggest that sometimes, now that you’ve done this, here’s a reward for you, without letting people know in advance what you’re going to get. There’s a power in that approach as well. In other words, make sure that you provide rewards that employees understand. They know they’re going to get something, but at the same time, try some unique and creative approaches as well.

Progressed-based is important. We’re trying to change people’s behaviors. If we focus only on outcomes incentives, our concern is that when you provide extrinsic incentives — money — people often make a change, but they are often making it for the dollar and not for their health.

Make sure that you create an incentive program that includes simple items — gift cards and t-shirts work in some cases — to help people move along. And then offer outcomes-based incentives for people who are taking their health seriously. Make sure that everyone can get something and make it more challenging as you go down the road.

6 Data Analytics Driving Successful Population Health Management

April 2nd, 2013 by Jessica Fornarotto

population health data analytics

Webinar Replay: Achieving Population Health Management Results in Value-Based Healthcare

The development of a successful population health management (PHM) effort starts with the data and the data analysis, states Patricia Curran, principal in Buck Consultants’ National Clinical Practice. Curran describes the role of data and data analysis, the six critical PHM data areas, and the “influences” and the “influencers” that affect a population’s road to better health.

Where are we today and where do we want to be in the future? All of the data that you can gather is carefully evaluated to consider several points: the culture of the company and the employees, the business objectives, the health literacy of the population, compliance and risk scores and the utilization trends.

Data is essential to understanding the population you wish to manage and designing programs to meet the needs of a specific population. Buck Consultants takes all the raw data that we can gather, analyzes it, and transforms it into knowledge. The ‘aha’ moment is when it all comes together and we use it to build a strategy for an organization’s PHM program. It’s important to use your own data to identify the population’s specific needs and target your program to those needs. There are six areas that form the foundation for a successful PHM program:

  • Clinical data is biometric data or lab data, and possibly health risk assessment (HRA) data, that helps identify risks and cost drivers and is used to monitor the program’s success.
  • Utilization data would be the utilization patterns. For example, how are people accessing their healthcare?
  • Adherence is beginning to replace the word ‘compliance.’ This refers to how well members and providers are adhering to evidence-based medicine guidelines. Are they filling their prescriptions consistently? Are they getting preventive care?
  • Operational data is participation data, productivity data, disability data and other information that helps to monitor and develop the programs.
  • Financial data shows how this healthcare activity that you’re offering translates to dollars and opportunities for real hard dollar savings. This data is key in order to get senior management support and finances to continue the program.
  • Satisfaction data is necessary to monitor how participants and your key stakeholders view your efforts.

Part of the data analysis also includes identifying all the things that influence the decisions people are making and the influencers that are affecting what you’re trying to accomplish. For example, influencers might be spouses, family members, friends, healthcare providers, and employer management staff. Influences might be a fear of financial issues, ignorance, indifference, and inconvenience.

Take this scenario as an example: an employer may have a goal to increase the level of mammogram participation or people getting mammograms on a regular basis. They bring in a mobile unit to provide on site mammograms. But after they do this, they find that there is still no change with mammogram compliance. They will then go back to their employee population and discover that the reason they didn’t have any improvement was because the supervisors on the line didn’t allow people off the line to participate. The line supervisor is the influencer that needs to be identified and rectified before there’s going to be any change.

37 Population Health Management Benchmarks

December 26th, 2012 by Patricia Donovan

Contemplating a comprehensive population health management (PHM) program in the new year? The following data from 2012 Healthcare Benchmarks: Population Health Management may help to shape your initiative. The report analyzes PHM trends for 102 companies, including program prevalence and components, professionals on the PHM team, incentives, challenges and ROI.

Of those 102 respondents, 62 identified their organization type. Of those, 23 percent were disease management/health coaches, 14 percent were health plans and hospital/ health systems, and 8 percent were employers.

Organizations were surveyed in September 2012.

• Organizations that have a PHM program in place: 58 percent

• Organizations that don’t have a PHM program in place but plan to launch one in the next 12 months: 36.4 percent

Areas covered by PHM program:
Health promotion and wellness 83.3 percent
Health risk assessment 68.8 percent
Care coordination/advocacy 60.4 percent
Disease management 75 percent
Case management 66.7 percent
Other 16.7 percent

Populations served by PHM program:
Commercial 85.4 percent
Medicare 47.9 percent
Medicaid 41.7 percent
Uninsured 22.9 percent
Other 14.6 percent

Health risk levels served by PHM program:
All 71.7 percent
Healthy 6.5 percent
Moderate risk 26.1 percent
Complex (5 or more conditions) 19.6 percent
Other 0 percent

Health professionals on the PHM team:
Primary care physician 59.6 percent
Specialist/other provider 36.2 percent
Nurse practitioner 40.4 percent
Case manager 63.8 percent
Registered dietician 34 percent
Health coach 55.3 percent
Pharmacist 31.9 percent
Social worker 34 percent
Other 23.4 percent

Primary method of determining intervention level:
Claims data 33.3 percent
Chart review 8.9 percent
Pharma data 0 percent
Health risk assessment 15.6 percent
Biometric screening 6.7 percent
Electronic health record 8.9 percent
Registry 6.7 percent
Self-report 8.9 percent
Physician referral 2.2 percent
Other 8.9 percent

Infographic: Health Data in One Drop

November 16th, 2012 by Patricia Donovan

A drop of blood can provide a rich picture of an individual’s health state — risk of heart attack, cholesterol levels, likelihood of pre-diabetes, and much more. This infographic from WellnessFx illustrates the health information stored in a drop of blood, valuable biometrics for disease self-management and health risk assessment.

Health Data in Blood
Courtesy of: WellnessFx

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