Posts Tagged ‘HRA’

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.

HealthFitness Refines Population Health via Engagement, Tools and Technology

November 19th, 2013 by Jessica Fornarotto

Integrated health coaching continues to move the needle on population health management with interventions that keep the healthy, healthy without compromising the clinical support needed for high-risk, high utilization individuals. Dr. Dennis Richling, chief medical and wellness officer for HealthFitness, and Kelly Merriman, vice president of service delivery for HealthFitness, believe coaching offers a great opportunity to change the health status of a population.

In HIN’s special report, Integrated Health Coaching: Reducing Risk and Empowering Change across the Health Continuum, these industry experts detail HealthFitness’ move toward integrated health coaching, including the rules of participant engagement, the role of technology, and the range of self-management tools provided for participants.

Question: What strategies reach the population and increase engagement in health and wellness coaching?

Response: (Dr. Richling) One of the key strategies has been the use of an incentive that draws people toward the program. Incentives are fairly effective in getting people to do certain kinds of activities. If we provide an incentive for taking a health assessment, for instance, then we can engage them in a health advising session. We can take that external incentive and try to leverage it into an intrinsic motivation to go into our health coaching program. We see a better engagement rate when we offer an HRA, and when we provide screenings and advisement.

(Kelly Merriman) Engagement is also how long participants are choosing to engage with their coach. One of the main reasons we created our EMPOWERED Coaching program, or coaching across the continuum, is to more appropriately assign those individuals who have a chronic condition that is being well managed with somebody specially trained in lifestyle engagement techniques. Individuals working with our advanced practice coaches are much more likely to remain engaged with their coach because they’re focusing on those things that are most important to them.

Question: What is the role of technology in the various levels of health and lifestyle coaching?

Response: (Dr. Richling) We have developed a sophisticated algorithm that uses claims data and HRA data to decide which coach would be the best coach for the participant. The algorithm evaluates whether the individual has the appropriateness of care compared to chronic care guidelines, whether they are compliant to those guidelines, if they are having trouble with functions of daily living, and it also evaluates the risk for high cost in the future. These all go into identifying which professional coach would be the best fit for an individual. Technology continues to play a role after a person and coach are matched:

  • Assessment of risk is ongoing; HealthFitness’ data and technology platform can reassess a participant’s health status whenever new data becomes available.
  • Health coaches access a unique dashboard of participant-specific information via a proprietary HealthFitness technology platform. The technology populates a record with personal health risk factors, claims data, biometric screening results and previous contact with the coach and other program personnel, as well as complete activity and program information feeds.
  • The platform also displays a 360-degree interactive view of client-specific program options so the coach can reference participants to health management activities and programs from their employer, whether HealthFitness provides the services or not.

Question: What tools do you provide to your coaching participants to help them self-manage their conditions?

Response: (Kelly Merriman) We have a series of educational and self-management tools available for participants via their wellness Web site and/or the mail. For example, a coach can share documents and resources with a participant through a toolbox, which then integrates with the wellness portal. Additionally, participants are able to set up and track their focus area goals of interest. The coaching program has a mobile phone interface that allows users to track their progress remotely and stay in touch with their coach.

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.

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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Data Analytics Drive Population Health Management Design, Success

October 1st, 2012 by Patricia Donovan

data analytics

HRA's don't tell the whole story of population health.

Even though most companies spend an average of $10,000 per employee on healthcare costs, two-thirds don’t measure specific outcomes from health promotion programs, notes Patricia Curran, principal in Buck Consultants’ National Clinical Practice. Data analytics can help to close this disconnect, suggests Ms. Curran, who shared these findings during a recent webinar on Population Health Management: Achieving Results in a Value-Based Healthcare System.

How should companies measure ROI from health improvement efforts? By gathering population-specific data and relevant costs before launching a population health management (PHM) program and setting specific goals, she advises.

“Identify what’s important to you that’s going to show that your program is successful; whether it’s a decrease in healthcare or trend, decrease in healthcare cost, improved productivity, absenteeism. Determine four or five areas where you’re going to look for successful outcomes. And then set up your program so that you’re collecting the data that’s going to tell you whether those things are happening.”

Robust data analytics are the main underpinning of a successful PHM effort, Ms. Curran noted. In laying out a blueprint for PHM, she defined population health management as the management, integration and measurement of all health programs offered by an organization — a set of interventions aimed across the health continuum, from the healthiest employees or health plan members to those with catastrophic illnesses.

There are six types of data analysis that should form the PHM foundation, Ms. Curran said. These range from clinical data (e.g. biometrics or aggregate health risk assessment, or HRA data) to humanistic data, which encompasses satisfaction with the PHM program. Companies shouldn’t base an entire PHM program on HRA data, she cautioned; this data is self-reported and doesn’t necessarily tell the whole story.

Instead, companies should analyze data to identify the ‘at risk’ population, which is about 20 to 25 percent of the population that accounts for about 20 to 40 percent of the cost, Ms. Curran recommends. “These folks are not getting preventive care. They’re obese, they smoke, and they have other healthcare risks.”

Once the PHM program is designed, how should companies motivate the participants? That answer will be different for each company, she says. “Figure out what motivates the population: is it plan design, wellness incentives, or purchasing incentives?” For example, the raffling of a pair of tickets to a NASCAR® event, which proved a popular incentive at a trucking company, might not motivate a different population.

Similarly, tailored to the appropriate population, technology such as dashboards and smartphone apps adds a ‘fun factor’ to programs, she says, and can boost PHM success.

Also motivating is the creation of a culture of health in which management supports and participates in the PHM effort — one that employs robust communications and tools that not only help individuals to control their health, but also clarify cost (such as comparison tools and calculators).

Incentives still play a role in health and wellness improvement, but that role is changing, notes Ms. Curran. On the horizon, more rewards for the healthy, for such things as completion of preventive care. The social and behavioral issues of a population come into play in the design of incentives, she notes. These can include such elements as a supportive network, be they colleagues or management, and a focus on loss avoidance. “How badly does the individual want the incentive?”

Returning to the all-important factor of program ROI, Curran suggested that there are other areas to look at besides cost to determine the success of a PHM program. “Reduced cost is an important one, but it’s not the only metric. Other things may be increased efficiency, improved health status, outcomes and compliance, improved lifestyle behaviors, participation, changed opinions and interest, reduced turnover and improved company morale.”

“Programs for activities’ sake alone can’t and should not be sustained,” she cautioned.

More advice from Ms. Curran on population health management is available in this audio interview.

Health and Wellness Incentives in 2012: Participants Have to Hit Clinical Marks

September 13th, 2012 by Patricia Donovan

health incentives

Incentives in 2012: Rewarding Risk Assessment, Lifestyle Change

Showing up isn’t enough any more to earn a cash- or benefit-based incentive for health improvement, say respondents to HIN’s fourth annual Health & Wellness Incentives survey. Instead, employers and health plans are rewarding measurable achievements in health behavior change &#151 weight loss, smoking cessation, BMI reduction or other lifestyle changes that reduce an individual’s risk of developing or exacerbating a chronic (and costly) illness.

“That’s the future of population health management,” concurs Patricia Curran, principal in Buck Consultants’ National Clinical Practice. “Companies have developed incentive programs, but they’ve found that awarding incentives just for participating is not necessarily achieving the outcomes they want. Just taking the health risk assessment and the biometric screenings isn’t getting the results.”

While completion of a health risk assessment (HRA) remains the most heavily incented health improvement activity for the fourth consecutive year, according to two-thirds of survey respondents, more companies are incentivizing the lifestyle behavior changes of weight loss (57 percent) and smoking cessation (51 percent) than 2011’s favored activities of preventive screenings and participation in on-site wellness.

This makes sense, says Ms. Curran. “They’re making participants toe the mark. They have to meet certain health goals, and they’re going to be measuring that effort. They’re going to incentivize individuals for meeting those goals going forward. It’s a new trend — making people more aware of the importance of these health goals. [Companies] really want to see people getting results, so they’re going to be targeting things like weight management, tobacco cessation, BMI.”

In other survey findings, the use of texting to communicate incentive program details doubled in the last year, from 7 to 14 percent. Social networks and health portals also gained favor for this purpose. At the same time, more are relying on the more traditional communication modalities of work site flyers and table cards, a trend that has risen steadily from 61 percent in 2009 to 68 percent in 2011 to 84 percent this year.

“You have to leverage the right tools and techniques matched to those consumers or their preferences,” notes Jay Driggers, director of consumer engagement at Horizon Blue Cross Blue Shield. A key area of study for Driggers’s consumer engagement team is behavioral economics, which he refers to as “the carrots and the sticks, things that will motivate people to change their behavior or to do something.” Incentives fall into this category, he says.

The survey also identified a 2 percent increase in the awarding of incentives via contests and drawings, a practice reported by 57 percent of 2012 respondents. “In most cases, I think a lottery can be a cheaper option that will drive more participation than a one-to-one reward,” suggests Driggers, who recently outlined Horizon’s approach to consumer engagement in its patient-centered medical home initiative.

Other 2012 survey results:

  • The number of respondents reporting incentives program ROI of between 3:1 and 4:1 has doubled in the last 12 months, from 2.6 percent in 2011 to 5.3 percent this year. Program ROI of between 2:1 and 3:1 remained constant at 14 percent from 2011 to 2012.
  • The use of biometric screening to identify participants for incentive-based programs rose slightly in 2012 to 40 percent, up from 36 percent in 2011. Opt-in or self-registration remains the top identification tool, at 62 percent.
  • Group incentives lost some favor this year, in use by just 23 percent, versus 36 percent of 2011 respondents.
  • In new survey data this year, 20 percent extend eligibility for health and wellness incentives to domestic partners.

For more survey highlights, download the executive summary of Health & Wellness Incentives in 2012: Rewarding Risk Assessment, Lifestyle Changes. A detailed analysis of these metrics, including year-over-year trends, is provided in 2012 Healthcare Benchmarks: Health & Wellness Incentives.