Health plan executives' top population health priorities

Here's how four plans are using the management strategy to improve quality, reduce costs.

We asked four health plan executives what their organizations are doing to make the most of population health management. Here's what they said.

Independence Blue Cross - Donald Liss, MD, vice president for clinical programs and policy at Independence Blue Cross, the largest health insurer and managed care organization in the Philadelphia region.

Managed Healthcare Executive (MHE): What are some of the most exciting population health management initiatives taking place at your organization?

LissLiss: Over the last decade, Independence Blue Cross has moved from a centralized approach aimed at direct outreach to our members mainly through call centers, to organizing our networks (doctors and hospitals) to include population health management as a fundamental component of their work.

In addition, our role has expanded to leverage the valuable patient information we collect in the ordinary course of our operations, such as claims and lab data, and making this available at the point of care to physician practices and health systems that have become accountable for clinical and financial outcomes.

Further, we are aligning our benefit designs to create incentives for our members to be more receptive and engaged in their own care. If we do our job right, our payment models, our information resources, and our plan designs will mutually reinforce one another.

MHE: What are some of your population health management plans for 2016?

Liss: Promoting our High Value Care program is a top priority for 2016. This program identifies specific opportunities for primary care physicians in our network to address identified gaps in care, and to do that in the most cost-effective ways.

These doctors are eligible to receive significantly enhanced payment for their efforts.  Primary care practices also are eligible for financial incentives for team-based care that helps deliver better results across the populations they serve.

We regularly provide clear, actionable reports as well as point-of-care messaging to doctors, which integrates population health management into their everyday activities.

We continue to champion the Patient-Centered Medical Home as a durable model of care and the foundation for an accountable healthcare system.

MHE: What are your top population health management tips for healthcare executives?

Liss: Population health needs to be an integral part of the physician’s business; it can’t be a separate exercise relegated to the quality management department. If population health management isn’t reinforced in how we compensate doctors, how we provide information, and how we design benefits, it will always be a stepchild.

Next: CareSource's population health priorities



CareSource - Bob Gladden, vice president of the center for analytics at CareSource, a nonprofit Medicaid organization with nearly 1.5 million members.

MHE: What are some of the most exciting population health management initiatives taking place at your organization?

GladdenGladden: CareSource has recognized the importance of population health management and shifted programs away from more traditional disease-focused approaches toward those that are holistic and centered on the entire member, not just a specific diseases or condition. 

We first began this journey in 2007 introducing Member Profiles to providers, delivering daily updated summary and detail data about each of our members that could be used to better inform clinical decisions.  We have since moved to more sophisticated predictive models that stratify members into clinical personas. These personas look at both the member’s current and anticipated medical needs and arrange them into categories such as Complex Managed, Uncoordinated Care or Acute Kids & Adults, to name three. 

Our entire population is now being moved into a care management model we call Care4U that offers an appropriate level of care management option for all, not just the sickest 1%.

MHE: What are some of your population health management plans for 2016?

Gladden: As we roll out the CareSource Care4U model, we also are moving toward incorporating more analytic and predictive components into our programs.

We have a daily predictive model in production that looks at all members admitted to the hospital and at the moment of notification of admission, predicts the likelihood of a hospital readmit. The team reaches out to those members who reach a certain threshold score before they are discharged from the hospital if possible, in order to reduce the likelihood of a readmit. 

We are developing a similar model for emergency department usage and look to incorporate extensive socioeconomic data into models, to further strengthen predictive capability. 

We also are looking forward to the states' inclusion of mental health in managed care services for Medicaid, knowing that mental health challenges strongly affect our members’ health, not just mentally, but physically. This will provide a much more complete population health view and allow for more comprehensive member care.

MHE: What are your top population health management tips for healthcare executives?

Gladden: It is no longer optional that there be a focus on population health.  This requires two major shifts for a company. The first is care management leadership that is able to move the team away from traditional single disease focused programs. Too often the approach in the past for care management has been the same as it has been for the delivery system, divide the body up into various parts without regard to the complete person. This is one of the reasons we have a renewed focus on Patient-Centered Medical Homes. Equally, we don’t want to divide up a person by their various diseases, enrolling a member in four separate disease programs. A comprehensive program considering all the conditions of a member yields better results with higher satisfaction. 

Secondly, it is no longer optional that you have a dedicated analytic team to create insights for your organization. This needs to include how your organization will customize population health for your membership.  You certainly can move toward products in the marketplace that will get you part of the way, but it does not allow for differentiation from the next company that purchases that same product.  As more and more data becomes available, it is critical that resources not only be focused on capturing and storing that data, but also centered on the insights, that are the purpose of collecting data in the first place.

Next: UPMC's population health priorities



UPMC - Donna J. Keyser, PhD, MBA, associate vice president, UPMC Center for High-Value Health Care, a unique nonprofit research enterprise that integrates the perspectives and experiences of patients, payers, providers and policymakers with academic training and expertise in order to achieve the triple aim of better and more efficient care and enhanced patient experience.

MHE: What are some of the most exciting population health management initiatives taking place at your organization?

KeyserKeyser: In collaboration with our employer, provider, and community partners, the UPMC Insurance Services Division is currently implementing multiple population health management initiatives that support our members in better understanding and improving their own health and care. Some examples:

  • UPMC MyHealth and the “Take a Healthy Step” (TAHS) platform offer an incentivized, highly personalized health management experience for our members. Based on the results of a health risk assessment, TAHS identifies risk-reducing activities tailored to a member’s specific needs, preferences, and values and incentivized through a deductible health insurance credit or virtual marketplace rewards.

  • The Employer Health and Productivity Roadmap creates a framework of shared accountability for both employers and their health and productivity partners to implement and monitor actionable measures that improve health, maximize productivity, and reduce excessive medical costs.

  • Recent enhancements to our Patient-Centered Medical Home program, including Shared Savings with participating practices, and our “Prescription for Wellness” program, which allows providers to write a prescription via the EHR for members to participate in health plan care management and/or coaching programs, serve to improve access to high-quality primary care, strengthen patient-physician relationships, and promote greater member engagement in positive behavior change.

  • These trends are further reinforced by an array of digital health resources, including a Cost & Quality Transparency Tool, a Health & Wellness Selector Tool, a “Wiser Together” Decision Support Tool, 3Ci Mobile SMS texting covering various lifestyle, condition management, and other relevant health topics, and mobile applications designed to positively impact access, cost, and quality for the health plan and our members.

  • Given the critical need to address social determinants of health for important population subgroups, community teams of nurses, social workers, and community health workers collaborate with social service agencies in providing integrated care management for our high-risk members in their homes and communities.

MHE: What are some of your population health management plans for 2016?

Keyser: In 2016, UPMC will continue to build on our data analytics, technology, service delivery, and community infrastructure in order to better characterize, understand, and address health risks across our population.

Targeted, individual-level solutions for improving health behaviors, such as our new online digital coaching program for stress management and other lifestyle issues, will be integrated with UPMC MyHealth Online and help to inform our risk stratification process as well as support our incentivized wellness programs.

In collaboration with our provider partners, we will continue to explore new clinical programs and service delivery models, such as an intensive lifestyle disease reversal program and specialty medical homes, that address the root causes of costly chronic diseases and promote access and care coordination for our members with complex needs. At the regional level, we will be working closely with various community-based organizations to ensure that our members’ efforts to better manage their own health and healthcare are fully supported in the environments in which they live, work, and play.

MHE: What are your top population health management tips for healthcare executives?

Keyser: For hospitals, healthcare systems, and other healthcare organizations seeking to better manage the health of their employees and the populations they serve, we suggest:

  • Investing in the development of a robust analytic/technological/digital infrastructure in order to ensure timely and relevant information sharing and communication among all key stakeholders.

  • Championing incentivized workplace wellness and chronic disease prevention and management programs as an industry norm for improving total health and productivity of the workforce.

  • Leveraging consumer and provider incentives to fully engage individuals across all risk strata, as well as their physicians, in achieving improved health outcomes.

  • Moving outside the walls of traditional healthcare settings to develop innovative community-based solutions for addressing the social determinants of health.

Next: UCare's population health priorities



UCare - Russel Kuzel, MD, chief medical officer at UCare, an independent, nonprofit health plan providing health coverage and services to more than 500,000 members in Minnesota and western Wisconsin.

MHE: What are some of the most exciting population health management initiatives taking place at your organization?

KuzelKuzel: We are partnering with Essentia Health, a care system in north-central Minnesota, to offer an exciting new Medicare Advantage Preferred Provider Organization (PPO) that leverages point-of-care decision making by the provider. We collaborated on this unique care model for the provision of services and 50/50 sharing of administration, risk, and results.

We’ve also developed a member-focused commitment to care that engages members directly with coaching for hepatitis C medication adherence after members have been identified and prescribed medication. This includes daily contact with members.

MHE: What are some of your population health management plans for 2016?

Kuzel: Medication adherence among our members is a focus area for us. We’re developing vehicles for messaging to members through multi-cultural conversation for medication adherence. Since we serve a culturally diverse population, communicating in a culturally responsive way is critical for member impact.

MHE: What are your top population health management tips for healthcare executives?

Kuzel: Access is still important. Keep your management local and as close to the point-of-service as possible. Be conservative with rewards and incentives. They tend to be limiting over time.

Easy, convenient access and availability of desired services promote better outcomes that are more sustainable. Sometimes the simplest solution is the best one. Extended, convenient hours for outpatient services still decrease ER visits.

Aubrey Westgate is executive editor of Managed Healthcare Executive.

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