To successfully navigate the volume-to-value marketplace shift, today’s healthcare organizations are sharpening focus on closing care gaps and reducing the negative health impact of social risk factors.
Some reports show that up to 80% of payers are integrating social determinants of health into their member programs. As a key front-line emphasis, population health management (PHM) outreach can identify patterns of risk and avoid high-cost health events. However, PHM campaign effectiveness depends on a strategy that includes stratification to accurately identify and address high-risk populations.
PHM outreach and support are critical to optimizing health outcomes. Research has long supported, for example, that social disconnectedness has negative effects on health. A 2009 study based on data from the National Social Life, Health and Aging Project shows that both disconnectedness and even perceived isolation negatively affect physical health. And a 2018 study presented at the European Society of Cardiology’s annual congress further supports that—increasingly common—loneliness is bad for the heart and a strong predictor of premature death. The study investigated whether poor social network was affiliated with worse outcomes in 13,463 patients with ischemic heart disease, arrhythmia (abnormal heart rhythm), heart failure, or heart valve disease. Loneliness was directly associated with poor outcomes, including a doubled mortality risk in women and nearly doubled risk in men.
To connect the right patient populations with specific services to fill risk inducing care gaps, effective PHM outreach comprises four elements:
Use analytics to identify the subpopulations at risk due to service gaps or decompensation triggers. Focusing on members that have barriers to accessing health promoting services such as vaccines, cancer screenings, and/or chronic disease monitoring services. Use analytics to also identify members that are at high risk for re-admissions, falls, or medication non-adherence.
Use analytics to allocate resources related to contacting the member based on their level of risk. This ensures support starts at most at-risk members.
Use asynchronous, low-friction communication channels (IVR, e-mail, text) and tailor channels to members’ communication preferences. Health plans understand that by leveraging a multi-channel approach to communication, they have the best chance of engaging members in the most effective manner to reduce barriers to care and drive positive results. Today’s digital experience is in high demand. According to Pew Internet, texting is the most widely-used and frequently used app on a smartphone, with 97% of Americans using it at least once a day. With tools like an engagement console, care managers can easily initiate and engage in mobile conversations with members and respond to questions in real time. The tool extends the reach of the care management team and boosts efficiency as the average phone call is 12-15 minutes, while it takes approximately one minute to outreach via text message. There are also mobile apps designed with a range of communication capabilities and social components that effectively engage health plan members and their support circles in health management activities.
Finally, as a proactive measure, provide tactical support for removing barriers to care, with a clear path for future updates with new information and education.
Business process outsourcers (BPOs) are uniquely positioned to support outreach with PHM intervention experience and payer-provider lifecycle and operational metrics learnings. They also bring the essential front-line automation and analytics expertise. Increasingly, health plans can align with these partners as providers of the targeted PHM outreach that bends the cost curve and also optimizes member engagement for better health outcomes.
Dr. Virginia Gurley is Senior Vice President and Chief Medical Officer at AxisPoint Health, an HGS company.