Population health programs don't always work — 3 lessons learned from health insurer execs

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Well-intentioned programs that aim to improve population health and social determinants of health sometimes don't take off as health plans intend. While member adoption may not meet expectations, the lessons learned from these instances are valuable and inform future ideas.

A panel of health insurance executives discussed this topic during a session at the Becker's Payer Issues Virtual Summit Aug. 3. The panel included Talya Schwartz, MD, president and CEO of MetroPlus Health Plan; Eric Galvin, president of ConnectiCare; and John Bulger, DO, CMO of Geisinger Health Plan. Morgan Haefner, editor at Becker's Healthcare, moderated the panel.

Here is an excerpt from the conversation, lightly edited for clarity. To view the full session on demand, click here

Question: Talk about a time when a population health or SDOH program didn't turn out the way you wanted it to. What lessons did you learn from that experience? 

Dr. Talya Schwartz: A few years ago, we identified that our older membership was struggling with social isolation. We had the talent in-house to develop a program to help this membership with social isolation. We designed a program and had high hopes for its success. And then when the program launched, we struggled to bring people into the program and maintain their participation. At the end, we didn't see any significant improvement in the care they received, adherence to care or a change in member retention.

It was a very well-intentioned program, but ultimately it's important to look at objective results and reevaluate those programs and see whether they have an impact. The lessons learned were that we need to collaborate with people who are experts in those various areas. Although we had the talent, we didn't really have the experience of how to administer this type of program. In the past several years, we've invested in identifying the right partners and working collaboratively with those partners.

Dr. John Bulger: I will expand on that answer because it's a great example of where we've had our biggest issues in the area of social determinants. It's when we haven't realized that there's a lot of people out in the community that are already working on these types of projects and are the experts on the ground. Especially in our case as being in a health system, sometimes you have health systems that are the "800-pound-gorilla" that comes in and is telling people what to do as opposed to taking a step back and sitting and listening to what they need and how we can provide that.

Recently, we've begun to ask, "How can we help you?" Asking that question and listening for an answer as opposed to charging in with good intentions and trying to fix everything ourselves has been a big lesson learned for us in the social determinant space.

Eric Galvin: We ended up putting into place this program called Peace of Mind. Through that program, we call our customers and ask how they're doing and what they need — not asking them for the eight things that we might need from them, but simply listening. Getting back to Dr. Schwartz's point about social isolation, you would be surprised at how many people were overjoyed to have somebody to talk to and ask a couple of questions of, even if they weren't core to what services we provided.

We made north of 30,000 customer outreaches. What we learned through that is certainly our customers needed someone to be concerned for them, but we also learned about their needs. We were able to connect them with various resources. A check-in call doesn't sound all that sophisticated. But at the end of the day, it was so impactful. 

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