For far too long, employers have largely felt powerless to impact the decades-long trend of increasing health costs and declining employee health. The advent of self-serve analytics and insights solutions such as Geneia’s Theon® analytics, insights and care management platform along with complementary services such as population health consultants offers employers powerful, new opportunities to improve the cost and quality of employee healthcare.
Recently, my colleague, Pat Ingerick, published the blog, Employer Analytic Insights: We Meet You Where You Are. In the blog, she wrote that no matter how savvy an employer is with analytics, there are always more cost, quality and utilization insights to uncover.
Employers using the Theon® platform can easily self-serve many actionable insights such as the number of employees who have not seen a primary care physician in more than a year and the number of high-cost members and use those insights to collaborate more closely with their health plans. Some employers, such as Curt, the vice president of human resources for a Fortune 500 company, are quite comfortable using the Theon® platform to generate advanced analytic insights including identifying cohorts of employees whose risk score is rising and then work with the health plan to engage them in their health. Other employers leverage population health consultants to help improve quality outcomes, costs and utilization.
Population health consultants work with health plans, providers and employers.
Last year, we wrote about how Geneia’s population health consultants work with health plans and their network providers to dive deeply into the data and create effective plans of action to address clinical variations across members, providers and facilities. Rather than simply provide clinicians with a spreadsheet, population health experts help health plans deliver concise, usable insights in ways that are meaningful to the clinician. (Click here to read our case study about how a health plan used population health consultants to improve quality performance and succeed in value-based care contracts.)
Geneia’s population health consultants also work with employers.
With an eye towards capturing population trends, using data to drive strategies to improve quality outcomes and identifying care management and wellness opportunities, these clinicians perform four key functions to assess each group:
- Population Analysis – Population health experts create the employer group profile by incorporating these factors:
- Membership distribution
- Age and gender
- Location and sub-populations
- Per member per month costs (PMPM)
- Cost/utilization drivers
- Population Drill Downs – Population health consultants utilize the Theon® platform’s Care Engager® module to evaluate trends at the member level to identify potential care needs. Among the data points they review are:
- Chronic conditions
- Excessive utilization
- Rising and high-cost members
- New members
- Population Trending – Create graphs to illustrate monthly trends in the following critical areas and monitor performance over time:
- Condition prevalence
- Inpatient and emergency department utilization
- Hospital readmissions
- Open care gaps
- Care Team Collaboration – Share findings to facilitate collaboration and improve outcomes:
- Collaborate with employer and health plan(s)
- Make and monitor referrals to care management programs including case, disease, high-risk maternity, oncology and transplants
- Support virtual and onsite wellness programs
One key area of investigation for our population health consultants is looking more closely at employees with many visits to the emergency department for primary care or conditions that are appropriate for treatment in an ambulatory setting. Often these employees need to be connected to a primary care physician.
Another area of opportunity for our consultants are employees whose risk scores and costs are rising. These are two potential indicators of three expensive and taxing chronic illnesses: diabetes, heart failure and COPD. Just as importantly, early intervention for employees with these three diagnoses offers the real possibility of mitigating future costs and declining health.
Population health consultants use a five-step framework (see image above) to help employers improve the cost and quality of employee healthcare: population identification, population assessment, data analysis, planning, strategy and evaluation.