Data-driven consumer engagement is the vanguard of the effort to provide cost-effective treatment of chronic disease. How one payer is tracking psychosocial indicators for the neediest patients.
I hear bugles in the distance.
As they trailblaze the vast value-based healthcare delivery frontier opening up before them, insurance carriers have encountered two daunting obstacles: engaging individual customers, who are becoming determinants of value; and harnessing a treasure trove of health data.
Consumer engagement has risen to pivotal importance in the healthcare industry, Margaret Rowland, MD, chief medical officer of Portland-based CareOregon, told me this week. "Consumer engagement is essential for achieving ideal health outcomes. If you are going to get good health outcomes, a population has to be engaged in the process. If they are not involved, then it won't make a long-term difference," she says.
CareOregon, a nonprofit that covers 160,000 people and focuses primarily on the low-income and vulnerable, has teamed up with Health Integrated to leverage the Tampa, FL-based company's data analytics and consumer engagement capabilities to help provide cost-effective care to the health plan's most costly patients: members of medically vulnerable populations such as people suffering from multiple chronic illnesses.
About half of American adults have at least one serious chronic condition such as hypertension or kidney disease, according the Centers for Disease Control and Prevention. "The majority of US healthcare and economic costs associated with medical conditions are for the costs of chronic diseases and conditions and associated health risk behaviors," the federal agency's website states.
Rowland told me health plans are facing challenges in reaching out to these members that go far beyond the bounds of traditional approaches to healthcare. Data analytics is riding to the rescue.
"Increasingly, we are understanding the psycho-social issues that affect vulnerable populations. For example, when we speak to a diabetic about a blood test, if they have nowhere to sleep that night then a blood test is just not their priority. As healthcare providers, we need to understand their lives when we speak to them. We need to help stabilize their social lives before we can really expect them to self-manage their health issues," she says.
Zachary Fritz, executive VP for sales and marketing at Health Integrated, told me last week that there are three main elements to the company's approach to helping health plans serve vulnerable populations:
- "Biopsychosocial" care management uncovers the physical, psychological, and social dimensions of a member's health conditions, then a "personal clinician" trained in social work and medical sciences targets interventions at particular needs
- Data analytics tools "identify, stratify, and intervene with greater customization and scalability" while measuring the impact of interventional measures
- A coordinated and integrated care delivery model strives to get the health plan, providers, and community resources "working together in the best interests of the individual and driving adherence to mutually agreed upon, medically necessary, and evidence-based treatment and care plans"
Deploying data analytics is a necessary step to target individuals in vulnerable populations who could benefit from health services, but delivering that care is a more personalized consumer engagement exercise, Fritz says. "The first step is identifying the right people through data analytics. But we go further because when an individual is simultaneously facing behavioral barriers and social impediments along with managing their multiple chronic conditions, it's a difficult challenge for them to be fully engaged in their physical health. Traditional, one-size-fits-all clinical programs don't have optimal impact for most people. We believe that a care team must first address what we call the 'root-root' causes of the barriers for better self-management."
Once data analytics have identified a health plan member in a vulnerable population, a personal clinician can assess the entirety of factors affecting the individual's medical conditions and help craft a globalized treatment plan, Fritz says. Addressing a member's "root-root" problems such as substance abuse or an ongoing domestic dispute can result in significant health gains: "Vulnerable individuals and people in vulnerable health situations face under-identified and under-treated behavioral barriers. When we engage this way, we influence the medical outcomes."
Unless health plans boost their data analytics and consumer engagement efforts, they face the risk of "missing" members in vulnerable populations and paying the price in unnecessarily high health service costs, according to Fritz.
"For us, a missed member is part of the 5-to-10% cohort that is driving 35-to-40% of the costs in Medicaid and Medicare populations. These members suffer from multiple chronic conditions exacerbated by psychosocial factors that may be in the form of a diagnosed behavioral health condition like depression or an undiagnosed, underlying challenge like poor social support, substance abuse, or a personality disorder. These factors impact physical symptoms and disease progression and often result in patterns of avoidable, costly healthcare utilization.
"In addition to being clinically complicated, these individuals are hard to reach and, understandably, difficult to motivate. Emails, text messaging, web portals, and even mail are usually not enough to engage this type of member," he says.
Engaging these types of members is in the interest of health plans. The value-based healthcare frontier will be an inhospitable place for insurers if the costs of chronic disease care continue to mount.
Christopher Cheney is the CMO editor at HealthLeaders.