Provider organizations are continually working to transform the care that they deliver to their patients to reduce costs and improve quality.
Growth in risk-based payment arrangements coupled with increased requirements for quality reporting from payers, such as the Centers for Medicare & Medicaid Services (CMS), has ramped up the pressure for providers to develop a focused population health management strategy for the patients they serve.
But getting started can seem daunting. If you're unsure where to begin or how to advance existing initiatives, the answers may lie with your own employees. By starting your population health management efforts with your employee population, you can build a foundation of skills, solutions, and knowledge to effectively manage risk and generate more positive clinical and financial outcomes for your own employees as well as your patients.
The following checklist can help you both initiate and advance your care transformation efforts by putting your employee population first:
Know Your Starting Point
What population health strategies already exist for your employees? Which leaders in the organization are tasked with driving quality improvement or cost containment? Is your employee benefits plan strategy aligned with your patient care efforts? Determine what is working and build on that success. Identify and prioritize gaps, and ensure that they are addressed in your overall plan.
Connect Your Leadership
Although managing your employees and managing patient populations require similar efforts, internal leaders often work in silos. Collaboration across executive, medical, human resources, and accountable care organization leadership teams ensures that groups are aligned based on common goals and investments in data aggregation and analytic platforms. This helps increase the adoption of care management programs.
Master Your Data
Focus on obtaining and properly maintaining the right data to drive analysis, program structure, management, and ongoing assessment. A proven analytical platform will enable you to become an expert in your employee healthcare needs and dig into cost and utilization trends. Built-in predictive models will help you take the pulse of future needs and pinpoint those who are most likely to need high-cost care before it's too late to act. Benchmarking takes your analysis one step further, enabling regional and national comparisons for multiple data points.
SEE ALSO: Business Intelligence & Value-Based Care
Make Risk Adjustment Your Friend
Anyone who has attempted to influence physician practice patterns and heard, "But my patients are sicker," understands this issue. Whether you are assessing your employees or your patient populations, you need to be able to assign risk scores to individuals correlating with the illness burden that they carry. This information can then be used to create unbiased evaluations of program success, monitor physician performance, and establish fair risk-based contracts.
You cannot immediately act on every need you identify, but thankfully, not every need is equally pressing. Stratifying your employee population according to the clinical and financial risk that they represent allows you to focus your efforts where they will generate the greatest impact, whether that is a disease state, a group of quality metrics, or certain physician behaviors.
Understand How Care Is Being Consumed
Closely examine how your employees are using healthcare services. Evaluating utilization data and physician activity, such as referral patterns and network leakage, can help identify areas of high out-of-network utilization and associated costs. If your employees are going out of network, your patients are too.
Expand Quality Improvement Efforts
Aligning existing quality initiatives with your population health management strategy amplifies efforts to ensure that care is both safe and cost effective. Your analytics platform can be leveraged to drive higher-quality care by identifying preventative care gaps. Use this data to focus clinical support on employees with quality risk factors, and create physician quality scorecards for ongoing progress reporting.
Go Beyond the Per Employee Cost Analysis
Successfully managing employee healthcare costs requires an in-depth look at spending. Connect risk drivers to high-cost utilization to understand where to start your remediation efforts. This analysis can also inform employee benefit plan designs to encourage in-network utilization, lower-cost prescriptions, and health and wellness program engagement.
Understand the Mechanics of Value
Providers are driving toward value-based healthcare, but what does value really look like? It is a complex balance of outcomes, quality, and cost. Comparative performance data identifies the best practices of your top caregivers and can empower your entire physician network to deliver higher-quality care to your employees and, in turn, your patients.
Fine-Tune Care Management
High levels of stress and a constant focus on others often lead to unhealthy behaviors, which are some of the reasons why healthcare workers have some of the worst healthcare utilization and cost patterns. If your programs work for your employees, they should work for your patients. Your employees can serve as a barometer for what is or is not working. They can also provide information on engagement strategies and the overall value of your population health management efforts.
Evaluate the Impact and Make Adjustments
Defining a core set of cost, quality, utilization, and engagement metrics and monitoring them frequently ensures that you are constantly evaluating the impact of your efforts. Build on your initial leadership alignment efforts by establishing a team that reviews these metrics and develops action plans to make improvements as you increase your knowledge on what works and what doesn't.
Always Be Planning Your Next Steps
The knowledge, infrastructure, and organizational alignment that you have put in place for your employee population provides an excellent foundation to transform the ways in which your organization does business. Plan next steps for advancing value-based care through contracting with shared-savings programs or engaging in risk-based contracts with payers. Use your success stories to advance discussions with health plans related to risk-based contracts or contract directly with employers.
Juliana Hart is director of provider solutions, Verisk Health.