One key ingredient can enable value-based health management to deliver on its promise: ENGAGEMENT.
by Dan HoemkeSenior Healthcare Advisor at Nudge
The transition from volume to value-based health management and contracting initiatives in Medicare, and increasingly in commercial markets, hasn’t materially changed the fundamental building blocks associated with management of financial and health risk within populations.
The Building Blocks of Managed-Risk
The fact is, whether you’re a payer, ACO, health system or self-funded employer, if you are going to assume risk, you have to manage it.
And if you are going to manage it effectively, you can’t rely on the types of impersonal, ineffectual member outreach strategies of traditional disease management.
The status quo of fragmented provider encounters that aren't properly contextualized for each individual won't cut it.
Bad or even bland experiences disengage consumers.
Key Stakeholders Need To Be Aligned and Connected
At the heart of all of this are those (very human) members/patients, and the pesky set of needs that come with them; with their inherent health risks, the fundamental need to mitigate associated financial liability and, of course, improve their health.
To add fuel to the fire, we’re in an era of high deductibles and consumer-directed healthcare with members/patients taking on the role of healthcare consumer. Healthcare "customer" may even be more apt.
Now more than ever, these members, patients, and healthcare consumers possess individual personas that reflect...
the financial burden and responsibility they bear for personal health and wellbeing,
what support they need and want at each phase of the continuum of care, and
how best they can be engaged and assisted
Today, these members pay an increased portion of their premium, determine how and when to use their benefits and consciously elect whether to participate and comply with health and care management directives from their physicians, health coaches or technical devices.
For the large part, they rely on participating healthcare providers delivering care through discounted fee or full risk capitation arrangements in coordination with population health management teams - all of whom are increasingly rewarded for utilization management and clinical outcomes.
Preventative and interventional clinical and behavioral program initiatives are the principle strategies being used by teams to manage population health.
The supreme challenge however, is how providers and health managers optimize personalized interaction with members (and vice versa) in ways that are both effective and efficient.
In an attempt to bind the building blocks of risk management and drive economies, a broad array of EMR and clinical management platforms are being deployed to assist providers and care management teams in accessing patient records and guiding and supporting clinical decisions.
Similarly, healthcare consumers are gaining access to apps and web-based tools and member service assistance to support benefits navigation, become more informed consumers and utilize available healthcare providers and services.
While well intended, most of the clinical and health management systems, technology platforms and workflows are limited in application, designed either for clinicians/care managers or member use.
The sheer volume and variability of systems, their lack of interoperability, and the persistent layering of additional system technology and piling on of operational processes is virtually swamping intended efforts and its weary participants.
As a result, adoption and effective utilization of capabilities is limited, application effectiveness varies broadly, and ROI is highly questionable.
But there is good news; the building blocks for effective management of financial and population health risk are readily available.
The Holy Grail in optimizing their strength and construction value is the engagement of healthcare providers and care managers with healthcare consumers in a powerful user experience that...
aligns goals and objectives
activates and sustains involvement over the periods of time required to make an impactful difference
and delivers cost-effective, health optimization
For any state-of-the-art platform to hope to actualize these core objectives of value-based health - in other words, to BE the Holy Grail for population health management - it must incorporate these 5 functional pillars...
Engagement and Motivational Coaching Science
Interoperable Technology and Connectivity
Persona-Based, Personalized Health Engagement Mapping
Customizable Health and Care Management Workflow
Member and Population-Level Engagement Performance Management
These five pillars are the success drivers for value-based programs, population health management initiatives and managed risk efforts.
This article is the first of a series through which I will discuss how each pillar enables effective consumer health engagement, and thus, enables value-based health management.