Dr. Ari Hoffman serves as Collective Health's Chief Clinical Officer and VP of Population Health.
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Population health management is a perennial challenge for benefits leaders. If money were no object, a company could offer all manner of perks that might contribute to better health. But with healthcare costs trending upward, every dollar must be well spent. To improve the overall well-being of a defined group of individuals, like a company’s workforce, population health management requires the collection and analysis of that group’s health data and medical claims history to identify trends and shortcomings.
The ultimate goal of the benefit leader's role is to promote better health in a cost-effective manner by identifying the most appropriate coverage for the population. While the specifics may change, every employer-sponsored plan should include what I call the Big Four: primary care, mental health services, musculoskeletal care and family planning. Beyond these foundational necessities, plan sponsors can tailor coverage to meet a group’s most pressing needs and omit irrelevant or superfluous offerings.
Let’s explore the role of data and appropriateness in population health management and how technology stands to effect positive change.
Good Data Is Everything
It should go without saying that healthcare needs will differ from population to population. Variables like age, gender, location and more should all be taken into consideration when designing appropriate plans. For example, younger workforces may benefit more from plans that offer robust mental health services, while older generations may need broader access to offerings like cancer care and navigation.
Benefits leaders must identify their workforce's specific data to target the actual health problems they face. Population health management must begin with developing a keen understanding of the population in question, and we have to challenge ourselves to look beyond national averages to understand what our people actually need to thrive.
The Appropriateness Continuum
With this in mind, benefits leaders should always evaluate plan design on a continuum of appropriateness. This includes preventive services, access to cost-effective sites of care and other high-quality parts of the healthcare system. Rather than thinking about tools like utilization management (UM) and case management (CM) as distinct buckets, use them as a guide toward appropriateness. How do your UM and CM strategies complement and uplift each other? How are you using your cost containment toolbox to promote appropriate utilization of care?
Ensuring employees have access to services that promote better health before major issues or ailments arise is imperative. That said, I’ve observed a shift from appropriateness to a focus on cost containment for healthcare needs that aren’t preventive. I urge benefits leaders to avoid this pitfall and view all care through the lens of appropriateness above all else. There are plenty of totally appropriate and much-needed services that come with a hefty price tag, but creating unnecessary barriers to accessing such care can be much more expensive.
Imagine one of your employees needs a specialty infusion to control their autoimmune disease, but it’s going to cost your company $75,000 a year on the pharmacy side. That seems like a prohibitive amount until you learn that forgoing this preventive care will cost hundreds of thousands due to hospitalizations and ER visits. Prioritizing appropriateness means removing obstacles to high-value and evidence-based care so employees can access the life-saving treatments they need, rather than standing in their way in the name of short-term cost savings.
Why Healthtech Inspires Optimism
Benefits leaders looking to move the needle toward effective population health management should consider investing in healthcare technology. Such offerings have the ability to connect the dots where humans otherwise can’t, leveraging data to identify existing and emergent trends within any given population.
I’ve said it before, and I’ll say it again: People are not averages. Not from a financial standpoint, or from a data standpoint. Healthtech platforms can help plan sponsors look beneath the surface of the data they have at their disposal to uncover meaningful insights. This technology simplifies benefit plan administration for self-insured employers by providing greater transparency into available and appropriate care, encouraging utilization and enabling plan sponsors to design coverage that is hyper-relevant to the needs of their workforce.
Why Population Health Management Matters
Healthcare costs aren’t just rising; they’re also shifting to individual members. Amid rampant inflation, the average American cannot afford the additional burden of increased prices for care and pharmaceuticals. As such, dissatisfaction with the American healthcare system has become a universal, bipartisan issue. To put it simply, people are fed up, and the consequences of sticking to the healthcare status quo are severe. Health outcomes suffer, bank accounts are drained and, for some, it means the difference between life and death.
While individual employers don’t necessarily have the ability to enact change on a national level, we can do right by our employees by embracing innovative solutions that improve access to affordable, relevant care. Investing time and resources into population health management can thus pose serious benefits (pun intended) to the American workforce.
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