2012, Healthcare Intelligence Network

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1 Note: This is an authorized excerpt from 2012 Healthcare Benchmarks: Health & Wellness Incentives. Note: This is an authorized excerpt from 2012 Healthcare Benchmarks: Population Health Management. To download the entire report, go to or call To download the entire report, go to or call , Healthcare Intelligence Network

2 2012 Healthcare Benchmarks: Population Health Management 102 healthcare organizations described their efforts in population health management, including the areas covered by the PHM program, the tools used to promote engagement, the incentives that are offered for participation, and more. Risk stratification and score are our [most effective tools in use in our PHM program]. > Hospital/Health System Improved quality on numerous primary and secondary prevention metrics (most based on HEDIS), and a reduction in total cost of care (TCOC) for pilot population were the [greatest successes we achieved with our PHM program]. > PHO [Our program expansion plans for the coming year] will include an extensive seven new sites with case managers who will increase provider engagement and system support. > Hospital/Health System [The most effective tool in use in our PHM program] is our EMR. > Staff Model HMO 2012, Healthcare Intelligence Network 2

3 2012 Healthcare Benchmarks: Population Health Management This special report is based on results from the Healthcare Intelligence Network s Population Health Management in 2012 e-survey administered in September Executive Editor Melanie Matthews HIN executive vice president and chief operating officer Project Editors Patricia Donovan Jessica Papay Document Design Jane Salmon 2012, Healthcare Intelligence Network 3

4 Table of Contents About the Healthcare Intelligence Network...7 Executive Summary...7 Survey Highlights... 8 Key Findings... 8 Program Components... 8 Results, Reimbursement and ROI... 9 Most Successful Strategies for PHM Programs... 9 Methodology... 9 Respondent Demographics...10 Using This Report...10 Responses by Sector...11 The Other Perspective The Disease Management Perspective Respondents in Their Own Words Most Effective Process, Tool, Workflow...18 Greatest Program Success...18 Program Expansion Plans...19 Conclusion Responses to Questions...22 Figure 1: All - Have Population Health Program Figure 2: All - Areas Covered by Program Figure 3: All - Targeted Populations Figure 4: All - Health Risk Levels Served by Program Figure 5: All - Health Professionals on PHM Team Figure 6: All - Risk Stratification Tools Figure 7: All - Program Components Figure 8: All - Health Coaching Delivery Modalities Figure 9: All - PHM Program Delivery Modalities...27 Figure 10: All - Tools Used to Promote Engagement...27 Figure 11: All - Program Attained NCQA Wellness and Health Program Accreditation Figure 12: All - Care Delivery Model Participation Figure 13: All - Incentives Offered for Participation Figure 14: All - Program ROI Figure 15: All - Measuring Program Effectiveness Figure 16: All - Greatest Challenge Posed by PHM Figure 17: All - Program Impact Figure 18: All - Plan to Launch Future PHM Program , Healthcare Intelligence Network 4

5 Figure 19: All - Organization Type Figure 20: Other - Have Population Health Program Figure 21: Other - Areas Covered by Program Figure 22: Other - Targeted Populations Figure 23: Other - Health Risk Levels Served by Program Figure 24: Other - Health Professionals on PHM Team Figure 25: Other - Risk Stratification Tools Figure 26: Other - Program Components Figure 27: Other - Health Coaching Delivery Modalities Figure 28: Other - PHM Program Delivery Modalities Figure 29: Other - Tools Used to Promote Engagement...37 Figure 30: Other - Program Attained NCQA Wellness and Health Program Accreditation...37 Figure 31: Other - Care Delivery Model Participation Figure 32: Other - Incentives Offered for Participation Figure 33: Other - Program ROI Figure 34: Other - Measuring Program Effectiveness Figure 35: Other - Greatest Challenge Posed by PHM...40 Figure 36: Other - Program Impact Figure 37: Other - Plan to Launch Future PHM Program...41 Figure 38: DM - Have Population Health Program...41 Figure 39: DM - Areas Covered by Program Figure 40: DM - Targeted Populations Figure 41: DM - Health Risk Levels Served by Program Figure 42: DM - Health Professionals on PHM Team Figure 43: DM - Risk Stratification Tools Figure 44: DM - Program Components Figure 45: DM - Health Coaching Delivery Modalities Figure 46: DM - PHM Program Delivery Modalities Figure 47: DM - Tools Used to Promote Engagement Figure 48: DM - Program Attained NCQA Wellness and Health Program Accreditation Figure 49: DM - Care Delivery Model Participation Figure 50: DM - Incentives Offered for Participation Figure 51: DM - Program ROI Figure 52: DM - Measuring Program Effectiveness Figure 53: DM - Greatest Challenge Posed by PHM Figure 54: DM - Program Impact Figure 55: DM - Plan to Launch Future PHM Program Appendix A: 2012 Population Health Management Survey Tool About the Contributor , Healthcare Intelligence Network 5

6 About the Healthcare Intelligence Network The Healthcare Intelligence Network (HIN) is an electronic publishing company providing high-quality information on the business of healthcare. In one place, healthcare executives can receive exclusive, customized up-to-the-minute information in five key areas: the healthcare and managed care industry, hospital and health system management, health law and regulation, behavioral healthcare and long-term care. Executive Summary 58% of survey respondents have a formal population health management program. As ACA reforms continue to impact the healthcare industry, population health management (PHM) is fast becoming the new buzzword for the management, integration and measurement of all health programs offered by an organization a set of interventions aimed across the health continuum, from the healthiest employees or health plan members to those with catastrophic illnesses. It s a rapidly growing shift in healthcare, as the industry moves away from rewarding quantity over quality and volume over value and toward chronic disease management and preventive health management. As we discovered in HIN s first annual Population Health Management survey conducted in September 2012, key to this movement is the focus on the whole population, with 83 percent of respondents citing the use of health promotion and wellness programs over disease management (75 percent) and HRAs (69 percent). Case managers continue to imprint the healthcare scene; 64 percent of respondents consider them part of their PHM team. And 79 percent said health coaching is a vital part of their PHM program, with 78 percent of those favoring telephonic delivery of health coaching. The often underutilized telephone is considered a key modality for PHM program delivery, and preventive services reminders (81 percent) were the primary tool used to promote consumer engagement and participation. But despite metrics showing a jump in patient compliance (reported by 54 percent), 42 percent of respondents said that patient/member engagement was the greatest challenge posed by PHM. Survey Highlights More than half of respondents have a PHM program in place. Case managers are the most crucial elements of an effective PHM team, reported 64 percent of respondents, slightly edging out PCPs (60 percent) and health coaches (55 percent). We evaluate work productivity and absenteeism to measure and improve our PHM program effectiveness. 2012, Healthcare Intelligence Network 7

7 Using This Report This benchmarking report is intended as a resource for healthcare organizations searching for comparable data and means to measure implementation and progress. It is also a helpful planning tool for organizations readying initiatives in this area. The initial charts and graphs presented represent results from all respondents; images in subsequent sections depict data from high-responding sectors. (Figure titles begin with the segment they represent; for example, All, Health Plans, Hospitals, etc.) Often, one of the largest responding sectors is composed of respondents identifying their organization type as Other. In general, we do not depict results from this segment because it represents a wide range of organization types, including consultants and product vendors. However, you will always find a graph indicating the demographics of respondents. The commercial population is the top population served by PHM programs, say 85% of respondents. Here are some additional tips for using this report: See how you measure up: Scan this report for your sector, and see how your program compares to others. Note where you are leading and where you are behind. Evaluate your efforts: Think about where you have been focusing your efforts in this area. Look for trends in the data in this report. Look for benchmarks set by your sector and others. Set new goals: Use the data in this report to set new goals for your organization, or to raise the bar on existing efforts. Use it as a reference book: Keep this report accessible so you can refer to it in your work. Use these data to support your efforts in this area. If you have questions about the data in this report, or have feedback for our team, don t hesitate to contact us at info@hin.com or The greatest success we achieved with our program is the lowering of participant claims. 2012, Healthcare Intelligence Network 11

8 Figure 3: All - Targeted Populations Which populations are served by your PHM program? 90.0% 85.4% 80.0% 70.0% 60.0% 50.0% 40.0% 47.9% 41.7% 30.0% 20.0% 10.0% 22.9% 14.6% 0.0% Commercial Medicare Medicaid Uninsured Other 2012 HIN Population Health Management Survey September, 2012 Figure 4: All - Risk Stratification Tools What is your primary method for identifying appropriate level of intervention? 2.2% 8.9% Claims data 8.9% 6.7% 8.9% 6.7% 8.9% 33.3% Chart review Pharma data (0%) HRA Biometric screening EHR Registry Self-report Physician referral 15.6% Other 2012 HIN Population Health Management Survey September, , Healthcare Intelligence Network 26