Destination total population health: The time is now for a new approach

Transcription

1 Destination total population health: The time is now for a new approach

2 Every year, human resource professionals experience the daunting task of renewing their health benefits. It s a business imperative that impacts employee productivity, engagement, recruitment and retention, and of course, the organization s bottom line and competitiveness. Typically, large employers start renewals with a heavy reliance on analytic tools to evaluate trends, employee needs, carriers, and health plan value and costs. These tools usually focus on multiple health plan metrics including their network coverage and unit costs/discount rates. For years, these analytics have helped plan sponsors select lower-cost networks and manipulate plan designs. But is this tried and true process compromising employers efforts to build a total population health management strategy an approach that is only made possible when data is synchronized from multiple sources and high-value intersections of care are identified for timely intervention and advocacy? The end game: Systemic well-being Systemic well-being The health care market is on the verge of a dynamic change, one that allows for a greater reliance on health management strategy across an entire population as well as a renewed focus on lower-cost, high-performing networks. A disruptive new calculus or pathway is emerging that will ensure each plan sponsor is leveraging data to not only make carrier and design decisions but to also create a consumer experience that changes behavior and ultimately outcomes. In this paper, we first discuss today s health benefit selection process and its opportunities. Then, we put forth a new approach, which begins with an intimate understanding of the employer s unique health care strategy and vendor contributions and ends with a sophisticated, data-driven system of well-being. Each employer population consumes health care uniquely. Numerous variables influence their ability to achieve systemic well-being. Population demographics Population risks Population dispersion Local health care delivery system Health care consumption patterns within the population Page 2

3 Health benefits planning today Today, when employers develop their health benefits strategy for the upcoming year, their decisions are largely informed by insights from prospective carrier unit cost analyses. These analyses synthesize medical claims data and population dispersion patterns with network discounts for each medical carrier being considered. Once the unit cost estimates are provided and compared for each carrier, the employer selects their carrier(s) and individual health management offerings available from the carrier(s), i.e., programs embedded within the health plan. This process ensures optimal plan design and network selection. Yet, it has a downside too: total population health and wellness becomes a secondary strategic consideration. Although a small subset of progressive employers have made total population health a strategic priority, too often employers miss an opportunity to tailor programs designed to fit the specific health needs and disparities of their unique populations. What s more, employers with several carriers may end up with multiple, disparate wellness programs that are embedded in each carrier s offering. In some cases, employers may have to fill in the gaps with solutions from niche vendors. This patchwork approach not only adds to the plan sponsor s administrative burden, but it also negatively impacts employee engagement. And it may do little to address overall medical spend because significant health challenges among employees aren t being targeted and addressed across the board consistently. TODAY: Consumer benefits focus analysis discounts dispersion estimates Plan C Plan and carrier selected Retrofit health management programs based on plan offerings Destination: Optimal plan design and selection Optimal population health management strategy THE RESULT: Fragmented vendors, poor consumer experience, complex administration, limited engagement and elusive ROI Page 3

4 The future of health benefit design In the future, employers will first create a tailored strategy for total population health. This carrier-agnostic strategy will be fueled by an end-to-end health management solution that produces a seamless consumer experience, sustained engagement and health outcomes that lead to systemic well-being. This approach requires a centralized approach that has a synchronized solution set and the insights to build a best-in-class total population health strategy. This approach will eliminate the administrative burden of managing several different health vendors while ensuring a consistent consumer experience for all employees. The solution will work with any carrier, and with multiple carriers, as is the case with most organizations. And once the total population health management strategy is built, important carrier and network decisions will then flow naturally. FUTURE: Consumer experience focus Population health opportunity analysis Health care consumption patterns within the ecosystem Health care system deficiencies* Health-risk profile at the ZIP code level* Industry insights* Health management solution design Advocacy care services Behavioral health services Care and clinical management Care reminders Employee assistance program (EAP) Global health and well-being Destination: Optimal plan design and selection Health and well-being On-site health management Pharmacy care services Optimal population health management strategy analysis discounts dispersion estimates Plan C Plan and carrier selected *Future capability THE RESULT: Higher employee engagement, administrative efficiency, improved health outcomes and increased employee productivity Page 4

5 Imagine... Imagine if employers could achieve optimal plan design and total population health. Working with a single, carrier-agnostic health management vendor who provides an end-to-end solution that addresses the unique health needs of an employer s population makes this possible. Contact us resourcecenter@ /resourcecenter It can ease administration, improve company-wide consumer engagement and improve a population s health profile. Next, imagine how employees would respond to a health care experience where they are guided, by a single point of contact, who can connect them with top-quality programs and services. Yes, it s a new way of thinking and doing business. And it s the future of health benefits. Author Peter N. Nieves Executive Vice President, Employer Market, Optum Peter Nieves leads a national team of client-facing advisors, service managers and business development professionals responsible for matching the growing demands of clients and prospects to the Optum solution portfolio. Prior to joining Optum, Peter was a senior partner at a global consulting firm for 12 years where he most recently held the role of global growth strategy leader. Peter earned his BBA from Iona College in New Rochelle, NY, and is an active member of its President Club. He serves on the board of the American Heart Association, Westchester, NY, and Fairfield, CT Optum Circle, Eden Prairie, MN Optum is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. All other brand or product names are trademarks or registered marks the property of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer Optum, Inc. All rights reserved. WF /16 Page 5