Covenant Health bends its own cost curve with analytics in population health program
Covenant Health Systems adopted a population health program to track and manage the health of its employees across three hospitals and affiliated facilities. Operating as a self-insured entity, Covenant saw this move as a necessity to improve health and get a grip on increasing expenses.
“There was a desire to change the cost curve of health insurance as a self-insured employer, and then offer something that would enhance the well-being of our employees, a two-pronged approach,” said Richard Boehler, MD, president and CEO of St. Joseph Hospital of Covenant Health. “Like every other organization, we found our healthcare costs were escalating 10 percent a year and we really were not doing anything to try to influence that.”
The goals of the population health program included understanding the healthcare utilization patterns of employees and their dependents.
Prior to this initiative, Boehler said that Covenant would essentially conduct a yearly recap report to understand which resources patients were using and what administrators could have done better at the time.
“Way too late, not actionable, we would simply get the bad news and say, ‘Gee, I hope next year is better,’” Boehler added.
So the health system decided it needed to do something about that to get more timely information and thus help better manage both chronic health problems and acute interventions.
“We found out that a lot of our employees did not use our own services,” Boehler said. “How could we create something that would make it more attractive for them and be in a better position to manage their health. If they are not part of your system and they are going outside it, then it’s a lot harder to influence the outcomes of care.”
Covenant had many employees with either chronic diseases or acute exacerbations of problems, people who were not conscientious consumers of healthcare, said Rebecca Williams, RN, care coordination manager at St. Joseph Hospital of Covenant Health.
“As a self-insured employer you have to think of yourself in a full-risk contract, you are really on the hook for everything with the exception of a little bit of cost-sharing with the patient,” Williams said. “Where was our money going, why is it going there, and could we do better?”
Covenant harnessed data analytics to help guide its population health management efforts. But it initially was not getting the insights it expected.
“When we first started looking at data, we found that everything we thought we knew, we were wrong,” Williams said. “The first thing we started thinking where the money was going, it must be avoidable ER use. We dug into the data, and nope, that wasn’t the case. Then we thought back injuries, we had spent a lot of money on prevention because of many back injuries, so let’s dig in there and maybe we could create a comprehensive back program. But it wasn’t even our employees, it was their spouses, so that went out the window.”
What the executives and caregivers learned was that they had to prioritize their employees in terms of healthcare consumption.
“You cannot take a population and put a stamp on it and say let’s do things this way; we had to look at prioritizing people and we worked with sophisticated analytics to see where our time would best be spent,” Williams explained. “The high utilizers were on dialysis or had an organ transplant or an acute burn, those were not things we could make an impact on. But that middle 70 percent is where we could make an impact. Keep people in the middle 70 percent from moving up to the highest spend category.”
And a major key to all of this is the timeliness of receiving information meant to help a population health management effort.
“Getting information when you can do something about it is key,” Boehler said. “When we know someone was in the ER this afternoon and have the ability to intercede and help them not be readmitted, that knowledge and the ability to act on it makes all the difference in the world.”
Boehler and Williams will discuss population health issues at the HIMSS and Healthcare IT News Pop Health Forum, April 3-4, 2017, at the Westin Copley Place in Boston, Massachusetts, during a session entitled “Stepping into Health: Leveraging Data and Analytics to Improve Employee Health Plan Performance.”
Related articles ahead of the Pop Health Forum:
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⇒ Partners Healthcare uncovers twist, and savings, in population health data
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