Product innovation: Integrated health management

The challenge

Treating patients with chronic diseases accounts for about 83 percent of the nation's annual healthcare spending, according to the Centers for Disease Control and Prevention. Reducing that number - preventing, rather than simply treating expensive chronic illnesses - is widely recognized as a necessary fix to our broken healthcare delivery system. Employers - insurers' principal purchasers - want payers to more actively promote the health of their employees and help those who are ill manage their diseases.

Members stay healthier longer for less money when their care is managed across a continuum of services, as when accountability for their outcomes is shared among payer, multiple providers, and other resources. Acute care should be integrated with prevention, counseling and wellness services. Integrated health management lets payer/provider collaborations deliver appropriate interventions when they can help the most and cost the least. For example, preventing obesity reduces the incidence of hugely expensive chronic conditions such as diabetes, cardiovascular disease and back disorders. And employers' bottom lines feel the impact of chronic diseases not just in treatment costs but in reduced employee productivity through lost time and disability. The value proposition of integrated health management - healthier, more productive employees who cost less to insure - makes it a crucial new payer business model.

But coordinating services and developing collaborative business models can present formidable challenges. Payers need to find the right mix of in-house versus outsourced health-management services that can demonstrably improve patient outcomes and reduce medical expenses.

How we can help you

You should examine and evaluate market trends and industry leading practices to identify opportunities to improve and streamline medical management services across the continuum. We can review your existing policies, practices and documentation to find ways to improve medical management. We can guide you to integrated health-management practices from strategy through implementation. Are you employing best practices in hiring, on-boarding and continual training? Are you experiencing a higher-than-normal staff turnover rate? Are employer clients looking for solutions you can't provide? We can help you assess the effectiveness of your vended programs and how to deliver an integrated model with your vendors.

You need to learn to use information at your disposal to identify high-risk patients, and to offer appropriate, early interventions. We can help you harvest information from health risk assessments, claims data, electronic health records and personal health records that can give you a more comprehensive view of each member's health status. We can help you develop the IT and informatics capabilities to become proactive rather than reactive in managing healthcare and its costs. Once members are identified, we can help you design programs to manage the more complex and frequent diagnoses that will ultimately reduce overall medical costs. You should strengthen the role of medical management in clinical and business processes. Are you being as efficient as you can be? Are you a help or a hindrance to provider office staff? We can observe and evaluate work practices of in-house client staff and providers' staffs and clinicians. Based on these observations and evaluations, we analyze work distribution, process flow and other functions to help plan actions toward integrated health-management practices.

Most payers outsource some or all of their health-management programs. You need to find the balance of in-house and outsourced health-management resources that are right for your organization and its members. Do you provide services to members in a seamless manner whether the services are through a vendor or through your internal medical-management staff? We can assess your internal resources and the capabilities of health-management vendors to help you differentiate your service offerings and reduce the dollars spent on medical care. We can help you streamline your processes and resources to accomplish aggressive cost-cutting goals.

Common services include:

• Strategy and future state visioning employing innovation analysis and collaborative design techniques
• Work-flow analysis with recommendations for improvements and streamlining
• Implementation of health-management practices from strategy through implementation
• Development of informatics capabilities to help identify high-risk patients and design of programs to manage the members once identified