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How Population Health will Drive Value for Managed Care Organizations

How Population Health will Drive Value for Managed Care Organizations

When we apply ourselves to support those with lifestyle and health challenges, we impact those close to us. We receive great satisfaction and a sense of accomplishment when we ‘fix’ an acute health concern. Healing more severe and chronic issues takes more time and patience, which is a huge investment and challenging in our new world of unhealthy distractions. Microbursts of healing and health promotion counterbalance these impulses to veer off of the path towards health and wellness.

Population Health teams combined with Quality groups facilitate these microbursts of health promotion. They are an ideal catalyst for scaling preventive measures and activities like an annual wellness visit, diabetic eye exam, or a flu vaccination. With educational messages sharing the value for our individualized lifestyle, we learn about the value it brings to us and our families. With persistent reminders, we may find the time in our busy lives to make the time to take care of ourselves and check-in with our primary care physicians and nurses.

Sophisticated Population Health and Quality teams know who would most benefit from specific preventive screenings to keep us out of harm’s way. They encourage feedback from their members to better understand the barriers they face when making a healthcare decision. They empower members to make a better choice based on their preferences for time, convenience, perceived need and ultimately, value to them and their family.

More sophisticated managed care organizations also combine member experience executives to the valuable Population Health and Quality teams to layer in these member preferences. It’s valuable for PopHealth and Quality to realize member preferences for how and when they would like to be communicated to about clinical and non-clinical issues. This includes things like explaining their benefits and additional member services they may appreciate like free transportation, cell phones, and meals, as well as, where to see a nurse or doctor about their 3-month long back pain. The member’s care team is the glue for them to improve the chances of these healthy micro-messages to land, resonate and promote behavior change.

As an example, Gina, a working 40-year old mother of 3 children ages 4, 6 and 8 may struggle to balance work, financials, the household, and the children’s school activities, let alone manager her diabetes and asthma. She hasn’t visited her doctor because of work and lack of time. Transportation isn’t ideal because her assigned clinic is 4 miles from both work and her home. Her eyesight is deteriorating and she feels like her energy is low and cannot work effectively. Gina needs help making her health a priority before she loses control of her job and family obligations. She needs the PopHealth, Quality, and Member Experience teams to remind her of plan benefits, reduce social barriers, and share the value of checking in with her health.

It takes a village! Matrix teams including Population Health Management, Quality, and Member Experience generate great value in engaging members in their health. We applaud the impact it’s made for health plan members and beneficiaries in saving and improving their quality of life.

As value continues to drive conversations in healthcare, it is important to understand how health plans can leverage member engagement and population health strategies to address social determinants of health and subsequently improve health outcomes.


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