This fourth panel, on private sector innovation, featured our most diverse panel yet: two purchasers and two providers. Needless to say, each panelist offered a unique perspective on the goals of population health management and on what constitutes the best approach.
Chet Burrell, president and CEO of CareFirst BCBS, told attendees that CareFirst knew it had a problem when it noted that its sickest patients accounted for 100 times the costs of its healthiest patients.
From his perspective, "quality" means “eliminating breakdowns in care for the sickest patients in our population.” That’s where CareFirst focused its efforts: they rolled out a series of provider incentives to create patient-centered medical homes and drive reductions in health care spending for at-risk populations, and they saw staggering results: For the roughly 50% of its population in these medical homes, CareFirst saw reductions greater than 10% in PMPM, ED visit costs, readmissions, and inpatient days, among other things.
Marleece Barber, the CMO of Lockheed Martin, offered a different perspective, speaking about how large employers address their employees’ care management needs to reduce spending.
Lockheed Martin established a goal of becoming “the healthiest company in the aerospace and defense sector.” From this mission, they elaborated a list of goals for the “healthiest workforce,” and a separate list of goals for the “healthiest workplace.” Workforce goals included educating employees on health care needs and options; offering convenient access to high-quality care; and creating a social support network for its employees. To become a healthier workplace, Lockheed martin revisited—and in some cases, revamped—its workplace policies, rolled out mobile workstations, expanded onsite health care services, and bolstered its messaging that Lockheed values and invests in its employees’ long-term health.
These goals aligned directly to Lockheed’s greatest cost drivers, which included diabetes, high blood pressure, and lower back pain, but also psychological issues like stress. Lockheed Martin’s holistic approach to health management stands in contrast to other approaches we have observed, primarily from employers with shorter average employee tenure which struggle to rationalize these types of investments in long-term results.
Henry Ford Health System
Dr. Chuck Kelly, the president and CEO of Henry Ford Health System, made his three key points right off the bat: first, data is your friend. Collect as much of it as you can. Second, be creative. Third, expect the unexpected.
According to Dr. Kelly, Henry Ford saw its early care management efforts on its own employee population as a golden opportunity: success would enable Henry Ford to secure additional contracts in the future, to “eat our own cooking.”
After successfully lowering costs for its own employees, Henry Ford put its care management product on the market and looked for other employers who might want to purchase this product. What it found—not surprising, for Detroit—was a population of heavily-unionized employers who faced persistent issues with diabetes that drove cost growth. So Henry Ford developed a comprehensive intervention that offered savings of twice the upfront costs to the employers. Several of Detroit’s large employers have signed onto Henry Ford’s care management initiative.
Community of Hope
After such a detailed discussion of how to manage costs for large employee populations, Kelly Sweeney McShane from Community of Hope spoke about a different angle of care management—"bringing people back to population health." Many of Community of Hope’s patients do not have health care coverage, speak a language other than English, and lack basic support for their health care needs. As a result, Community of Hope has sought to provide basic screenings and health care access information to an exceedingly disenfranchised population. Their work aimed to get patients into the health care system, accessing free health and dental health screenings and understanding how and when to seek crucial care.
While tracking precise impact proved challenging, Community of Hope served 270 families and their children in 2012 alone. For these patients, Community of Hope expanded access to health care, secured more frequent screenings, and improved overall satisfaction with their health care.
A Common Theme Across Panels
These four different perspectives and stories shed even more light on the topic of panel three, scaling care management efforts. As Daniel Meuse said, scale is relative: in some cases, it’s a large population of disenfranchised, underserved patients; in others, it’s thousands of employees; in still others, it’s every resident of a rural area.
One thing is certain: identifying and targeting patients most in need of help requires high-tech resources, like patient registries and risk-prediction algorithms, which helps stakeholders determine where to allocate its high-touch resources—the care managers, pharmacists, navigators, family members, and others who guide at-risk patients to the care they need.
It's important to remember that patients frequently lack any visibility into these complex efforts. According to the Advisory Board’s Dave Willis, some have reported that when they explained medical homes to patients, the patients’ response was, “haven’t you been coordinating my care all along?”
In many cases, the age-old advice about patient-centered care holds true: for all the data we have on likely patient behavior, it is important to talk to patients as people, and to understand not just what the algorithm says, but what patients themselves tell us about their challenges and their needs.