The Forum

We analysed 25 population health interventions—and these 2 are the most cost effective

by Tomi Ogundimu

Editor's note: This story was updated on 9 August 2018.

Determining which investments to make in care delivery transformation is a difficult task without good data on initiatives with demonstrated success. While most provider organisations look to adhere to evidence-based guidelines, there are few explicit standards for many innovations in care transformation. To make the right investments that change the care delivery model, population health managers should prioritise initiatives proven to move target metrics related to cost, utilisation, and quality.

To help our members make these strategic decisions, we have published the Care Delivery Innovation Reference Guide. We've spent the past year doing an extensive literature review of the evidence behind 25 of the most popular interventions to give providers an easy-to-use guide on what cost, utilisation, quality, access, and satisfaction results to expect from different care transformation efforts.

Here are three surprising lessons we learned from that nearly year-long study.

1. Not all chronic disease management programmes are created equal—without proper implementation, some could cost you money in the long term.

For seasoned population health departments, chronic disease management is their bread and butter. In theory, these programmes are lower-cost investments in care management that stabilise clinically challenging patients, direct utilisation away from acute care settings, and preempt risk escalation.

However, chronic disease management isn't an easy win. Studies have shown a wide range in how much downstream cost is actually avoided with these interventions. In fact, some studies on COPD management have even demonstrated long-term cost increases, often because of an overly broad investment in services covering a range of ambulatory treatment.

To build an effective chronic disease management programme, narrow in on the 10-15% of the population for whom you can inflect utilisation patterns using data-informed risk stratification. For those with a hospital stay, focus post-discharge follow-up on patient education, teaching new self-management skills, and encouraging behaviour change. Lastly, employ protocols from primary care and care management teams to co-manage or transition patients at-risk of escalation to specialists.

2. Be strategic when investing in under-studied interventions. The results may not be what you expect and may require you to initially narrow the scope of your services.

It's not news that a lack of transportation can be a major barrier to care and positive health outcomes for patients. When it results in missed appointments, insufficient transportation can cost the system money and potentially result in downstream escalation. Many of you have already launched services to meet this important patient need.

However, non-emergency transportation services haven't been studied much in academic literature—and have produced mixed results in existing studies. The relatively low strength of evidence for this intervention was surprising, but it doesn't negate the importance of meeting this need for patients. Instead, population health leaders must narrow the focus on their services before designing a programme, which starts with partnering with community leaders to understand nuanced transportation barriers and preferences.

3. To get the most out of your investment, two care innovation interventions stand out among the rest.

Out of the 25 interventions reviewed to date, we found that only two have been studied over a long period of time and consistently demonstrate improvements on cost, quality, utilisation, access, and patient satisfaction metrics: high-risk care management and community health worker programmes. Why? Both interventions are tailored solutions that address the most pressing clinical and social barriers of at-risk patients, driving overall engagement and customising care plans.

To get started with identifying and prioritising programmes that align with strategic goals and patient needs, Global Forum members can access the Care Delivery Innovation Reference Guide.

Your first two decisions when designing a high-risk patient programme

Coordinating care for high-risk patients requires organisations to redesign the typical care team model to account for additional patient care needs. Thus, some progressive population health managers are creating super-utiliser programmes. In this blog post, we examine what a super-utiliser programme is, and the questions you need to ask when designing one at your organisation.

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