In an earlier life, when I worked in consulting, we once did a project for a retail bank whose growth had stalled.
The bank’s business could be broken down into basically just two customer segments: services for regular people and services for wealthy clients, or what they called "private banking."
Private banking was by far the most profitable segment, but the bank’s typical networking-based tactics for growing the high-end customer base weren’t driving results. So they brought us in to help.
Defining an 'in-between' customer segment
What we realized was that the bank actually had three customer segments, not two. There were regular people. There were rich people. And then there was the middle—regular people who were likely to have high net worth in the future.
We called this middle group the "Emerging Affluent," and we recommended that our client give customers in this group extra attention and special services, so that if they became prospects for private banking in the future, the bank would already have a relationship with them.
Progressive health systems also targeting the middle
What does this story have to do with care management?
Our Care Transformation Center research is finding that, like my retail bank client, the best population health management organizations are also targeting three segments of patients, not just high-risk and low-risk.
We've identified a middle tier of patients that we call "rising-risk," or patients with multiple risk factors who aren't driving significant health care utilization yet. Health systems are focusing on the middle-tier patients for the same basic reason that banks should focus on middle-tier customers: today’s middle tier could be tomorrow’s top tier.
(Of course, in health care, the objective is the opposite of the one that the retail bank has: if care management succeeds, the "rising-risk" patient never becomes a high-risk patient.)
Handoffs especially important
There’s another similarity between the retail banking example and care management, too. What we found in the banking industry was that the key to success of the "three segments" strategy is timely, accurate handoffs between segments.
If the bank misses an opportunity to upsell an "Emerging Affluent" customer to private banking, its customer might go somewhere else.
Similarly, if formerly "rising-risk" patients develop more complex diseases or greater comorbidities, they will require more extensive care management services. And if health systems fail to identify them in time or change the way their care is managed, these patients are at risk for high costs and poor outcomes.
Advanced analytics can quickly flag patients who seem to be moving into a different risk tier. But as my colleague Lisa Bielamowicz has pointed out, health systems should complement their quantitative risk assessments with qualitative judgments, making intelligent use of the information that doctors and nurses already have.
- The one thing to know about population health management
It's not just one population you need to manage, it's three—and each requires a different model of care. Watch Dave Willis explain which populations you need to focus on, and the keys to managing them effectively.
Meet the Needs of Each Patient Segment
At the Health Care Advisory Board's 2013-2014 national meeting series, we'll devote a full morning to discuss best practices for managing patients at different risk levels. With 24 meetings in 16 cities, we hope to see you soon.
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