What Employers Should Know About Population Health Management

What is Population Health Management (PHM)?

Population Health Management (PHM) refers to the process of improving clinical health outcomes for a group of people through proactive care coordination and member engagement programs. These programs focus on policies and resources that help to keep members healthy by addressing emerging health risks and proactively managing the care of patients with comorbidities.

Traditionally, population health programs aim to reduce health risks and cost drivers; in other words, employers who take a strategic interest in the health of their workforce are rewarded with reduced plan costs.

How Population Health Management Reduces Healthcare Costs

Effective population health management programs help employers contain healthcare costs in the following ways:

1. Avoid catastrophic claims and avoidable complications through medication adherence, closing gaps in care, and monitoring chronic conditions
2. Reduce condition severity through effective condition management and positive lifestyle behaviors
3. Early detection and prevention of disease

Plan design changes are highly effective in modifying health care utilization and cost savings, as these include significant financial incentives for employees and their families in the form of reduced out-of-pocket spend for visiting lower cost facilities and seeking conservative or alternate treatment options such as physical therapy prior to undergoing a knee replacement. Whether employees are with you for six months or sixteen years, altering healthcare utilization yields immediate hard-dollar savings.

Traditional population health management solutions typically require active engagement and participation from employees at a minimum to yield any ROI, but fail to address individual behavior or the true barriers to achieving positive health outcomes.

The roundup below gives an overview of how OneDigital has evolved their approach to PHM to address the complexity of total wellbeing. 

A Modern Approach to Population Health Management

Historically, PHM programs have gauged the health of group members solely from clinical diagnoses, lab results, and prescription utilization. However, this narrow focus on physical health risks ignores other major variables that impact human health, including:

• Health and benefits literacy
• Social determinants
• Mental health
• Financial wellbeing

Modern PHM programs should place a greater emphasis on the whole person, including these previously neglected indicators, in order to develop more effective policies for improving a cohort’s health and total wellbeing.

When physical or mental health conditions go unmanaged, employees may face higher safety risks, increased absenteeism, and greater difficulty sustaining performance and wellbeing. They also might lack self-efficacy or motivation to change lifestyle habits or practice self-care, which can cause exacerbated health conditions requiring more expensive interventions down the road.

While mental health conditions often intensify physical health challenges, financial wellbeing can cause mental health challenges. For example, people with debt are three times more likely to have a mental health problem.

Questions for consideration:

1. Does a majority of your workforce live in a food desert or low-income areas with little access to healthy food? Provide healthy eating options in the workplace or offer a healthy food delivery service as a voluntary benefit.
2. Are employees struggling to fill prescriptions? Consider waiving co-pays as a short-term investment that can prevent higher future costs.
3. Do employees truly understand their benefits?
4. Are employees having trouble accessing and using their health benefits? A Healthcare Navigation Service can assist them in seeking out lower-cost providers and using their benefits efficiently.

Assess the Status Quo and Consider Policy Interventions

Modern PHM programs should gather a wide variety of data points to measure the current state of workforce health. This process should include non-physical indicators of health. For example:

• Is 401k usage low? Employees who are struggling with financial stress could also be experiencing mental health challenges, delaying care, unable to focus at work, or need help with financial wellbeing.
• Are workplace injuries increasing? Burnout or other mental issues lead to a greater risk for workplace injury, along with lack of sleep and substance abuse issues. A full assessment of wellbeing programs, including mental health benefits, should be considered.
• Has there been an increase in the number of employees taking short-term leave? Employees could be suffering from burnout or stress brought on by a multitude of factors. HR policies can be put in place to create a more supportive environment.

Once areas for wellbeing improvement have been identified and policy changes have been implemented, monitor your strategy over time to assess the overall impact on the health and wellbeing of your workforce.

Common metrics include:

• Increased benefit utilization 
• Employee needs and satisfaction through employee surveys
• Improved engagement and morale
• Better health outcomes

Understanding Your Employees' Health Needs

There are several ways to know your people, from analyzing health risk to gathering industry insights, but often overlooked is the significance of recognizing employee value drivers.

With dwindling expendable resources, scrutiny as to which benefits and resources are most valued by employees is critical. OneDigital deploys an employee value driver survey as part of their approach to population health management to identify programs that are most meaningful to optimize employee health and wellbeing.

Providing Guidance, Education, and Proactive Care

The impact of a healthy lifestyle and proactive health interventions cannot be overstated when it comes to striving for optimal health; although, motivating individual behavior change is hard. OneDigital's Engagement & Education team works with clients to create an environment that encourages self-care, provides resources and encouragement for employees to make positive lifestyle decisions, and educates plan members on the best way to use existing health benefits to seek preventative care.

Employers often have many resources available through existing partnerships with vendors and carrier partners. These benefits should be communicated throughout the year based on specific health risks and needs of your employees. Year-round communications are a great solution to gain more value out of existing benefits and resources.

Implementing A Population Health Management Strategy

The key to truly minimizing health risk (and costs) is to offer benefits and resources that cater to the individual needs of your people and deploy a meaningful year-round education and communications plan to ultimately improve healthcare utilization, eliminate wasteful healthcare spending, and improve health literacy. 

For more information on Population Health Management and other strategies to improve the health of your people and business, read the Cost Containment Playbook: 25 Strategies for Healthcare, Pharmacy, & Workforce Optimization.