Health data comparisons show that employees in the healthcare industry have higher instances of obesity, smoking, chronic disease, and stress-related illnesses than the average employee in America. Additionally, data shows the cost of providing benefits to healthcare employees and their families is $11,651 per employee, per year, compared to an average annual benefit cost of $10,475 for large companies from all industries.
As such, health systems evaluating their delivery system reform options are finding success in programs that focus on improving the health of their own workforce, according to a white paper published last year by the Arlington, Va.-based Evolent Health, a provider of population and health plan management capabilities. Building off of the accountable care movement that is dramatically changing the health system landscape, Evolent Health identified the unique value of the employee accountable care organization (eACO)—a network of coordinated care specifically focused on improving the health of a hospital's employee population. Hospitals and health systems are a target-rich environment for lowering costs and improving health because the costs associated with employee health benefits are higher, the report concluded.
In 2004, the University of Pittsburgh Medical Center (UPMC) successfully implemented an ACO-like model when it launched MyHealth, a population health management program equipped with a full suite of wellness offerings aimed at employees and dependents. Within two years, more than 90 percent of employees had actively engaged in the program, and the five-year compounded savings for UPMC over industry benchmarks exceeded $65 million, according to the white paper.
Another healthcare organization— Covenant Health Systems based in Tewksbury, Mass.—has made similar efforts. Covenant has recently announced that it has adopted an analytics platform via the Emeryville, Calif.-based MedeAnalytics to manage the health of their employee population across its three New England hospitals and affiliated facilities to prepare for broader ACO arrangements. The analytics platform aggregates and normalizes disparate claims, digital records, cost, patient satisfaction, and other clinical and financial data. This allows Covenant to proactively identify gaps in care and stratify patient populations by severity of risk, which will improve the overall health and wellness of their employees, according to Covenant officials.
“Identifying high-risk patients and ensuring that the earliest clinical interventions are put into place is an important part of successfully managing patient populations and risk. More importantly it allows us to work in partnership with our employees to improve their health,” says Richard Boehler, M.D., CEO of the Nashua, N.H.-based St. Joseph Healthcare, one of three hospitals within Covenant Health Systems. Covenant will build a cross-functional clinical and financial claims team to address population health, integrate longitudinal member claims data from payers into their database, and leverage the MedeAnalytics Population Health solution to identify high-risk employees, its officials say.
Boehler joined St Joseph Healthcare less than a year ago and immediately was involved with the journey to building a data warehouse for its insured population, he says. Each of Covenant’s three acute care hospitals—two in Maine and one in New Hampshire— is involved in a Pioneer ACO in its specific environment, and that was really the first step in doing population health, along with understanding the challenges in managing clinical data and influencing patient outcomes, Boehler says. “It became clear that there was a population very close to home—our own employees—that we would be able to have a beneficial impact on. We wanted to build the capability both from an information and a clinical perspective to be able to manage the health of our own employees,” he says. “That would also position us well for the opportunities beginning to present themselves with the large employers or major insurers that we’re working with locally. We were also trying to go beyond the wellness types of activities that many organizations adopt,” Boehler says.
One important key to managing any patient population, Boehler says, is working with payers and third- party administrators (TPAs) to obtain longitudinal member claims data. “Historically, the TPAs have a lot of the information, and you’re not getting it in a timely enough fashion to influence a given patient or employee—whatever lens you are looking through,” he explains. “They are unaccustomed to sharing even adjudicated claims on a regular basis. Of course, we want to evolve to real-time claims submitted, because that will be most effective. So we’re doing this in stages,” he says.
Coming from the hospital side, relationships with TPAs are characterized mostly by contract negotiation, says Boehler. “I liken it to me going to a car dealer and trying to buy a car. I have some knowledge from websites and consumer reports, but someone who has the knowledge of the industry and understands the entire process would make a difference. That’s where a partnership like the one we now have [with MedeAnalytics] helps change how the process works.”
And Boehler stresses that an organization has to be prepared to say, ‘“When we get that data on a timely basis, this is what will we do with it, this is who will use it, and this is how the data will influence change.’ So there needs to be a bit of an infrastructure in place, and for us that meant gearing up our primary care practices and also building a number of care coordinators who will be able to help with managing some of the people who have above average needs.”
Some of them are going to be very easy, with no chronic care needs, but 15-20 percent of the population, by virtue of intervention, can influence outcomes, continues Boehler. That’s why the ability to risk stratify and look at individuals, who by virtue of having chronic disease, would be likely to have a problem, is a big part of the process, he says. “Who is going to be likely to have a problem based on prior experience? You need to pick out those people who are likely to have the greatest challenges and devote most of your effort there.”
Also specific to employee population, there is a need to have a firewall to control who has access to protected health information (PHI), Boehler says. “Who are the people who have a clinical need to know, and who needs to know from finance and human resources?” Boehler asks. “I might, as an executive get an overview executive report, but you wouldn’t necessarily want me getting patient-level detail that could be a challenge. It comes down to role-based security and the need to know. You cannot underscore enough the importance of controlling access to PHI.”