Claudia is a consultant with The Chartis Group and a member of the HIMSS Clinical & Business Intelligence Population Health Task Force.
Top 10 Steps to Take Before Launching a Population Health Management Program
Obtain top leadership support including the funds and the willingness to live the wellness talk by participating in the program and personally meeting at least one wellness goal. Leader performance evaluations can be altered to include an element of proof of wellness accountability.
All leaders must go through the Health Risk Assessment and biometric screening even if they are not on the health plan, so they can champion the cause. Leaders who stratify into any risk help must agree to work with a coach. Many leaders need to see or at least understand the ROI to accept the risk of starting a new wellness program.
Garner Executive Support to Talk the Talk and Walk the Walk: A First Step Before Launching a Population Health Management Program
Develop a partnership with Human Resources in order to market the program through open enrollment benefit information packets and presentations. Human Resources will work with the program ongoing as part of the core program accountability team to assure the program is providing top services to the HR employees or members at value to both HR and the members.
The program will identify trends and bring these to HR to design value added benefits to target diseases and bring overall health plan cost down for the health system and the member.
Meet with physician leaders (CMOs, CMIOs, Group Practice Medical Directors) and CFOs to describe the culture change and assess readiness. Discuss how the coach will interact with the providers which may be visits to the provider practice to review members in common at first and grow to embed a coach in the practice once it becomes an ACO or PCMH.
Physician champion specialists from the hospital should be identified to assist with disease specific value-add benefit plan enhancements including weight loss, diabetes, psychiatry and health prevention. Services not offered by the health system are identified for external partnerships using supporting center-of-excellence information.
Physician Collaboration: Collaborating with Physician Leaders: a Critical Step Prior to Launching a Successful Population Health Management Program
Engage hospital legal counsel to assure that proper documents and department structures are in place so that the member employee is clear regarding Human Resources not having access to their protected health information. The accountability program is acting on behalf of the health plan and not Human Resources.
Legal will also be needed to approve online consents for health risk assessments of members and voluntary agreements to coaching including annual renewals. Members are not necessarily patients, so if the member doe go to a physician, coaches should be clear on processes for releasing information if not covered in the original consent.
Legal can also work with risk management to determine if any professional liability insurance is needed for the coach RNs. Procure legal assistance for any new technology vendor contracts.
Data Sharing Intricacies Require Legal Oversight
Build a relationship with the health system labs for ongoing discussions around support for biometric screening which involves glucose and cholesterol testing. Fees for the draw and tests should be determined up front, at-cost or extreme discount for self-insured members as part of the health plan benefit.
The lab has to develop processes to bill the wellness program and not the patient. Phlebotomists may be needed for screening events. Printing and routing of tubes with bar code labels to the appropriate hospital lab, especially when the screening event is off-site for several hours requires close coordination with lab leaders. Decisions on finger stick versus blood draw with associated cost, result turn around time and degree of accuracy should be addressed.
Meet with finance to develop a budget. Within this budget include the following:
- Staffing for coaches, member services support, manager(s), contract work for screening including phlebotomists
- Supplies for screening such as gloves, centrifuge, scales, measuring tape, batteries, labels
- Marketing to include such things as a logo design, shirts for screening and health fairs, flyers, website design, banners, etc.
- Equipment including laptops, mobile hot spot, lab label printers, phones
- Professional services and Information Technology setup and support, vendor subscriptions
Research other health systems who have successfully installed accountability programs to estimate return-on-investment. Develop a graph showing the forecast of decreases in health plan costs in the next three to five years thus paying for the wellness program budget and incentives.
Expenses saved with reduced cost-of-care can be used to fund the accountability program.
Work closely with the CIO and IT team to design the technology. In order to build a program effectively and efficiently, an integrated technology foundation is necessary to measure both the program member and employer decreased cost and increased quality.
This work involves gap analysis of current technologies based on this business plan strategy, assessment of vendors to fill those gaps, system selection and implementation.
Population Health Information Technology Partnership
Meet with information security to assure all PHI is protected between the various IT systems to give credibility when assuring members of this protection.
Meet with the marketing experts that support the hospital community outreach programs to request assistance in marketing the new wellness program. Typically flyers regarding wellness and prevention already exist and the content can be used with the new population health campaign logo.
Community outreach and marketing will provide guidance on communicating the wellness program to members with Human Resources.