TOTAL POPULATION HEALTH MANAGEMENT

The impact of the Affordable Care Act (ACA) is affecting the clinical, financial and administrative activities of healthcare organizations. Consumers and healthcare professionals alike now need to manage new and complex clinical issues including the declining health status of Americans, rising illness prevalence rates, growing number of chronic conditions diagnosed, and steadily increasing costs.

It is no longer enough for health plans and employers to focus only on the relatively few members who drive the majority of expenses. Improving clinical and financial outcomes depends on a mindset change towards a healthcare services delivery model designed to address the clinical and lifestyle management needs of an entire population. This is a huge shift from how health plans have operated previously, and it requires a new capability - Total Population Health Management (TPHM).

While the idea of effectively managing an entire population is not new, the Affordable Care Act and the move to value-based payment brings emphasis back to the management of the total population to foster future success of health plans and Accountable Care Organizations. TPHM guides health plans to focus on members who are most likely to be impacted through engagement, leading to improved outcomes through personalized and actionable segmentation strategies.

SOLUTION FRAMEWORK

  • Know your customer
    • Dynamic population health stratification framework
    • Customer segmentation with access to one of largest sets of consumer databases in US
    • Direct B to C marketing
    • Semantic technology to bridge SQL and non-SQL data
  • Engage members to drive behavioral change
    • Global clinical services footprint: telephonic and back office
    • CareRadius platform, with CareFind and Care Affiliate
    • Customer experience & healthcare academies
    • Omni-channel customer engagement
    • Digital care management
    • Next generation engagement analytics
  • Involve and align providers
    • Care Affiliate
    • Network management support
    • Provider quality assessments
    • ACO support
  • Measure process and outcomes
    • End to end Star Rating support
    • End to end HCC RAF support
    • HEDIS support
    • Informatics and TPHM dashboarding support
    • MedConnection for medical records summarization

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“Unfortunately, the financial impact of a member’s clinical risk is not a variable that can be easily impacted by factors the employer or health plan can control. In contrast, the clinical risk of each member can be greatly reduced when the member is properly engaged in care management and feels empowered to close the gaps in clinical care.”

Total Population Health Management 2.0

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“CMOs now have the tools to enable a fundamental change in risk management and consumer segmentation by expanding attention to the entire population within ACA programs as opposed to focusing only on the few chronic-care patients who drive the majority of the expenses. Clinical professionals now need to be directed by the CMO to maximize the use of valuable and high-cost resources in engaging the segments of the population that are most likely to engage with clinicians, manage their conditions and, if needed, adjust their lifestyles.”

Impact of the ACA on Health Plan Chief Medical Officers

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