Andrew Whitman, VP of Customer Success
Getting a population health management program up and running is one thing, managing an on-going program is quite another. We recently spoke with Andrew Whitman, Vice President of Customer Success at Decision Point Healthcare Solutions, to get a better idea of how this works.
Andrew described the population health workflow for us and broke it down into the following processes.
Member selection, message development and channel selection
At Decision Point, we start by helping plans identify which members are not likely to exhibit desirable behavior (such as compliance with evidence based guidelines, adherence with medications, satisfaction with the plan, etc.). We’re not actually identifying members that are non-compliant or non-adherent as much as we are predicting who is likely to be non-compliant and non-adherent so that plans can reach out to these members earlier in the year rather than scrambling as the year end reporting cycles are about to close.
Once we’ve determined who these actionable members are, the next step is to develop messaging which is informed by the drivers of non-compliance as identified by the predictive models. Finally, in partnership with the plan, we determine which channels are most appropriate for reaching the members.
Decision Point applies robust predictive capabilities, leveraging a wide variety of plan data to determine individual risk categories of member behavior for the various measures and actions being analyzed. Risk categorization allows Decision Point to help the plan get the most value from their outreach budgets by targeting members in the higher risk categories for outreach, while reaching out to members are likely to take action on their own less intensively.
Risk categories can also be used to influence which channel to use, reserving the most effective, but also most costly channels for the highest risk members. More on that in a bit.
Message development and calls to action
Each message is crafted to elicit a response, or call to action, from a member based on the segmentation and barrier to the actions as identified by the models. For example: does the member have issues with their PCP, are they having trouble understanding how to use the care system or plan benefits, are they struggling with multiple comorbidities that have created a complexity of care, or are they in need of a PCP to coordinate care with a specialist.
We look at each segment and align them with the risk factors in order to determine the correct action. Often, the messages are similar channel to channel while a specific channel is selected as more effective to drive engagement.
Live-call scripts, this is where member services or care management specialist calls the member directly, are developed with multiple paths based on the expected interaction with the member. Scripts are created with segment specific messaging, so the call to action may be different for members depending on, for example, their health literacy, physician relationship, health system engagement, or clinical complexity for chronic issues like diabetes or acute items, such as a heart attack.
Then, based on those segments, actions are determined. Consequently, there may be four or five scripts for live calls, while automated calls be more streamlined, while still adhering to segment specific messaging.
Scripts are also customized from plan to plan based on the plan’s differing benefit structure and their comfort level and access to specific channels. So we make sure each script highlights the most effective benefits the plan has to offer, whether that’s something as simple as recommending transportation or scheduling support to moving the member into a relationship with the plan’s care management team.
Cost hierarchy and channel selection
There are several dynamics to channel selection: the hierarchy of channel use, member channel preference, member risk of non-compliance and of course, the plan’s outreach budget. Live calls are most expensive, automated outreach or IVR is less so and email and text are least costly. With this in mind, taking a “bottom up” approach can be a great member outreach strategy because it allows plans to use their most inexpensive tool first, then gradually activate more expensive channels as they zero in on their harder to reach members.
Taking this approach, we suggest starting with email/text messaging, which enables plans to inexpensively reach a wide audience. Once they have winnowed the population down or if email addresses or cell phone numbers are unavailable, IVR is deployed to get even more folks to respond. Live calls are activated last once either to those that have not been reached or those identified as the most high-risk members.
Text and email – While these are low-cost, high volume channels, they tend to work best with younger plan members who, in general, are less likely to answer the phone. The best aspect for the technically aware members is the ability to provide a link either to additional resources or a dialable phone number to support the call to action.
Interactive Voice Response(IVR) –The automated telephony system interacts with members, gathers information and routes members to the appropriate resources in the form of voice, callbacks, e-mail and requests for additional materials. The recorded conversation must be scripted and sequential. This channel is used to reach people who are likely engaged, but may need a push to take action. Without a direct line for transfers, however, IVR is limited in its ability to move an individual around the healthcare organization. We’ve also learned that its effectiveness can be somewhat limited with people over 80 or that have hearing issues.
IVR has the benefit of tracking responses that can be feed back into the models to increase accuracy.
Live calls – The most effective, but also the most expensive channel, live calls allow a plan associate to engage directly with a high risk/potentially noncompliant member, adjust their response to the individual, then move the member to action helping them schedule a doctor’s visit, provide additional information that can help the member understand their benefits, or transfer the member to clinical resources that can provide additional clinical information. For instance, if the member does not have good relationship with their PCP, member services can help them find a new PCP. The more complicated a person’s issues, the more likely we are to recommend live calls.
All told, we are recommending channels by balancing the ability to engage an individual using our engagement model, and considering a member’s behavioral risk, health complications, plus the member’s age.
Assigning the Workflow
Once the messages are set and the channels are determined, it’s time to assign the workflow. In addition to the initial outreach channels that are deployed to engage members, Decision Point works with plans to understand what types of additional plan resources are available to provide members with additional assistance should the member require or request this assistance. Typically, there are three levels of resources to deploy:
- Member Services Call Center resources – that provide information about benefits, PCP switching, transportation, scheduling etc.
- Nurse or Care Management – trained clinical resources that help members understand their conditions, and coordinate care with PCPs and other plan resources and benefits.
- Pharmacy Benefit Manager or Pharmacists – help members understand their medications, reduce the possibility of drug complications or interactions, and find ways to save on costs
Each plan is different. The goal is to leverage available resources to help deal with each category of individual, then put the plan into work.
Our final step is always reflective. We measure the success of each campaign to determine:
How well did it work? Were the original objectives of the program met?
Where did it worked well?
Where there is room for improvement?
This information, both quantitative and qualitative, is used to fine tune the models as well as the outreach programs to increase effectiveness. Population health management should be a continuous learning loop where results are continuously checked, refined and optimized.