Population Health Management (PHM) is the continuum of care from wellness to catastrophic conditions across all treatment settings. Having the “big picture” of where individuals fall on the continuum, as well as their health status, determines the type and intensity of help they will need to optimize their health and ability to perform the spectrum of life functions.
Employees who are informed are likely to:
(1) address the causative factors driving health behavior and lifestyles
(2) know where to seek education and support, and
(3) network proactively with local providers, the insurer and community resources; thereby avoiding expensive emergent and inpatient occurrences.
Some employers may think these savings opportunities are already in place and performing well, but if you ask many of their employees with serious health problems, they’ll report a lack of nurse care managers helping them specifically. PHM means that once engaged, the nurse navigator should work with the member holistically, and help them manage their specific needs, wherever they may be on the health continuum—from wellness to catastrophic health conditions.
If you or a loved one has recently accessed the health care system for a serious illness or have been diagnosed with an ongoing, chronic health condition; like diabetes, cancer, dementia or another life-changing event, then you can attest to the next point. It is difficult to know where to go for help. Employee patients frequently lack, but would appreciate access to a professional network, to help them get needed health services, and make sure that they understand and know how to follow a provider(s) treatment plan—a coordination challenge in and of itself. Once the right provider is selected, it may take time to be seen—but with local nurse care navigators, who have important relationships and can network, the process is expedited.
Savings from PHM programs are important, as they help pay for new expensive, lifesaving medicines and treatments, along with inevitable catastrophic cases that plague every health plan. Chronic health conditions, for example, are defined as those lasting a year or more, which require ongoing medical attention and/or limit the activities of daily living. Most of these conditions can be impacted through lifestyle modification, compliance with the physician’s treatment plan, and professional support from a nurse care navigator skilled at guiding and supporting health plan members with their efforts to improve their health and lives.
However, no two companies are alike in their businesses, employee health profile or corporate culture. Employers have found that it is not only the catastrophic conditions inherent in the high risk employee cohort, but also individuals who have reached the high risk group as a result of many different health issues (co-morbidities), lacking a personal physician, and inappropriately using the hospital or emergent care services for preventable problems. Plan members who are bouncing from one physician to another, because they may not understand what they need or where to obtain the requisite services, also present opportunities to improve clinical and financial metrics.
That is why each company needs to build on its existing programs in a way that will optimize member health awareness, a culture of wellness and early intervention. The trick is to identify the top problems at your company with the help of a data analytics engine that can generate individual health analysis yielding dynamic, reliable and actionable insight into an employer population. Employers can use that individual health analysis to then implement strategies that improve employee health and thus improving measurable clinical and financial metrics to cushion costs of high dollar health cases.