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What does population health management insight look like? Is it myriad data sets whose yielded risk score accuracy and value exists independent of human expertise? Or does true insight require a mix of both human acumen and the latest technology available to today’s healthcare market?

Let’s take the question one step further: What does it look like to have true insight into a certain population’s health? The distinction between the two types of insight – technology-derived data sets and human expertise – is clear, both types are key to accurately assessing and improving the health of a population. It is important to understand the distinction and the application of each type of insight.  

Published in the June 2016 Broker World, Neil Godbey, CEO and Chairman of Advanced Plan for Health, gives an example of what analytics insight provides:

“With the right analytics engine, brokers can streamline risk analysis to provide their clients with key insights–at micro and macro levels–that shed light on crucial aspects of their member population and generate actionable results.”

Mr. Godbey then explains why access to cutting-edge analytics tools provides insight:

“Analytics tools can uncover individuals who can benefit from care management, compliance with preventive and condition-related best practices, and participation in health activities. New tools, when examining custom data sets, can predict conditions, trends, gaps in care, admissions and readmissions six to 12 months in advance.”

All of which are crucial in determining and improving the health of a population, be it a specific population or population health in general. The insight provided by the “right analytics engine,” paired with human insight, is a must if one is to improve population health outcomes  and subsequently an employer’s bottom-line goals.

Below is another example presented by Mr. Godbey, illustrating why human insight accumulated from years of population health management experience is important:

“Data trends should be keyed to per member, per month (PMPM) cost to level-set the field, accounting for fluctuation in employee levels and changing number of covered families. This will help determine if a few high-cost patients skewed one particular year and influence stop-loss and reinsurance decisions.”

This a prime example of why population health management insight, or experience, is critical. An experienced analyst has unique insight into what it takes to make a significant impact not only on the employer’s bottom-line goal or health plan costs, but the health of a population.

Godbey writes:

“There’s a reason participation in wellness and disease management programs is under 20 percent today: The plan doesn’t invest the time in the patients”..….

“Typical plans’ ‘case management’ programs involve occasional check-ins, email or paper newsletters and not much meaningful interaction. It takes more than that to improve outcomes. A new kind of case manager can talk about generic equivalents with the patient and improve the patient’s health, save copays and avoid ER visits.

They can also help guide patients to lower-cost options that they didn’t know were available: Patients are often overwhelmed by procedures that have a lot of aspects to them, such as hip replacements, and are apprehensive that costs will be driven up with the different specialists and many practitioner interactions before, during and after the procedure.

Empowered with analytics-driven data, case managers can work out the different aspects of this procedure with the physician in the prior utilization process to prevent cost overruns that neither the patient nor health plan want to experience.”

Turning data insight, or “data points” into action is the goal of a data analyst – but who oversees the process? Is it the broker? Employees themselves? A wellness coordinator? Or, is it the responsibility of the employer to improve health outcomes?

As you can guess, that’s a rhetorical question. We are no longer entering the big data universe, but are fully entrenched in it, and we have the answers to the major questions. All that remains now is to act and to act with dependable insight, be it unique (experience) or general (data), because true insight enables true population health management. 


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