Advocates of population health management are hoping that patients are willing to take an active role in managing their own wellness as they're counting on prevention efforts to keep their covered lives as healthy as possible. They're also counting on health insurance benefits to incent patients to use preventive health services.
McKesson spoke with two population health experts to get some answers: Jonathan Niloff, M.D., vice president and chief medical officer at McKesson; and Andrew Mellin, M.D., vice president and medical director for population and risk management for McKesson.
What role does prevention play in population health management?
Niloff: Prevention plays an important role because it can have a dramatic impact on certain diseases. Screenings for various cancers, managing diabetes, vaccinations for specific viruses. All of these are examples of preventive health services that can make a huge impact on preventing or controlling diseases, how they're treated and the cost of that treatment now and in the future.
Mellin: Preventive health services are absolutely critical for population health management. At the most basic level, preventive health services bring patients into the doctor's office where the patient can establish a relationship with a trusted provider for future health care needs. Beyond that relationship, preventive services can identify disease processes earlier to allow the patient and provider to take action, often at a lower cost and with better outcomes than if the disease had been discovered later.
How can payers use benefits design to encourage enrollees to seek out preventive health services?
Mellin: Benefits design is key to encouraging the right behaviors. If a particular preventive health service isn't covered and an enrollee has a high deductible, he or she may forgo an important health screening. Appropriate benefits design can guide enrollees to those services by removing most, if not all, of the financial barriers.
Niloff: There are plan designs under which annual visits to your primary care physician are considered wellness visits and don't have a co-pay. Similarly co-pays may be waived to encourage certain types of preventive screenings.
The Accountable Care Act requires health plans sold through state health insurance exchanges to cover the cost of 15 types of preventive health services without charging enrollees a co-pay. Many private plans outside of the exchanges have followed suit. Why did it take the ACA to make this happen?
Niloff: The challenge with preventive health services from the payer's perspective or even from a provider's perspective is return on investment. The ROI for preventive health services can be very long. If a patient isn't aligned with a single health plan or a single provider for a long period of time, another plan or provider may reap the savings benefit of the screening or testing that you paid for.
Mellin: With a substantial number of patients switching health plans every year, in the past the return on investment one health plan might make in covering preventive services would be realized by a different health plan after the patient switched, so it was often hard to justify the ROI. With the ACA, the playing field is leveled, and consumers and employers now expect preventive services to be covered in all plans.
How can payers and providers encourage enrollees to take advantage of health benefits that cover the cost of preventive health services?
Mellin: Value-based contracts incentivize providers to educate and engage patients on the value of preventive health services. The additional payments in these contracts allow providers to create a care model that identifies patients needing services and then to perform outreach to educate patients on the most appropriate actions.
Niloff: It's often a lack of education or understanding by the population with respect to the benefits of screenings and other types of preventive care. Patients may not know that they actually have financial incentives to get such care under the plan that they have. Payers and providers must do a better job with patient education.
What other strategies can payers and providers use to encourage the use of preventive health services as part of their population health management programs?
Niloff: Payers should continue to work on benefits design. Rather than waiving co-pays, which is a passive incentive, what about reducing premiums for consumers who engage in prevention and wellness activities, which is an affirmative incentive. Providers should improve access to preventive health services. Options include mobile screening clinics or after-work appointments, among others. They need to make it easier for patients to get preventive care.
Mellin: Payers and providers need to realize one size doesn't fit all in terms of patient education. They need to tailor messages by socioeconomic status, by education level, by culture, by environment and by communication channel. They need to leverage technology, social media, alternative care delivery settings and community services to reach enrollees and patients about the health and financial benefits of preventive health services. Health care organizations that want to be successful at this need to think like consumers and make the process as simple as possible for their patients.