Last month, Health Management Associates hosted its annual meeting in Chicago with a sharp focus on the “rapidly changing world of Medicaid: opportunities and pitfalls for payers, providers and states.”
In case you couldn’t make the event, members of the Pursuant Health team shared the following insights from the sessions.
Predicting Health Care Utilization
States are encouraging Medicaid MCOs to get their members to complete health risk assessments so more HRA data can be collected. But what is the value of this member data? Cheryl Lulias, President of Medical Home Network, provided a compelling answer.
Her analyses showed that a question in the HRA, which asked members to rate their own health, was a strong predictor of future health care costs and utilization. Members answering “fair” or “poor” were much more likely to visit the ER and get admitted to the hospital.
Related: Pursuant Health gathers insights from the estimated 20 million individuals that use our kiosk network to complete health assessments, biometric screenings, and other health-related activities. Looking at our recent data, we see that 21% of individuals rate their health as “fair” and 5% as “poor”. Learn more about the rich data we collect on our nationwide kiosks.
But, other questions also predict health care utilization, such as whether the member needs help getting food, clothing, or housing or whether the member lacks transportation. Such questions represent a growing area of focus for health plans: social determinants of health.
Social Determinants of Health
Forty percent of factors that influence health and can be modified are tied to social and economic factors, according to Mike Leavitt, former Secretary of the U.S. Department of Health and Human Services. Catherine Anderson, SVP Policy & Strategy with UnitedHealth, got to the heart of the matter when she said, “You cannot convince a mom to get her mammogram and other wellness visits if she doesn’t know where her food is coming from.” While the important role social factors play in health is widely accepted, a larger question is now facing plans. What to do about it?
Karin Van Zandt, VP of Life Services at CareSource, points out that there may be as many as 80 different community-based resources in a given market. The real challenge is in connecting members with social or economic needs to the right community services. To tackle this challenge, North Carolina is building a statewide resource database and a standard set of screening questions to match members to these resources.
Currently, the Center for Medicare and Medicaid Innovation (CMMI) is experimenting with the Accountable Health Communities (AHC) model. These integrated pilots are trying to prove that coordination between health care providers and community agencies can improve health outcomes and reduce care costs by focusing on social determinants of health.
It Starts with Health Surveys
As MCOs aim to improve their member engagement and address the social needs of their population, things come full circle, back to having the right data. In order to tailor messages and interventions, plans need to know more about their members, more than they get from the 834 transaction set or from claims.
A growing number of states are pushing HRAs, adding social determinants of health questions, and tying withholds or bonuses to completions. Indiana, for example, uses a withhold to incentivize its MCOs to hit a 50% Health Needs Screening (HNS) completion rate. Pursuant Health has played a key role in Indiana. With our network of kiosks in retail pharmacies and our real-time incentives, we’ve helped Medicaid plans like Anthem attain Health Needs Screenings for members who are typically hard to reach. Learn more about our HNS program with Anthem in Indiana.
In his keynote talk, Mike Leavitt declared that our healthcare system is 25 years into a 40-year transformation. Referring to other large industry changes, such as banking, telecommunications, and transportation, he argued that these transformations all took 30 to 40 years. Over the next 15 years and beyond, data will play the key role in efforts to control cost, integrate care, and personalize healthcare. At Pursuant Health, we are building a platform to improve how health plans capture member data. We want to position health plans for the next phase of this transformation.
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