Last week, Rich Williams, a health insurance industry thought-leader, former healthcare executive and co-founder of the Dallas-based population health management company Advanced Plan for Health, addressed the problem of rising health insurance costs before an audience of benefits consultants at the Sixth Annual Institute for HealthCare Consumerism Forum & Expo in Atlanta.
“Many traditional approaches for managing rising healthcare costs for employers aren’t proving successful,” said Williams. “Being able to predict and address costly healthcare patterns related to an individual’s behavior is the game changer.”
Williams explained that self-insured companies typically identify risk by evaluating the following: age, existing/chronic conditions, historical trends and how much chronic conditions traditionally cost and that most industry-wide population health management solutions intend to target the 5 – 7 percent of high-cost health plan members in order to remain inclusive.
“Oftentimes, population health management solutions don’t include the added risk of personal behavior into an analysis of a population,” said Williams. “The best results come to those who are able to determine which behavior patterns are causing a rise in costs and then predict future risk and potential spikes in healthcare spending.”
Behaviors that are often masked in rising costs include the number of physicians a person sees, how many pharmacies they are using and how many different providers are writing prescriptions. Frequent overlap and lack of coordination between doctors and pharmacies can drive healthcare costs up without improving the quality of care. Many times the cost-saving solution is to work with the individual member to improve their continuity of care by helping them find a single physician who can provide ongoing care.
“There is growing evidence that continuity of care for patients with chronic conditions can prevent hospitalizations, reduces health care costs and may even extend life in some populations,” Williams noted. “Implementing a nurse navigator is a simple solution that employers can provide to streamline continuity of care and ultimately reduce healthcare costs.”
Williams explained that nurse navigators are dedicated to assisting employees and their families in understanding all of their healthcare-related needs. Navigators increase engagement because they coach and counsel, having true-to-life conversations that focus on each individual and work to meet their specific needs. Nurse navigators also streamline processes and improve efficiency, which can have a significant impact on the bottom line.
The Institute for HealthCare Consumerism’s Forum & Expo aims to provide brokers cost-saving, empowering tools, top-quality solutions and a clear understanding of the changing landscape in health and benefits. Through workshops, general sessions, pre-conference events and networking opportunities, attendees gain relevant insights from industry thought leaders and policymakers on how to navigate defined contributions and exchanges, cut costs, engage employees and comply with current healthcare laws. Attendees also have an opportunity to learn from peers who have successfully adopted healthcare consumerism programs.
Williams’ company, Advanced Plan for Health, was developed to help self-funding companies manage rising healthcare costs using population health analysis to identify risk and then develop and implement an actionable plan to reduce healthcare costs. The company’s data- analytics risk engine, Poindexter, provides analysis on a micro and macro level and offers a clear view of opportunities with customized cost-saving solutions that help optimize health benefit programs.
According to Williams, Poindexter is able to identify the current and future risks of individuals by analyzing claims data and individual behavior — not just through an aggregate percentage or a high-risk group based on chronic disease. With clear-cut data and actionable steps to enhance health benefit plan performance and value, Poindexter fuels Advanced Plan for Health’s ability to improve the collective bottom line.
Founded in 2004, Advanced Plan for Health helps employers manage risk and optimize health care benefits and costs; no matter the model of care or type of entity taking on financial risk. The company’s custom-built data analytics risk engine, Poindexter, provides dynamic, reliable insight into a given population. Poindexter provides access to essential at the strategic, provider or clinical user level. With Poindexter, employers have the ability to predict conditions, trends, gaps in care, admissions and re-admissions- six to 12 months in advance. This analysis of individuals within a population ultimately identifies opportunities and risks; key information in the creation of Advanced Plan for Health’s customized action plans. For more information visit www.mypoindexter.com.