Introduction

As organizations look for ways to reduce costs and improve outcomes for members covered in their health plans, one thing is increasingly certain: Current legacy systems are not up to the task.

Although traditional mainframe and client-server-based systems host robust and specialized applications, they were not designed for a new age in health plan management that calls for comprehensive and secure data sharing among providers, payers and others. For a growing number of organizations, cloud computing is the missing piece that will help them build a high performance engine to accomplish this highly-collaborative objective.

To address these and other related issues, the Healthcare Performance Management Institute held a live Webcast on December 1, 2011, featuring experts from various industries and the technology community. Included in the panel were:

• Michael Clark, Vice President of Development with Pacific Intermedia, who has served on over 30 Enterprise N-Tier Healthcare Projects. He has extensive experience in IT platform design and scalability and has guided Pacific Intermedia’s move into Telehealth, executing projects in Europe and Asia.
• Todd C. Thompson, Chief Technology Officer for the Financial Services & Human Capital line of business within Lockheed Martin Corporation. Thompson has worked for Lockheed Martin for 23 years of his 30 year career in information technology. He is a recognized expert on utilizing information technology to solve business problems for large enterprises in both the commercial and federal sectors.
• Henry Cha, President of Healthcare Interactive. He is a healthcare technologist who specializes in delivering software as a service (SaaS) offerings that help companies better manage employee healthcare programs and related costs. His SaaS technologies provide a simplified and consolidated environment for employee members. He is also an expert in using computational and statistical techniques to present and analyze health data.

Panelists observed that professionals in the healthcare community have been slow to reap the myriad benefits of the cloud. Although some organizations have taken a “wait-and-see” approach because of security and privacy concerns, others have been so burdened with legacy system challenges that they find the prospect of supporting yet another platform daunting. This complexity, however, is exactly the reason why the cloud is just what the doctor ordered for health plan management.
 

Cloud deployment can help various entities share information across disparate systems in real time and enable a new level of collaboration that is the key to improving individual outcomes. It also gives the industry the capability of launching robust new applications.
 

Most importantly, the ability to access data, analyze it and leverage it to identify and quantify risks -- in time to change behavior and reduce those risks – improves outcomes and dramatically reduces treatment costs.

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Located in Greenwood, Mississippi, Viking Range Corporation manufactures, markets and distributes high-end kitchen appliances and cabinetry. Beyond its core manufacturing business, however, Viking’s operations also include a variety of hospitality and lifestyle ventures, including: cooking schools, restaurants and a spa. As a self-insured employer, Viking provides healthcare coverage for approximately 800 employees and their dependents. There are over 1,400 covered members.

Viking implemented a Healthcare Performance Management strategy in January 2010. The strategy has generated a significant return on investment and noticeably reduced the company’s healthcare costs. From 2009 to 2010, the company has achieved:

• $1.16 million savings on annual medical and pharmaceutical claims;
• 16 percent reduction in annual medical and pharmaceutical costs per employee;
• 13 percent drop in the probability of high cost medical and pharmaceutical claims; and
• 9 percent decrease in hospital admissions.

The company achieved these results by utilizing predictive modeling technology to continually target its members with the highest probability of high-cost claims across disease categories. It also offered incentives for engaging with Care Managers and fostered a corporate culture in which wellness is a shared organizational priority driven from its executive leadership on down.

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The Critical Role of Technology-Enabled Collaboration and Healthcare Performance Management

Introduction

More than 18 months after the Affordable Care Act (ACA) was signed into law, the public sector is working hard to transform its business processes and systems to accommodate a revolutionary new paradigm for healthcare delivery. One thing is certain: yesterday’s legacy systems are not up to the task of managing tomorrow’s health data and business processes.

In a Webcast hosted by the HPM Institute, a panel of experts weighed in on the challenges facing the public sector as it gears up for the transformational new task of implementing healthcare reform and how cloud technologies can help accomplish those objectives efficiently and cost effectively.

The panel participants featured in the Webcast were:

• Liddy Garcia-Bunuel, Executive Director of Healthy Howard, a unique community health program for the uninsured in Howard County, Maryland

• Alice Burton, President and Founder of Burton Policy Consulting in Maryland, a firm that works closely with state-level and private sector clients to navigate issues arising from health reform implementation

• Gene Walker, President of HCI Federal, a provider of cloud-based technology solutions in the public sector

“We all know that healthcare reform legislation has had an impact on the healthcare landscape and how the public sector delivers healthcare,” said George Pantos, Executive Director of the HPM Institute. “Numerous challenges and barriers confront looming deadlines under healthcare reform legislation.” Cloud-based technology can be leveraged to help federal, state and local governments cope with these challenges.

The magnitude of that challenge is significant. A report by the Centers for Medicare and Medicaid Services (CMS) last year projected that government healthcare expenditures will top private spending for the first time in 2012. The Federal Employees Health Benefits (FEHB) Program cost approximately $40 billion in 2010, including both premiums and out-of-pocket costs.

“From the state perspective as well as any other perspective, health reform is best described as overwhelming in its size and breadth,” said Alice Burton with Burton Policy, which helps state-level public and private sector clients navigate health reform implementation. “I think the biggest challenge in the area is the health insurance exchange and the reality of its change into a competitive marketplace. That’s very different for state policymakers to implement a new program, a new initiative, but really it’s just one of a series of options in the marketplace.”

Gearing up for health exchanges and other requirements of the ACA is an even greater challenge for the public sector – one that existing government systems are ill-equipped to manage. Cloud technologies provide the federal and state governments more bang for the buck because they don’t have to make huge technology investments. Cloud technologies also enable collaboration among the various stakeholders in the process.

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Introduction

In a Webcast hosted by the HPM Institute – a Bethesda, MD-based research and education organization dedicated to promoting the use of health data and management principles to improve wellness – a panel of experts discussed the growing use of cloud-based health data systems within their own and their clients’ organizations to improve outcomes and reduce costs. The Webcast was held on July 27, 2011.

Cloud technologies – and the new business processes that they either enable or enhance – have created new opportunities to better analyze data from disparate sources (clinics, pharmacies, insurance companies, etc.) to better correlate and support improved decision-making.
 

As part of this Webcast, the HPM Institute conducted a poll of attendees regarding their utilization of cloud-based health data systems finding that: 

• Fifty-five percent of participants believed that cloud computing can help their firms better use analytics to manage their health benefits before risks surfaced.
• Sixty percent stated that their organizations would be better able to aggregate healthcare data from multiple sources to identify risk, reduce costs and improve health outcomes.

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Introduction

In light of skyrocketing costs, organizations increasingly are looking to get more bang from their healthcare buck. While in the past that goal has translated into cutbacks in health plan options or increases in employee contributions, those tactics have met with only limited success.

But leading edge technology advances are giving organizations another, more powerful tool in the fight against skyrocketing health plan costs — strategic integration of Healthcare Performance Management (HPM) into the human resources (HR) environment.

“The purpose of HPM, for many companies, has been to save money,” says Henry Cha, President of Glenwood, Md.-based Healthcare Interactive. “But at the end of the day, it is to be able to apply corporate disciplines using software — such as Customer Relationship Management (CRM), Enterprise Resource Planning (ERP) and other software based tools — to help manage the healthcare enigma. Today, we’re not using software to manage these elements. This is our opportunity to finally get control of healthcare using software.”

The concept of using software to achieve a more holistic view of a company’s operations is well-proven. Organizations long have been using ERP and CRM software to control costs and manage the overall health of the company. But Cha says that enterprises can achieve even better results by integrating HPM tools into their HR departments.

By using these tools strategically, HR departments can create a management environment whereby the health plan and employers can leverage healthcare data and analytics as part of a strategic platform that engages employees and helps them live healthier lives.

But most organizations can’t do that today because health data is separated from HR-oriented information on knowledge, skills and abilities (KSAs). If companies can integrate those two forms of data, they can achieve a far stronger base of knowledge that will empower them to more effectively manage employees.

“HR performance management for employees is the gathering of metrics, creating what is called KSAs, or knowledge, skills, abilities metrics — in essence, employees’ performance abilities,” Cha explained. “So not only are companies gathering this information, but they are creating development plans for each individual or group of individuals. They are using technology platforms in HR to create real-time interactions, so you get the best performance from these individuals.

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Introduction

Since it was founded in 1991, The SCOOTER Store has gained a reputation for helping people with limited mobility reclaim their independence and enjoy a more active and satisfying life style. So when the New Braunfels, Texas-based firm sought to contain the skyrocketing costs of providing health care to its employees, it embarked on a strategy to not only manage costs, but help its employees become healthier.

Based on a core ideology, “Always Do the Right Thing,” The SCOOTER Store sells powered wheelchairs and scooters to people who require the mobility solutions to accomplish one or more activities of daily living. The company, which employs about 2,800 employees, has also been recognized by Fortune magazine as one of the “100 Best Companies to Work For.” Most of The SCOOTER Store’s employees — about 1,750 — are based at the corporate headquarters. The rest work in distribution centers, in the company’s rehab division, Alliance Seating & Mobility, in the Home Care division or as field reps in 47 states.

At a time when most businesses are under pressure to get more bang from their health benefits buck, The SCOOTER Store has discovered that Healthcare Performance Management (HPM) can play a key role in helping boost cost efficiency and health outcomes.

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Introduction

Organizational wellness initiatives are among the hottest buzzwords in health care these days. Yet, as a growing number of companies grapple with the challenges of adopting wellness programs that yield measurable gains, two key success factors stand out: integration and incentives.

Southampton, Pa.-based WellNet Interactive’s mission is to help employers leverage integrated technology, customized member engagement strategies and employee incentives to improve the health of their employees, while also reducing the skyrocketing cost of health-care benefits. Most industry experts believe that the success of an organizational health management program is directly tied to employee participation in that program. The twin challenges for most companies developing such plans is how to drive employee participation and how to measure the success of their programs in terms of improved health outcomes and reduced plan costs.

That’s why WellNet takes a holistic approach toward helping organizations develop wellness and health-management initiatives. That approach uses advanced technology and data analytics to identify at-risk segments of the member population, translate that data into wellness initiatives that can identify and manage risk, use incentives to encourage employee participation, and apply credible metrics to quantify bottom-line benefits.

“I look at that on two levels,” explains Judy Mueller, WellNet Interactive president. “We have two primary objectives: 1) engaging the members in meaningful dialogue that points to improvement in health status; and 2) having an impact on medical expenses — and that’s what the CFO, CEO and the executives in the human resource department are going to be concerned with.”

Improving health outcomes is an important issue for Mueller, a licensed registered nurse with a background in critical care medicine and 20+ years of experience with insurance, reinsurance and medical management organizations. From an organizational standpoint, WellNet’s goal is to reduce medical expenses and stabilize medical trends over time. For individual members, the goal is to create good health outcomes for them and their families. To accomplish both goals effectively, wellness initiatives must go beyond the traditional approach of addressing acute or chronic disease management — they must also broaden an organization’s focus to identify risks in time to do something about them. And that means leveraging data across the entire member (employees and their dependents) population.

“If you widen the net of people that you can draw from and you can get those members to participate at a high level with the wellness strategies and on a 1:1 basis with our care managers, the ultimate outcome is going to be good for the member and for the employer,” says Mueller. The technology and data analytics help us identify members with a unique set of medical conditions and structure outreach strategies based on that member’s needs and expectations. We pay special attention to how members learn and internalize health-care information, what the culture of the company calls for and how to best communicate with both. Taking the time to really understand this helps us to customize our approach and reaps the optimal in participation rates and ROI. In turn, not only will the health outcomes of individual members be improved because they’re based on unique medical concerns, but the employer will also be able to generate better health outcomes for its employees at a lower cost.

“And that’s really what our mission is, to create savings for the medical plan in terms of reduction [in health problems] and expenses, as well as stabilization of the trend over time — and then good clinical outcomes for the members,” Mueller says. “These are not mutually exclusive — they actually work hand in hand.” Indeed, better outcomes drive reductions in medical costs because when members are healthier and more productive, organizations will have fewer workers’ compensation issues and lower medical expenses over time.

“And I emphasize over time, because it does take time for all this to work,” Mueller says. “Our advantage lies in our technology and analysis, which allows us to be more proactive and accelerate the performance cycle. For us, it’s a high tech/high touch approach to health management, and it works.”

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