The HPM Institute is constantly researching and writing new reports to discuss the concept of healthcare performance management and how it applies to various aspects of company management and healthcare management as a general concept. The reports and white papers the Institute publishes aim to educate Institute members, employers and members of the public on how to deliver cost efficient health benefits backed by progressive, analytic-driven technology to better manage and control health costs without sacrificing the quality of care that employees receive. Topics range from discussing the conceptual role of HPM, data analytics, social networking in HPM to predictive modeling, the role of the CFO and CIO in HPM, and privacy, risk and governance in HPM.
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In the rapidly changing healthcare landscape, new delivery and reimbursement models are transforming the U.S. health system and redefining the traditional patient-doctor relationship.
Telehealth, which uses technology and mobile devices to connect patients and physicians for real-time consultations, is one of the delivery models adding a new dimension to healthcare. By fostering “virtual” patient-doctor interactions for non-urgent medical issues in lieu of costly in-person visits, telehealth is an alternative, affordable and effective way to access healthcare by phone, internet video and e-mail.
A looming shortage of primary care physicians, costly office visits and constantly escalating health insurance premiums are driving forces that make telehealth an effective way to help meet the needs of a broad range of Americans, particularly students enrolled in higher education. Despite some resistance from state physician groups, telehealth continues to gain popularity as a viable healthcare alternative for today’s college students who rarely are detached from their mobile phones.
While the recently enacted Affordable Care Act (ACA) expands healthcare coverage for dependents, the costs associated with keeping students on the family’s plan will affect many parents who are struggling to meet tuition and living expenses; and coverage does not equate to access. As a complement to parent and school insurance plans, telehealth—which is not insurance— provides today’s mobile phone- and computer-connected students with direct, quick access to primary care doctors for basic health information, consultation, diagnosis and prescriptions for non-controlled substances. Parents gain peace of mind knowing that their student has ready, aroundthe-clock access to quality, physician care away from home; and schools can expand their campus health services to 24/7 without additional infrastructure or personnel costs.
As insurers increasingly reimburse doctors for telehealth services—and as colleges forge collaborative relationships with telehealth firms—telehealth is expected to continue its steady growth on America’s campuses. Major trends are shaping the increasing use of mobile telehealth services within the U.S.’s college and university populations: higher costs for parentand school-sponsored health plans; a critical shortage of primary care doctors; and potential reductions in the availability of school health plans due to budgetary constraints. Parents, students and schools need important information about the benefits and limitations of telehealth, how it works and how it can be used to greatest effect. This paper addresses all of those aspects of telehealth’s growing penetration in American higher education.
Sustaining a successful population health management program, no matter how success is defined, requires a collaborative effort at every stage of the life of the program. Senior level support and a high-level of employee engagement in healthy behaviors are key elements of successful population health management, whether for medium or large employers and increasingly for smaller employers.
Sophisticated scientific and analytical methods that address chronic and emerging health risks, and then develop customized risk management strategies, are based on members’ “readiness” to adhere to healthy lifestyle behaviors. This model represents a breakthrough in successful population health management. While this model can be applied to hospital and physician health systems, successful member engagement in healthy behaviors can also be applied in the employer sponsored group health plan context.
Employers benefit when effective workplace wellness programs improve the health of their workforce. Productivity is diminished when employees are ill and unable to perform their jobs and illness has hampered their productivity.
To keep members healthier, employers at the forefront of change – who seek to improve their bottom-line by reining in spiraling healthcare costs – are focused increasingly on the twin strategies of workplace wellness and a higher level of employee engagement in healthy behavior. These strategies inevitably are interwoven as a result of the difficulty managing employee health without greater employee self management of their own health risk factors – whether identified through health risk assessments, biometric screening or other scientific methods. This paper discusses the fundamentals of an effective engagement process as a key factor in an employer-sponsored population healthcare management strategy, and shows how combining targeted “high touch” R.N. nurse health coaching with high-tech automation and digital tools can facilitate the process of mitigating healthcare costs by promoting health.
Organizations in both the public and private sectors are confronting the operational implications of healthcare reform fueled by mandates and continually rising health costs as executives across industries analyze their options. Many are realizing that their most significant opportunities for taking control of healthcare management challenges lie within their own business processes and IT environments and may require them to transform the way they do business.
The convergence of sweeping regulatory demands for increased transparency, connectivity and security have combined with the industry’s long-standing dependence on legacy applications, data silos and point solutions, to generate a “perfect storm” that can overwhelm many organizations. This storm has the potential to disrupt organizations that do not evolve from their fragmented information systems into environments that integrate business processes at all levels of health service delivery.
For many organizations, the answer to these challenges lies in moving to cloud-based computing environments. Cloud computing enables on-demand network access to a shared pool of configurable technology resources (such as networks, servers, storage, applications and services).1 Because the cloud creates a computing environment in which resources can be rapidly provisioned and released with minimal management effort or service provider interaction, it represents a way to address new regulatory and market trends. It can help organizations reduce the healthcare cost curve while improving outcomes.
Health insurance brokers traditionally have played the role of linking business customers with insurers, leveraging their resources to find the most cost-effective solutions for those businesses and their employees. The centerpiece of that strategy has been healthcare cost control, either by steering employers toward less expensive plans, cutting benefits, or by increasing employee contributions. However, as steam picks up behind the concept of Healthcare Performance Management (HPM), the competitive imperatives in the broker industry will change dramatically.
HPM is a technology-enabled, data-driven business strategy that tackles the challenge of controlling healthcare costs and improving quality in much the same way that enterprises have optimized customer relations, supply chain management and enterprise resource management.
As the healthcare landscape changes, brokers who embrace and master the principles of HPM can benefit greatly from the changes that this discipline introduces into the enterprise management of health plans and policies. It is becoming increasingly evident that it is no longer good enough to simply adjust plan costs and establish stand-alone wellness initiatives within an enterprise.
Changes in insurer and carrier business practices caused by health reform legislation also underscore the need for a new broker business model. The Patient Protection and Affordable Care Act, which requires carriers to satisfy minimum medical loss ratio (MLR) requirements, places significant new pressure on broker commissions. Insurers are already reducing broker commissions in the small-group market to help ensure compliance with MLR rules. While these efforts are expected to reduce premiums, they will also reduce broker commissions, now counted as administrative expenses. It raises a compelling question: What future do brokers have unless they find alternative ways to create new revenue streams?
“All stakeholders in healthcare, including insurance brokers, will have to adapt their business model and develop new areas of expertise and capabilities to be successful in the reform era,” says Michael Weinstein, a spokesman for Highmark, Pennsylvania’s largest health plan, to Insurance & Financial Advisor, one of the nation’s leading sources for insurance industry news.
An HPM-driven new business model can help brokers and their customers use data about key workforce population risk factors and trends to make rational investments in preventive programs within a specific employee population. The data can then be leveraged to effect desired changes in health outcomes.
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