Population health management is a vital part of an insurer's overarching goal to lower costs and improve quality care. At Horizon Blue Cross Blue Shield of New Jersey, population health means partnering with providers to offer valuable claims information to help them better manage patients with expensive chronic conditions.
Beginning more than four years ago with a small pilot, Horizon has since expanded its program statewide and incorporated insights and learnings along the way.
To learn more about how Horizon has successfully managed its population's health, FierceHealthPayer spoke with Steven Peskin (pictured right), Horizon's senior medical director for clinical innovations.
FierceHealthPayer: Can you provide a high-level overview about how Horizon approaches population health management, and how you control costs and reduce utilization?
Steven Peskin: We started around four a half years ago collaborating with clinical partners. We provide a lot of information to our clinical practices, especially around risk stratification. We work very collegially with our practices to help them develop processes for managing patients with chronic conditions or who risk developing chronic conditions.
A cornerstone to our work is what we call population care coordinators. We now have more than 250 nurses across the state of New Jersey who work in the physician practices. There may be a dozen working in a large system or there might be one coordinator for two or three small practices. Although they're employed by the actual practices, these folks are trained by Horizon. We provide a two-day training at the beginning of their tenure, so to speak, but it doesn't stop there. It continues with face-to-face mentoring, webinars and quarterly meetings. So that's a real lynchpin to the work that we've been doing with the practices.
FHP: Can you talk more about the care coordinators and what they do on a day-to-day basis? What specific benefits do they provide the practices?
Peskin: The care coordinators work metaphorically shoulder-to-shoulder, side-by-side with the physicians, the nurses and physicians' assistants in the clinical practices.
A day in the life of a population care coordinator shows he or she is involved in pre-visit planning; team meetings in the beginning of the morning session and the afternoon session; active outreach for care gaps (for example, reaching out to people who need mammography or cancer screenings); managing patients with chronic conditions and developing, executing and updating care plans.
FHP: What type of information does Horizon share with its provider partners to help them manage their high-risk patient population?
Peskin: We provide monthly reports to practices across a secure site. Those reports have information for practices on things like emerging ambulatory systems, emergency room visits, admissions and readmissions. They also detect rising risk of patients. We work in the total cost of care so providers can see where the costs are for a large number of categorizations. You might actually want to see that going up rather than going down because we know that patients with chronic conditions often times have comorbid behavioral health. So addressing those can have an ultimate impact on improving outcomes and reducing complications.
FHP: Have you been able to lower costs or improve quality with your population health management program?
Peskin: Based on a review of 2013 claims data comparing more than 200,000 Horizon members, we found a 14 percent higher rate in improved diabetes control, 12 percent higher rate in cholesterol management and an 8 percent higher rate in breast cancer screenings. The data also showed a 4 percent lower rate in emergency room visits, a 4 percent lower cost of care for diabetic patients, a 4 percent lower total cost of care and a 2 percent lower rate in hospital admissions.
FHP: Have there been any steps that you've put in place that didn't work?
Peskin: Certainly there are situations where we will attempt to persuade, recommend or suggest that a particular practice look at a certain process for addressing patient engagement that didn't really work with that practice. So there are a lot of what we call "special cause" as opposed to "common cause" variation. At a systematic level, we've been very good at testing things. Everything that we do and put in place we've tested in the real world before we release it. It's like releasing software. You have people who are trying to crash the software on purpose and get it to not work. So you know when you release software that it's stable. So that's how we've implemented different kind of interventions for our practices.
There have also been some challenges in the timeliness of the data. A lot of our practices want information in real time. But everything doesn't happen in real time. So we're trying to see how we can speed up certain processes. We're making a major investment in a private health information exchange, which will help improve our ability to exchange information with our clinical partners. It's one of our long-term goals so we can improve our data and our population health capabilities and really work collaboratively with our partners.
FHP: How do you identify which of your members are high-risk? Do you have any predictive modeling methods in place?
Peskin: We use some proprietary tools to stratify risk. Our analytics department has been working on some very interesting predictive modeling and how to identify anticipatory risk versus rising risk.
FHP: It sounds like the care coordinators, like you said, are the lynchpins to your success. Are there any other elements that you would attribute to your ability to manage members with chronic conditions?
Peskin: There's no one person who can make all this happen. If you don't have the physician champion in the practice, it's going to fall flat. So you could have the best population care coordinator in the world, but if the physicians are disinterested or passive-aggressive, then it won't work. Culture is vital to the success of a practice's ability to embrace this notion of comprehensive, team-based care. So clearly, that's part of it.
Information data exchange is another important aspect of success. That's why we hold monthly webinars where we showcase best practices, have a biweekly newsletter and an annual summit. We invest a lot of time in what we call the onboarding process. But it's not just an onboarding and you're out on your way. So it's this education constancy that's key to our success. It's persistency.
FHP: What type of information are you passing on to these practices during the onboarding and education activities?
Peskin: There's a theme for each monthly webinar, whether it's how to better engage consumers, addressing folks who chose to go to the ER department for sniffles or low back pain, how practices have built their medical neighborhood or how to understand the analytics that we provide. We've done sessions on motivational interviewing. We tend to stay away from purely clinical areas, but we have done some updates on new diabetes guidelines. We respect and acknowledge that clinical areas are the domain of the clinicians, but we might bring in a subject matter expert on certain issues.
[Editor's Note: This interview has been edited and condensed for clarity.]