Understanding the Health Care Needs of Your Population Leads to Improved Health Outcomes and Reduced Program Costs

New data from Towers Perrin indicate that the business and social impacts of rising health care costs still loom large but also that leading companies are successfully mitigating that threat through a variety of health-focused management techniques that are paying off in significant ways — and point toward broader solutions to the cost crisis. Employers and public programs are turning to population health management programs (PHPs) to reduce overall health care costs and empower participants to improve their health and quality of life.

But how do employers and government agencies tailor their health management programs to meet the needs of their specific populations? KePRO's Integrated Health and Care Management services are the answer. Our approach is population- and member-driven. KePRO employs management techniques that not only meet the needs of each client, but also address the needs of individual members and ensure high quality care, improved self-care and enhanced health outcomes.

Start with the Data

KePRO's solution starts by employing the latest analytic technology. KePRO doesn't rely on a single system, but instead uses a comprehensive suite of predictive-modeling software, proprietary analytic tools and statistical algorithms to analyze a variety of data:

• Demographic information
• Medical histories
• Pharmaceutical claims
• Behavioral claims
• Laboratory data
• Health-risk assessment responses

Our model includes three components. Powerful predictive modeling software lets KePRO identify high-intensity or high-risk members. Our proprietary analytics package identifies utilization rates, gaps in care and inappropriate medication usage. And the reporting and query component summarizes analytical results to guide the creation of a comprehensive care management program.

Predictive Modeling

Using predictive analytics allows KePRO to identify members who are currently incurring high costs and members who are likely to incur high costs in the future. The methodology uses proprietary analytic tools to provide insight into the risk profiles of individual members, and includes such factors as:

• Illness burden
• Preventive services
• Gaps in care
• Proactive care
• Lifestyle risk (e.g., overweight, smoking, hypertension, high cholesterol)

Advanced Analytics

The advanced analytics system identifies and classifies members who have the greatest need for intervention by our care team, which is composed of case managers, social workers and health advocates. The goal is to use the results of analysis to effectively target care management interventions that are most likely to help members change risky behaviors and reduce health care costs.

Addressing the needs of members in these ways has multiple measurable benefits:

• Minimizes under- or over-utilization of emergency department services
• Minimizes acute care hospitalizations
• Increases appropriate medication use through polypharmacy alerts
• Lets physicians offer palliative care and provides them with advance directives for members approaching end of life
• Identifies a medical home for members who have multiple providers and no primary care provider

Reporting

KePRO's reports provide a detailed analysis of the health care climate of each client. Valuable information that reveals client cost drivers include:

• Multiple Admissions — Identifies members who have multiple admissions in a 60-day period. These members will be contacted and, with their consent, placed into case management.
• Place of Service — Displays the place of service for each visit or admission and identifies any trends such as a high percentage of emergency visits. Members will be selectively contacted and, when appropriate, offered case management services.
• Top DRGs — Displays the average cost and length of stay of the top 20 diagnosis-related groups (DRGs) by volume. This report can be used to investigate any DRGs that have longer lengths of stay or higher costs than expected.
• Utilization and Costs of Clinical Services — Provides a detailed account of the following:
• Inpatient utilization (includes days/1,000 members, admissions/1,000 members, bed types utilized [regular, ICU, step-down], length of stay)
• Pharmacy utilization (including oral and injected drugs)
• Procedures (e.g., radiology, laboratory, pathology)
• Outpatient utilization (e.g., clinic visits, level of care)
• Specialty services
• Emergency department utilization
• Home care utilization
• Chronic care utilization

Personalizing Results

Using the data, KePRO develops a comprehensive care plan individualized for each member. By facilitating and advocating for options and services that meet each member's health needs, we can improve their health outcomes and reduce overall health care costs.

Watch for the next issue of Connect, in which we'll give you a view of how KePRO brings all the elements of case management together in a comprehensive program.

For information about how KePRO can provide comprehensive care management for your organization, contact our business development professionals at 1.800.222.077.