Identifying population risk in new members requires aggregated health status data

As new enrollees enter the market from public exchanges and expanded Medicaid programs, health plans must determine how to appropriately assess member health in order to align interventions and better predict costs. Doing so effectively, however, requires having access to as much information as possible. A combination of multiple data sets — including claims-based data and health risk appraisal (HRA) data — allows plans to categorize risks more effectively than using claims data alone.

Gus Gardner HRAs, or patient surveys, go a long way in providing a picture of member health, in addition to identifying those who may fall in a high-cost category. Patient surveys enable plans to go ‘straight to the source’ to measure health status. Provided online or electronically, mailed, over the phone or as a point of care assessment, patients can choose to complete surveys in the manner that is most comfortable and convenient for them. These surveys:

  • Capture health burden from chronic disease
  • Identify members at high risk for adverse outcomes
  • Predict probability of near-term utilization (e.g. hospital readmissions and use of health care services)
  • Identify frail members at high risk of falls
  • Screen for depression and other emotional distress
  • Monitor members’ physical functioning, activities of daily living and emotional well-being
  • Quantify population and individual wellness for intervention and behavioral change initiative
  • Identify negative health trends using longitudinal score analysis and normative data comparisons (better/same/worse comparison to established norms)

The result is a defined, at-a-glance view of each member, compared to national norms. More than that, the patient survey can help to facilitate greater physician-patient communication.

Deb Lange - head shot resizedHistorical claims data and responsive patient surveys also help plans be on the forefront of addressing the needs of the dual eligible population. Leveraging combined data can increase accuracy, paint a more complete picture of the patient, assess changing health status and create a patient repository for operations and research. Through this insight, we can begin to better influence the health care costs and quality of care in this particular patient population.

To read more about identifying population risk, download our article, “Identifying population risk in new members requires aggregated health status data.

Gus Gardner, Group President, Optum Life Sciences

Deborah Lange, MS, Sr. Director, Business Solutions, Optum

Deborah is a Senior Director, Business Solutions at Optum. She is responsible for helping clients fully utilize their existing data and software tools to meet their business needs, including care management activities, managing ACOs and other risk contracts, employer group reporting and provider profiling. She focuses on developing custom case and disease management programs. Prior to Optum, she worked as the VP, Clinical Analytics and Performance Reporting, for the Greater Rochester Independent Practice Association (GRIPA) in Rochester, NY. Deborah received a master’s degree in medical statistics from the University of Rochester after earning her bachelor’s degree in math/computer science.

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