In my previous blogs I have outlined the need for providers to develop customer relationship management and patient relationship management capabilities but a fundamental requirement for success is the ability to segment the consumer and patient. Currently, providers are focused on segmenting patients based on their predictive clinical risk.
The challenge to only leveraging predictive clinical risk is that Individual behavior accounts for 80% of health status the number one determinant, ahead of environment, genetics and access. As providers organizations invest in care management models and resources they need to understand where an individual falls from a behavioral perspective. Care management resources can be a mix of clinical and not clinical resources that ensure the long-term goal of population health.
Questions to ask include – Are they engaged or not engaged in their own healthcare?, What is their awareness regarding health and the health care system? and What is their confidence level in navigating the healthcare system?
The care management outreach models should develop patient profiles based on the individuals clinical risk (value to manage utilization and cost) and behavioral (attitudes and engagement levels). An individual with a high clinical risk and high engagement level – engaged chronic – will be receptive to the care manager model where the care manager in conjunction with the physician and individual develops and manages to a care plan. These engaged chronic are motivated to manage their condition and leverage resources from care managers to health coaches to physicians to online tools.
An individual with a high clinical risk and a low engagement level – unengaged chronic – is not as receptive to the care manager model, thus the use of a clinical is not the optimal use of resources or investment. The unengaged chronic can be better served by a health coach that supports personalized education and guidance to help the individual gain confidence. The ultimate goal is to move the individual to an engaged chronic.
Those individuals that are low clinical risk and high engagement level – engaged well – can be supported by a health coach. These individuals are motivated to gain healthcare knowledge and monitoring their health status to proactively maintain health. While the individual that are low clinical risk and low engagement level – unengaged well – are interested in navigating the system and accessing care on a reactive perspective thus a health advocate can be the best resource.
The bottom line is that care management models are not a one size fits all but should incorporate health advocates, health coaches and care managers. Each of these individuals can play quarterback alongside the physician to support the needs of the individual and the population.