Did you know that 5 percent of your health plan members drive 50 percent of costs? 1 And 86 percent of all health care costs go toward treating people with chronic diseases.2
That’s why it’s more important than ever that health plans are able to identify and support those who would most benefit from a condition management program. Evidence suggests that the longer an individual is engaged in a condition management program, the better their gap closure rates.3 But claims-based identification may only occur after a significant time lapse.
A recent study looked at the value of telephonic health risk assessments (HRA) in identifying members with chronic health conditions versus claims-based algorithms. It involved members of a large managed Medicaid health plan in the southeastern United States that purchased telephonic HRA services from Optum.
The HRA study analyzed members who self-reported at least one of the identified chronic health conditions — diabetes, asthma, COPD, CHF or CAD — via a telephone HRA to determine the number and percentage of those members who were also identified by claims data.
The study also determined when any such claims-based identification took place in relation to the telephonic HRA, and calculated the mean and median days between HRA self-reporting of the condition and claims-based identification.
Results varied among the conditions, but the overwhelming majority of members were identified by the telephonic HRA prior to claims-based identification— most between 95 and 127 days earlier with the HRA.
Based on these findings, the ability to identify and enroll more members with chronic conditions earlier through telephonic HRA can translate into better outcomes and greater cost savings. To learn the detailed results, read the case study.
About the Author:
As Director of Product Management, Shannon leads the product development team for the Optum Payer Prevention Services. She and her team work tirelessly to deliver the programs that help people be healthy through population health innovation, wellness strategies, quality and client support. She brings 20 years of experience from her positions at American Heart Association, Alere Health and Optum.
Shannon has a Bachelor of Science degree in health promotion/wellness and a Masters of Health Education degree from the University of Texas at Austin. Shannon enjoys staying active and spends her free time with her husband and her beagle.
- United States Government Accountability Office. A small share of enrollees consistently accounted for a large share of expenditures. May 2015. gao.gov/assets/680/670112.pdf.
- Centers for Disease Control and Prevention. Chronic disease prevention and health promotion. cdc.gov/chronicdisease.
- Optum BOB analysis of 5,990 condition management participants with diabetes compared to 28,005 condition management non-participants with diabetes over a 12-month period.