Hello, colleagues.
This is the second part of a series on population health. This month we will look at:
- How we approach population health.
- The critical role of primary care; and
- How technology informs our programs for targeted populations.
“Population health” is a term most clinicians are aware of but may think of in different ways. At EmblemHealth and ConnectiCare, we are aligned with the CDC’s approach:
CDC views population health as an interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally. This approach utilizes non-traditional partnerships among different sectors of the community – public health, industry, academia, health care, local government entities, etc. – to achieve positive health outcomes. Population health “brings significant health concerns into focus and addresses ways that resources can be allocated to overcome the problems that drive poor health conditions in the population.”
Making population health changes requires a multi-pronged approach. Two of those prongs we are focusing on at EmblemHealth and ConnectiCare include primary care and the use of technology to predict who needs extra help.
Primary Care
Primary care plays a crucial role in a strong population health model. We have observed that patient-centered medical homes are an effective way of delivering proactive primary care. As medical directors, we want to see all of our members working with a primary clinician, regardless of whether or not there is an official primary care provider (PCP) designation through one of our benefit plan designs. Screenings, immunizations, and other preventive care can help our members achieve the healthy futures we envision for them. A strong primary care relationship, built over time and based on trust, can uncover other ways a patient needs help beyond the office visit and beyond the medical needs.
We understand the importance of removing barriers to primary care. That is why:
- Many of our plans have no or low member cost-sharing for primary care services.
- We offer financial incentives, such as:
- The Adult Comprehensive Health Assessment Provider Incentive Program to compensate providers who are not part of a value-based arrangement but help close gaps in care for our members with Medicare, Medicaid, and Essential plans.
- The EmblemHealth Medicare Member Rewards Program to encourage members to seek preventive care with their clinician.
Use of Technology
There are many ways technology can help improve population health. One way is the use of artificial intelligence (AI) in identifying targeted populations with special health needs. We can analyze data gathered from claims (hospital stays, pharmacy, and diagnosis) and utilization review requests from our own systems and those of our partners to identify patients with high comorbidities, predicting who can benefit from one of our Care/Case Management programs. We also use this data to inform when new programs are needed.
What’s Next?
Next month, we’ll look at how our approach to population health is influencing our perspectives on specific chronic conditions and how medical management within the plan helps our members and clinicians especially regarding social determinants of health.
Lama
Lama El Zein MD, MHA
Sr. Medical Director/Population Health and Clinician Engagement
If you missed Population Health - Part 1, see our November 2022 edition of Office Visit which covered:
- The unique perspective we, as medical directors for EmblemHealth and ConnectiCare, have on population health.
- How we are redesigning our own team.
- How we are improving transitions of care.
If there are other health topics you would like our perspectives on, please write to us at
emblemhealthmedicaldirectors@emblemhealth.com.
While we welcome your suggestions, we ask that you do not send protected health information (PHI) or patient-specific issues to this mailbox. This mailbox should not be used for complaints, grievances, appeals, or claims inquiries. The Claim Inquiry and Message Center features in the provider portals (EmblemHealth|ConnectiCare) should be used for those issues.
