Improving the Health of Your Workforce: A New Paradigm for Employers

In part 1 of our podcast series "What Employers Need to Know About Population Health," Mitch Kaminski, MD, MBA, editor-in-chief, Population Health Learning Network, and population health program director, Jefferson College of Population Health, and Neil Goldfarb, president and CEO, Greater Philadelphia Business Coalition on Health, discuss improving the health of your workforce using a population health approach to segment and target interventions.

Read the full transcript: 

Welcome back to "PopHealth Perspectives," a conversation with the Population Health Learning Network, where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today, we are joined by Dr Mitch Kaminski, Editor-in-chief of the Population Health Learning Network and Population Health Program Director at the Jefferson College of Population Health and Neil Goldfarb, president and CEO of the Greater Philadelphia Business Coalition on Health.

Mitch and Neil discuss improving the health of your workforce using a population health approach to segment and target interventions. This conversation is a part of our podcast series, "What employers need to know about population health?" Thank you for leading the conversation today, Mitch.

Mitchell Kaminski, MD, MBA: Thank you for that introduction, Edan. Thank you, everyone for joining us in our podcast today. I'm excited to talk about population health and how it applies to employers and their health care for their employees.

Just a few words about my background. I'm a family physician, I've been in leadership positions, and I've also helped to run large Accountable Care Organizations. It was during that time that I realized the employee population is unique from, for example, a Medicare population or a commercial population of patients.

Unique for the following reason, when I was involved with the ACO, we were partly supported by a health care system and because of that, we realized that our health care system employees were a population in and of themselves. We also realized that the health care organization was responsible for paying for that health care.

We had a population and we had control over the total cost of care and we could promote programs to advance the health of our employees. What I discovered pretty quickly though, is that for human resource and health plan leaders in the health care system, there was annual focus.

There was also a big focus on keeping the employees happy. There was also lack of understanding population health principles, the role of primary care, and how to address escalating costs and wasteful care. I realized that the employee population was a unique one and that there was a lot of opportunity to improve their care while saving the costs.

I'm excited to have Neil Goldfarb join me. Neil and I with two other faculty members developed an educational program at the Jefferson College of Population Health for employers and population health in improving the health of their employees.

Neil has that perspective on developing an educational program, but he brings to that extensive experience in working with employer groups, both regionally and with national organizations. Neil, I wonder if you could tell us a few words about yourself. I have a few questions for you and I'm interested in your perspective.

Neil Goldfarb: Great, Mitch. I am President of the Greater Philadelphia Business Coalition on Health. We're a regional coalition serving Southeastern Pennsylvania, Southern New Jersey, and Delaware, also known as Greater Philadelphia.

We have 50 employer members representing around 1.5 million covered lives. These are employers who are responsible for our health and health benefits for a very sizable population, not only in our region, but nationally. They are employers who care about health for many reasons.

Not only because a healthy workforce is more productive, and also cost less in terms of their use of health care, but also health leads to greater engagement in the job. Health leads to greater retention of employee. Goodwill also is important for employers.

As a result, over the years, many employers have chosen to invest in health and wellness kinds of programs. They've had mixed results. We've heard some pushback that wellness doesn't work from the research community, from outsiders, but I would argue wellness works if it's done right. You need to take a population health approach and that's what we're here to talk about today.

Dr Kaminski: Thanks, Neil. What exactly do you mean when you say taking a population health approach to caring for an employee population?

Mr Goldfarb: We're going to take the whole concept of population health in terms of identifying who the population is segmenting them appropriately, recognizing what their needs are, implementing programs, evaluating programs, doing things in a cyclical fashion. That's conceptually what population health is all about.

What is unique is that employed populations are not totally different, but they do have some unique needs. I think there are opportunities to educate employers about population health, but then to show them how population health translates, specifically, to their job and their population.

As one example, how do you segment the population? We know that there are big differences within a population in terms of demographics, age and generation, gender, race and ethnicity, social determinants of health.

All of these different factors drive how you are going to respond to an employer's health offering. Are you going to understand it? Are you going to want to engage with it? What are you going to be looking for to get out of that program?

Employers need to start to segment their population and recognize one size does not fit all. I can give you a several examples, but let's take one. Recently, I had a conversation with an employer who is focused on developing a diabetes management approach and has contracted with a vendor who is quite well-known nationally for diabetes management.

That employer tells us that the disease management program is getting a 50% engagement, which they think is very good. My question from a population health perspective is what's happening with the other 50% and are they in fact different?

Are the 50% who are not engaging...the 50% we need to get engaged, are the ones who enrolled in the program, the ones who are already doing a pretty good job of managing their own condition, and just needed a little bit of support.

A good example of what population health brings to the table is how do we want to segment the population? How are we going to intervene differently to get as larger participation as large a positive outcome as possible from that program?

Dr Kaminski: Neil, I understand. It's about applying data and science to your population to direct your initiatives. How familiar and how comfortable are the employers that you work with, with moving to that approach?

Mr Goldfarb: It's a great question, Mitch, because one question is about their comfort and the related question is can they even get access to the data? They're closely intertwined, but we know that employers in many cases do not have direct access to data.

They may have a health plan administering their health benefits and they haven't specifically written into their contract with the health plan that they own the data, that they have the right to get the raw data.

Many employers are contracting with different vendors for disease management, for care coordination. They have to make sure that they have a way to get that data. There are lots of different data streams that employers could potentially access.

The first question is, what data are out there and are you getting those data? Then, are you able to use those data to mine them effectively? A lot of employers have concerns about legal and regulatory, and HIPAA, and confidentiality concerns, legitimately.

We can teach them about the firewalls that they can erect so that the people who are making decisions about health management are not the people who are making decisions about hiring and firing. Get your data and then the question is how comfortable are you with it? Do you know what questions to ask?

To your point, a lot of times employers get the data, and then they don't know how to start to dig into it. What are the main questions to ask? As one example, I've been engaged in conversations lately with a bunch of employers about the National Committee for Quality Assurance, NCQA and its HEDIS initiative, which for over 20 years has been collecting annual data on health plan performance.

It's important because NCQA has developed a bunch of standardized metrics that can be applied to measure care quality. When we ask employers, do you know what HEDIS says? Almost always, we get, no. We can educate them.

It's not that they have to necessarily use HEDIS, but it's a good way to start to think about how am I going to measure things in a standardized fashion? What's the population I'm going to identify? How big a population am I going to look at? How am I going to use claims data or perhaps health risk appraisal data to measure a particular rate or metric that's of interest to me?

Where am I going to get my benchmarking data to say, "How does my population compare with other employers in this region or with statewide measure or a national measure?" One of the things we know employers struggle with is even when I measure something, how do I know if I'm doing well or poorly or where my opportunities offer improvement?

Dr Kaminski: Neil, I feel like we're starting to peel an onion here. It also helps me understand why we have 10 courses in a two-year master's program in population health for employers, because there is there are so many facets of the care to consider.

I do want to talk about one additional issue. You've talked about how healthier employee populations make business sense, but we haven't talked about the problem, which is that health care costs are escalating. In the past 20 years, employers have grown to spend four times as much for the health care that they provide to their employees.

Those employees are paying nearly four times as much for their share of health care in terms of deductibles and copays. Where does that factor into a population health approach and how much of that is a concern with the employers that you've worked with?

Mr Goldfarb: Well, that is absolutely at the core of why would we talk about population health for employers. I believe, and you, Mitch, and most listeners believe that a healthy population will cost less.

They will need less service, they will be seen for preventive care, they will be identified as having some chronic condition at an earlier stage of that illness so that secondary and tertiary prevention methods can be applied.

If we all believe healthier populations cost less than one of the key ways we can, if not drive down costs, at least decrease the slope of cost increase. Then, we owe it to ourselves as employers and to the populations we serve, because they're increasingly having to pay out of their own pockets for a lot of care.

We owe it to everybody, including society, to do everything possible to get people healthy. As Dee Edington, a major guru of population health talks about, prevent people from getting worse. Let's identify where they are and keep them where they are now. If we can't make them healthier, at least don't get worse.

It's all linked ultimately to the economics, but I do want to say that employers I believe, particularly the employers I work with, would believe that improving health is not just about cost. Cost is clearly one of the important factors, but it is about those other things I talked about, including being the right thing to do to try to do what you can as an employer to benefit your workforce.

Dr Kaminski: Neil, thank you very much for participating in this conversation. It's been a helpful overview of how employers can benefit from population health principles. We are only scratching the surface.

I'm glad that you've agreed to come back for several more podcasts when we can delve deeper into some of the issues that we've raised and invite some panelists to speak with us about their own experiences in improving the health of their employees.

Mr Goldfarb: Mitch, I appreciate the opportunity and it's always a pleasure to talk with you.

Thank you so much, Mitch and Neil, for talking today. I look forward to more podcasts.

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