Population Health Strategies That Work

In part 3 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; Neil Goldfarb, president and CEO, Greater Philadelphia Business Coalition on Health; and Michele Bildner, MPH, MCHES, project manager, CDC Foundation, highlight population health intervention strategies that have proven successful without being overly resource‑intensive.

Read the full transcript:

Welcome back to "Pop Health 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; Neil Goldfarb, president and CEO of the Greater Philadelphia Business Coalition on Health, and Michelle Bildner, project manager from the CDC Foundation.

Mitch, Neil, and Michelle discuss intervention strategies that have proven successful without being overly resource‑intensive. These strategies can be implemented by smaller or potentially under‑resourced employer organizations.

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.

Mitch Kaminski, MD, MBA: This is Mitch Kaminski. I want to thank you all for joining us for our third podcast in a series about applying population health principles to management of employee population.

In our first podcast, Neil and I talked about the basic approach of applying population health and how it works for employee populations. In our second podcast, we began talking with an additional expert, Michael Kobernick, about how an employer begins to shift their focus to managing their employees' healthcare using population health principles.

I'm really excited in this third podcast to have Neil join me again, along with Michelle Bildner, who is from the CDC Foundation. We're going to be talking about strategies that work. We're going to be talking about tools and resources that are available to employers, an example of some of them and how they can help an employer better manage their employee population.

With that, Michelle, do you want to say a little bit more about yourself and get our conversation started?

Michele Bildner, MPH, MCHES: Thanks, Mitch. Thanks for having us. We at the CDC Foundation are the go‑to nonprofit that's been authorized by Congress to mobilize philanthropic partners and private‑sector resources to support the CDC's mission.

My role is as a project manager in our noninfectious disease programs, where I'm focusing on how public‑private partnerships can be leveraged or designed to prevent and manage chronic diseases in the working population and working with private sector businesses to learn more about what that should and could look like.

Dr Kaminski: That's great, Michelle. Thanks. Neil, welcome to our third podcast. Thanks for participating as well.

Neil Goldfarb: Thanks, Mitch. This is Neil Goldfarb. The Greater Philadelphia Business Coalition on Health, which I run, is a regional employer coalition seeking to improve the health of the population and the value of the health benefits stand.

We have a lot of experience helping employers identify and implement programs that will help move population health along.

I'm pleased to be back to talk with you and Michelle today.

Dr Kaminski: That's great, Neil. Michelle, maybe you could start by telling us about your wonderful website and the tools and resources that have been developed.

Ms Bildner: Yeah, definitely. Something that we pride ourselves on at the foundation is developing partnerships and pointing those partnerships or partners in the direction of the evidence that CDC has produced for us and for the public at large.

One of the resources that you might be thinking about is something that we pointed to in our blog post, and that is the CDC Workplace Health Resource Center.

I want to back up to the blog in that we have bridging the gap, communicating about public health to employers, is that we realized that businesses are doing so much for employee health and for population health. We recognize how much they have to juggle.

How can we help make decisions easier, based on sustained evidence, to change the population health outcomes and improve them among their workforce?

I think that Neil has a really great experience with some of these tools from the workplace health promotion, and even something that has been certified and authorized by Centers for Medicaid and Medicare, with the DPP program.

That's an example of the public health world putting something into the hands of potential private‑sector employers.

Dr. Kaminski: That's neat, Michelle. Can you or Neil give an example or two about how an employer has implemented these resources for their population?

Mr Goldfarb: Sure. Let me expand on Michelle mentioned the DPP. If listeners are not familiar with it, it's the National Diabetes Prevention Program that we all call the DPP. It is an evidence‑based program used to help identify people at risk of developing diabetes and help them change their lifestyle to prevent their developing diabetes.

It has been shown in academic research to work. It has been shown in employer settings to work.

We as a business coalition had educated our employer members on the DPP. We have helped link them up with vendors who offer DPP services, and we have helped them look at their metrics to evaluate did the program have an impact?

I'll tell you that of our 49 employer member organizations, 14 have implemented the DPP so far, and we have not yet heard any complaints. Every employer has found that the program works. It helps people lose weight. People report living healthier lifestyles, and we know that with the weight loss comes a significantly reduced risk of developing diabetes.

One of the great things about the DPP I also want to mention, because a lot of times, employers view wellness as expensive or out of their budget. The DPP is pay on a pay‑for‑performance basis. You only pay for each person who enrolls in the program, each person who completes the program, and each person who achieves the goal of weight loss.

The total cost for people who achieve all three of those milestones is typically $300 to $500. When you think about the additive cost of diabetes in even one year, a couple of thousand to 5 thousand dollars, depending on which study you're looking at, the DPP is extremely cost effective, and there's no reason why every employer should not be offering that program today.

Dr Kaminski: Thank you, Neil, for that example. Michelle, do you have additional thoughts about that?

Ms Bildner: Yeah, definitely. I resonate with what Neil is saying.

I think even more at the organizational level with how employers are looking at population health and employee health outcomes is to think about yes, using the evidence‑based, we launched a wonderful pilot in Northern Georgia in 2020 during the pandemic, a program that was launched on site for medication therapy management with blood pressure.

We used an innovative approach using our community pharmacist to come onto the work site and engage in this health coaching, this motivational interviewing type of program to help participants lower their blood pressure as well as their weight.

This example speaks, of course, to the outcomes that can be achieved through evidence‑based implementation, but also the culture that the company had established over years with creating a culture of workforce health.

Some of those simple strategies that we learned about are around making the work that you're doing, making those programs, those interventions meaningful to employees.

We talked about in the second podcast, if listeners haven't caught up with that yet, is around engagement. You have to meet people where they are. That's something that we definitely heard as well.

We also heard about value in the last podcast. That resonates and it's another thing that we can validate here, that the programs that you offer or the benefits that you offer must add value to both the organization and the employees.

Do you see employee morale changing? Do you see engagement changing? How do you measure value? Those are some ideas.

Of course, leadership has to be on board, not just at the benefits design level, or the benefits manager, or the wellness folks, but also from the top down. Is it embedded in the culture? If you have a DPP program, are employees able to participate on the clock, so to speak?

What does that actually look like? Are those facilitators available?

With that is where you start to see trust increase with your employees, that yes, we're launching these kinds of well‑being initiatives or even care initiatives to protect your health and promote your health. We genuinely care about you.

Those are the four things that I think are the takeaways that are less programmatic but more of shifting the paradigm in the way that we approach employee health and wellness.

Dr Kaminski: That's great. It raises some additional questions. I think we do have time to delve a little bit more into them. One is, you talked about public‑private partnerships. I'm wondering for employers, if they are engaged with a private insurer, how these programs can be put into place. What kind of collaboration does it take?

The second question that comes up is, this sounds like a great amount of work that requires a lot of resources, planning, strategy. What is an employer who, for example, has only a hundred employees or less, what can they do when you're talking about such big initiatives?

Ms Bildner: From the public‑private partnership side, one thing that we can talk about is looking at your local community and what public‑private partners are available. In most counties and jurisdictions and cities across the US, that might be your public health department.

I know Neil has a great example of working with the public health department in his community, so I'll pass it over to him.

Mr Goldfarb: We're in a fairly broad territory, a nine‑county territory, but our home base is Philadelphia County. We worked a lot with the Philadelphia Department of Public Health.

We learned very early in our coalition's history going back to 2012 and 2013 that the Philadelphia Department of Public Health had created a bunch of resources for employers, like a guide to how can you create healthy vending with sample contracts for your vending machine provider?

Resources on smoking cessation for employers and employees and how to create a smoke‑free workplace. Resources on how to make stairwells accessible and encourage people to use the stairs.

Mental health first aid. We know many employers recognize now that mental health is more important to address than ever, given the pandemic. There are resources that many public health entities offer like mental health first aid, which will actually train you and your management staff in how to recognize people who are struggling with mental health issues and how to help them.

Not to become their therapists, but how to talk to them and where to advice them to go to seek help.

A whole range of very specific programs that our public health department already was offering. Pennsylvania State Department of Health has a whole website with resources for employers. Then, of course, Michelle mentioned the CDC's Workplace Health Resource Center.

Great resources for employers, and most of them do not involve significant investment of funds.

Ms Bildner: I would add onto that. Some of the questions about resources that you brought up is that, yes, there are programmatic interventions, as well as what I mentioned already at the organizational level. What can a conversation with employees look like about what they'd like to see in their health and wellness offerings? Can that be facilitated?

If that's not part of the culture, there is a bigger question that you might want to ask. To the point of benefits design, what you also asked about is what your guest on the second podcast mentioned, is around that accountability.

How can employers hold claims more accountable, ask different questions, get at a deeper granularity of the population to get that sub‑population stratified to really understand who is suffering from lack of engaging in care for diabetes, for example.

There is that data piece too and using evidence‑based decision making in the design of benefits. Will my benefits cover approaches that are known to help mitigate chronic diseases?

Dr Kaminski: That's great. Thanks, Michelle. Neil, your coalition members, what have their experiences been in working with private insurers when they have those linkages?

Mr Goldfarb: We have some members who are fully insured and some who are more self‑funded. On the fully insured side, all employers should be asking their health plans what health and well‑being resources do you offer? What programs are you offering? Are you offering the DPP? Are you offering smoking cessation, or a gym, or other kinds of incentives for people?

On the self‑funded side, we have a little bit more latitude, but even so, should be having conversation with the health plan to find out what they are offering or who they've contracted with that we might be able to tap into.

As an example, many health plans already offer with their self‑funded clients, you can get up to six registered dietician, nutrition, and counseling services.

A lot of these things are already built into your health plan structure, and you can avail yourself of them at fairly low cost. Again, you're only paying for the people who actually use the service.

Dr Kaminski: Thank you, Neil and Michelle. You obviously have such deep experience and knowledge about implementing pop health principles for employers.

In our final minute here, I wonder, Neil and Michelle, if you want to make any final summary comments.

Ms Bildner: Our role will continue to be to seek to understand what businesses are experiencing and recognizing that businesses aren't a monolith and use that understanding to shape the kinds of resources and support that we provide to the private sector.

As far as this is concerned—bridging science with implementation on the ground and learning how to use shared language between public health and the employer sector—those are two really important aspects to the work.

We look forward to continuing to do this in the next couple of years.

Dr Kaminski:  That's great, Michelle. And Neil?

Mr Goldfarb: I want to give a shout‑out to business coalitions on health. We are one of 50 coalitions on health around the country. I would encourage everybody listening to seek out do we have a local business coalition on health? Some of them are city‑based. Some of them are state‑based.

If you don't have a business coalition on health but think there might be interest in your community in starting one, I'd be very happy to help give you some advice on how to do that, just like I started the coalition in greater Philadelphia back in 2012.

Ms Bildner: Neil, I'm so glad you said that, because I would be remiss if I didn't say that we have worked to a wonderful, shared understanding with Neil's group. That's another great example of public and private partnerships, although it's public‑to‑public.

I think if your local community, especially if you're a health department or work in a nonprofit organization, how do you link up with those business coalitions on health? Really great.

Dr Kaminski: Thank you, Neil, and Michelle, for joining me in this podcast. I do want to say, Michelle, I was impressed with the tools and resources on the CDC Foundation website. We'll make sure that our viewers have the link to be able to look at the wide variety of tools that are already available to our employers.

Thank you everyone who has been listening into our podcast, and I wish you all a good remainder of the day.

Thanks for tuning into another episode of Pop Health Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.