What Does Incorporating Population Health for Your Employees Require?

In part 2 of our podcast series, “What Employers Need to Know About Population Health,” Mitch Kaminski, MD, MBA, editor-in-chief, Population Health Learning Network, population health program director, Jefferson College of Population Health; Neil Goldfarb, president and CEO, Greater Philadelphia Business Coalition on Health; and Michael S Kobernick, MD, MS, CPE, senior medical director, health plan business and lecturer, Jefferson College of Population Health, shed light on the requirements for employers to integrate population health management programs into their workforce with a focus on the use of ongoing monitoring and use of metrics.

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're joined by Mitch Kaminski, MD, MBA 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 Michael Kobernick, senior medical director at Health Plan Business and lecturer at Jefferson College of Population Health.

Mitch, Neil, and Michael discuss the requirements for employers to integrate population health management programs into their workforce with a focus on the use of ongoing monitoring and use of metrics. 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: Thank you for joining in our second podcast on improving the health of your workforce and how population health principles can be applied by employers to their employee populations.

I'm really excited to have Neil and Michael join me today for discussion. Both Neil and Michael are my faculty members at the Jefferson College of Population Health, where we've developed a new educational track for employers and employer leaders in population health and applying it to their employees.

Neil and Michael, welcome. We focus in this podcast on what it takes to apply population health principles to our employee populations. Michael, maybe you want to start out by telling us about your experience and what you think is required.

Michael Kobernick, MD, MS, CPE: Certainly, Mitch. Thank you so much for asking me to participate here. Let me introduce myself to the audience just briefly to give some context about my experience.

I'm currently a senior medical director at Blue Cross Blue Shield of Michigan. I'm in the health plan business division. I spend all my time advising employers on how to manage the health care benefit. In addition, I did this after a 30-year career as an emergency physician. So I bring that perspective as well.

I was the first graduate from your program, the masters program in Population Health at Jefferson. We've worked together now for 5 years. I've learned that the employers in advising them really don't understand how to apply the principles of population health to their management of their health care benefit. We've created this track because so many employers are providing health care without a depth of knowledge in the area that we're going to talk about today.

An example is employers really focus on cost. How do I reduce cost? I hear it all the time. My trend is ever-increasing. How do I deal with that? It's becoming unsustainable. One of the things that population health teaches us is that value is the relationship between outcome and quality and cost. Some of the work I'm doing with employers is to elevate the quality outcome to equal cost in their understanding of value so that they're focusing on outcome.

That takes us to, how do you get to a good outcome? You can't get a good outcome without addressing core population health issues, which include the social determinants of health. The work we're doing now with our employers is generating data on sub-segments of their employee population and understanding them and then designing initiatives based on those social determinant findings.

For instance, if I'm working with a manufacturing plant and they're in an urban area, we run zip code analysis on those individuals in the urban area. If we find that they're in a food desert, for instance, then the intervention that we work with the employer on will be creating access to healthy food. That's an example of sub-segmenting the population.

If it's a large African American population with a high incidence of hypertension, we might design a health improvement initiative to meet the needs of that population. The message there for employers is work with your payer and your consultants to understand the population and then design initiatives to address those particular issues that you uncover.

Dr Kaminski: Thanks, Michael. I'm curious from Neil, because I know you've worked extensively with a lot of employers, how does your experience compare with what Michael was telling us about?

Neil Goldfarb: I'm in agreement with what Michael said. Neil Goldfarb here. I'm president of the Greater Philadelphia Coalition on Health.

We're a regional business coalition bringing employers together to try to address employee health and the value of the health benefit spend. We recognize that improving population health for employee populations and the other covered lives is one of the key ways to not only control cost, but also improve productivity, improve job satisfaction and engagement, and improve retention.

I want to emphasize what Michael said. So much of population health is really about getting your data, looking at your data appropriately, understanding who your population is, and also, on the backend, collecting data to evaluate what's working and what's not working in your programs.

Dr Kaminski: The next question is, does this work? Michael, you started out by saying it's not primarily about cost. But, because that's a pressure that all employers are feeling, to reduce the cost of the health care they provide, does this approach...has it been demonstrated to help employers achieve both a healthier population and reduce cost? Or is this all theoretical?

Dr Kobernick: That's a great question. One of the things we think about in population health is thinking about the well space, the rising risk space, and the complex illness. We've seen focus over the years in the well-being space. Honestly, the evidence of engagement in those programs is mixed. When an employer offers a well-being program, whether it's a weight loss or exercise, the evidence is mixed.

What the evidence is clear about is when individuals engage in the program, their long-term outcomes are better. The central issue there is getting people to take advantage of the programs we offer.

Complex case management, again, mixed results from a cost perspective. On the quality side, we know we're improving outcomes in those individuals as measured by reduced ED visits of hospitalizations or improved compliance with metrics.

The group that we're really struggling with now, Mitch, is the rising risk group. A story I tell employers is that about 8% of their spend is going to relate to diabetes, 8% to 10% of their total spend. If we look at it by age band, the 30- to 40-year-olds account for about 2% of the spend. The 40- to 50-year-olds account for 8% to 10%.

There's an opportunity in the 30- to 40-year-olds to create health improvement initiatives. We call that getting upstream on the health care area. There's an opportunity to get upstream and reduce the incidence of diabetes as people age.

We advise them to look at diabetes prevention programs, primary care visits where they're screened to be at-risk for diabetes. We tell them that if they are found to be at-risk for diabetes or have pre-diabetes, if they lose 5% of their weight, they reduce their risk of diabetes by 50%. It's a really compelling statistic. Employers are interested in that. Yet it's not an area that we see a lot of solutions.

Dr Kaminski: That's great. What I'm hearing from both of you, two words jump out at me. One is data. The other is engagement of the employees.

We only have a few minutes left. But I wonder, in general, how you help employers to, first of all, appreciate the need for data and get access to that data? Second of all, how do you promote employee engagement to see success of these programs? Neil, I'll go to you first.

Mr Goldfarb: Mitch, I think there are a couple of things on the data side. Employers can hold their vendors, including their health plans, more accountable for providing data and providing meaningful data. I want to give a couple of quick examples.

When we look at diabetes, which Michael was talking about, employers know diabetes is driving a lot of their cost. They're seeing a report from their health plan showing what the costs are for people with diabetes. What they're not seeing in that basic report is who are the people with diabetes who are driving costs.

Our research has shown as an example that 60% of people with diabetes are not being adherent to their diabetes medication. There's a subgroup that we need to focus on to make sure people know about the medications, the importance of medications, find out what the barriers are, and help them overcome those barriers.

Also, on the diabetes front, people may not have access to their testing supplies or may not be able to afford their routine care. They may not understand how to test. There are a host of factors that are driving differences. It's not just looking at diabetes. It's looking at segmenting that population. Comorbid depression doubles cost for people with diabetes.

There are lots of ways that we can pick a chronic disease and then really try to understand, what are the different needs for the different subgroups of the population? One reason people are not engaged is because the programs are not really meeting them where they live, which is their biggest challenge.

Dr Kaminski: Thank you, Neil. That's a good illustration of taking that data and then diving deeper into it and really making actionable plans. With our few minutes left, Michael, I wonder if you want to tackle the engaging with your employees challenge that's part of this pop health strategy.

Dr Kobernick: That's a great question. Truthfully, employers are really discouraged about this because they offer a variety of programs. Employees don't take advantage of them. So, the first part of the conversation is don't get discouraged. Think in terms of the incremental help you're providing. That's the first piece of it.

I think, to Neil's point, we are not meeting people where they are. Some people take advantage of a wellbeing program or an exercise program. Some don't. We need to offer a variety of programs.

The other thing that Neil mentioned that I think is crucial is, how are we cognizant of and sharing with our employees that we're really aware of how the stresses of daily life affect them? The behavioral health concerns, stresses of daily life, the availability of virtual counseling, the acknowledgment that people are stressed and they're worried...They're living in a pandemic. They're worried about their finances or worried about their kids.

Offering solutions for that is an important part of engagement. Sometimes, we're finding if people can get engaged in a virtual conversation, a therapy-based health and wellbeing improvement conversation, that that will lead them to further engagement in other aspects of the health system. It’s a complex problem, don't get discouraged. Think incrementally.

Mr Goldfarb: If I could build on that for one second, I agree fully with what Michael's saying about not getting discouraged. But, also, try to understand what's working and for whom and what's not working and for whom. Keep building. Recognize that population health is not static.

You need to continually assess your programs and fine tune them and reach out to these populations that you might not have successfully reached before. Don't get discouraged. But, also, don't get lazy. Don't view it as I tried that program, it didn't work, because it probably worked for some people. We need to figure out who it worked for.

Dr Kobernick: So much to say, so little time. The only thing I would add to that is it's so important for employers to really, really understand the value that they're providing to the employees. If we think about how much we're spending on sick care, I have companies that are spending a billion dollars on sick care and 2 or 3 million dollars on health and wellbeing and getting upstream on disease.

If we think about that imbalance and if we think about bringing additional value and expenditure to the health, well-being, early diagnosis space, we can make tremendous change. Part of this conversation in thinking about how we provide our health benefits to our employees is really thinking about the balance of how we spend our dollars.

Dr Kaminski: Neil and Michael, thank you. You did exactly what I thought you could. That is to encapsulate in 15 minutes the broad perspective of how an employer goes about implementing population health principles into care of their employee population. I know it's a lot of material to cover. In fact, we've got a two-year masters course in covering this kind of information.

I appreciate your willingness to give your overview thoughts. I'm looking forward to our next podcast, which is going to get more specific about some tools and resources that have been developed for employers to use in their journey to improve the health of their employee populations.

Thank you all for listening to our podcast. Thank you again, Michael and Neil, for sharing your experience and your deep knowledge about population health for employers.

Dr Kobernick:  Thank you for having me.

Mr Goldfarb:  Thanks, Mitch. Always a pleasure.

Thanks, Mitch, Michael, and Neil.

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