As part of our ongoing series describing Primary Health (new model, full spectrum, health monitoring, engagement catalyst, and commercial advantage), it is now time to turn to its value when applied to an entire population. We have already described how Health Monitoring can rapidly detect, in near real time, the health of the population through daily check-ins via our Passport App, as well as through the direct connectivity we enjoy with our Members. It is the implications of this vital Member connection as it relates to managing the entire population that will be the focus of this post.
There is quite a bit of lip service paid to “population health” efforts in the employer health industry. For decades, insurance companies have sold employers on their ability to use claims data to identify gaps in care, and then attempted to influence the closing of those gaps to improve the health of a defined population. These efforts have traditionally been met with very limited success; typically, the outreach efforts connect with just 2-3 percent of the population, and of those who actually engaged, very little behavioral change was experienced. However, these programs are sold over and over again, year in and year out, by the carriers.
Enlightened employers have realized that while the insurance companies have all the data, and in many cases the right concept for intervention, they are missing the one thing that matters when trying to achieve true behavior change—a trusted relationship. Getting a call from a rando insurance agent asking about your personal health information is akin to trying to sell a brick raft. No float in that boat.
But…what if you had a trusted medical group—with an established connection with the member, care insights piped directly to the entire care team, and a partnership with an employer who can create incentives—taking on the difficult task of actually proactively managing the health of your Population1? Despite Population Health2 being around for so long, the principles—let alone the definitions—of Population Management3 are not well understood (See Footnotes below). Crossover’s Primary Health model is architected to monitor the ongoing health of the population AND to also make the direct interventions necessary to do the hard work of meaningful behavior change. That is what medical groups should be doing, but as everyone knows they are often not capable of doing so (missing data and care insights), not paid to do so (fee-for-service enables “treat ‘em and street ‘em” mentality), and not expected to do so by anyone (not typically held accountable for performance).
Primary Health solves this situation through a combination of engagement, care, and payment model innovations that allow us to:
- Aggregate. We have invested in an enterprise data warehouse solution that gathers all the “streams” of data to form a large and growing data “lake.” This requires permission from the employer, technical integration with the payers (who often pretend to play nice, but have to be compelled to share the data), and some serious Extract, Load, and Transform horsepower to match it all up.
- Analyze. What makes the data lake usable is our Clinical Operating System, which functions as a dam to both pool the information in usable ways, as well as—and most importantly—to pump it out through Clinical Analytic turbines to generate Care Insights. These Care Insights are the “electricity” that is then used to “power” individual Members to make behavioral changes in their lives.
- Advise. The actual “Switch” that turns on the powerful Care Insights is built into our proprietary Member technology. Care Insights come in multiple forms: gaps in care, prevention reminders, or recommendations for enrollment in targeted clinical programming based on condition. What is so powerful is that each phase of power is wrapped with an insulation of trust—the true conduit of care!
The “power” behind our care model is the Care Insight Generation that is delivered directly to our Member’s—literally. And when you do this right, it is truly electric! A simple visualization is below:
But, our work is not yet done.
Everything described above has been performed in various ways by insurance companies for decades. The major difference is their inability to deliver the Care Insight “electricity” to the actual homes where the power can be put to useful work. That is the critical missing element—and why Crossover succeeds where insurance companies fail. We not only have the connection to each Member, but most importantly, we have their trust. When 95% of Members are willing to take our recommendations for care—we can light up the motivation to engage in true behavior change, while helping them take ownership for their own health.
This can be seen simply through the following steps:
- Connect. Crossover already has a direct pipeline to every single Member who signs up for our services. Through modern communication, we are a click away from our Members, we know them on a first name basis, and they trust our recommendations. They know we will never abuse this trusted relationship, and that we act as a healthcare fiduciary on their behalf (i.e., as an independent medical group we will never refer them to a specific healthcare provider out of obligation as we are an unconflicted, unencumbered, non incentivized pure play medical group).
- Communicate. We aren’t sending snail mail to people’s homes to share outdated information from two years ago. We are sending secure messages in real time to Members who communicate back to us using modern tools, modern techniques, and modern teamwork software. Furthermore, the communications come from an actual team with everyone playing their part, to the top of their license, and working together for the benefit of the Member.
- Close. Finally, the direct connection and open channel are helpful—but the trust is invaluable. I consistently argue that employers and payers should always bet on the most trusted entity to help close the gaps in care. Effectively closing gaps comes from literally being close, and closeness is a natural outcome of our relationship-based approach.
This process is visualized in a simple workflow which also highlights our partners:
Again, Primary Health is not just an access play, it is not an urgent care play, rather, it is THE play for those who are serious about managing the total cost of care, who understand that high quality results in high value, and who know that great experiences lead to high engagement and trusted relationships. Everything about Crossover Health ultimately builds toward these trusted relationships, which are a vital requirement of having enough “power” to achieve the Triple Aim.
- Populations can be made up of any defined group of individuals that make business sense to group together. They can be defined by groups of individuals receiving care within a health system, or financed by a specific entity, defined by geography, or within specific segments, or by identifying characteristics that can be known with some certainty.
- Population Health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. These outcomes are influenced by a broad range of factors including social determinants, disparities, and inequities that can exist within the defined population.
- Population Management is the design, delivery, coordination, and payment of high-quality healthcare services to manage the Triple Aim for a population using the best resources we have available to us within the healthcare system.