Payers Double Population Health Programs Amid COVID-19

Among the many initiatives accelerated by the COVID-19 pandemic are efforts to address inequalities in the U.S. healthcare system that have persisted for years but were highlighted when the coronavirus hit the country’s shores.

As a result, payers are implementing new programs to try to improve member health beyond the traditional care pipeline, especially through broader data collections and strategic partnerships, executives said Tuesday. insurers at the AHIP annual conference on Medicare, Medicaid and Double Eligible.

The pandemic created new needs that payers were not necessarily yet equipped to meet, according to Julie Weatherly, program analyst at Independent insurer Blue Cross based in Pennsylvania.

Weatherly said the company has discovered that many of its Medicare Advantage members have difficulty ordering groceries online when store shelves in their regular stores are cleared of certain items. Recipients found it difficult to use the apps to select goods and delivery times.

The payer reached out to bigger companies like Wegman’s and Giant, but their supply chains were too disrupted to be helpful. So IBX got in touch with a regional grocer who worked with local farmers and was able to help members get the food and supplies they needed.

This partnership has changed some perspectives.

“I think traditionally people thought the only way to partner with a business is if it’s big or if it has experience with Medicare Advantage – all of those kinds of legal and compliance issues that we asked the vendors before approaching them to make it work, ”Weatherly said.

Andrew Renda, vice president at Humana who works on population health strategy, echoed the importance of staying local. Humana has more than a dozen population health strategy leaders in various markets who are liaising with community organizations in those areas to determine which methods will work best, he said.

Panelists agreed that starting a successful social determinants of health program involves collecting and interpreting data.

Renda said that building data ecosystems “becomes the basis of everything we do” and helps determine the correct, evidence-based interventions.

And any pilot program should be built with scalability in mind, according to the executive.

Humana uses a Centers for Disease Control and Prevention assessment tool that measures days of poor mental and physical health in individuals over a 30-day period as a leading indicator, tracking data on treatment adherence and preventive screenings.

“I think one way to look at it is to have the right study design to make these demands justify the larger investments,” said Renda.

Executives said equity programs can deliver a return on investment, but they often take place on a different timeframe than stakeholders might expect.

This can help set separate ROI goals and look at the steps you need to take to determine if a program is successful.

“I think often times some of the social determinants of health interventions take longer to see return on investment or results than some of our more traditional clinical interventions,” Weatherly said. “So I think for us it’s also a level with people who may not have a background in public health or social science.”


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