How Can Integrating Data, Population Health Optimize Employer Health Care Delivery Amid COVID-19?

In addressing the coronavirus disease 2019 (COVID-19) pandemic, a more active-based approach is warranted among employers to optimize care. Through detailed databases and a greater focus on population health, Paladina Health has promoted this transition to a more informed, value-based health care delivery system, said Kirk Rosin, chief revenue officer of Paladina Health.

Transcript

AJMC^®: Hello, I'm Matthew Gavidia. Today on MJH Life Sciences’ Medical World News, The American Journal of Managed Care^® is pleased to welcome Kirk Rosin, chief revenue officer of Paladina Health.

Can you just introduce yourself and tell us a little bit about your work?

Rosin: Sure, Matt, thanks for having me! I'm Kirk Rosin, chief revenue officer for Paladina Health. We're 1 of the largest direct primary care networks in the country. So, we're serving hundreds of thousands of patients across 20 states, and we work directly with employers providing them primary care services on an on-site or near-site basis.

AJMC^®: For employers designing health plans to address the pandemic, what factors warrant consideration?

Rosin: This has certainly been an unprecedented time for employers and it's really accelerated a lot of initiatives that have existed in the health care world and brought them to the front doors of many employers. So, what we've seen is a tremendous intersection between worksite health, community health, personal health, there's been an incredible attention paid to infectious disease transmission and the environment in which that's happening. So, employers have had to be incredibly diligent and cautious about how they're returning their employees to work and if they're creating safe work environments for them to operate in.

So, most employers, as they think about their health programs, have really brought together that worksite health concept, as well as their traditional health benefits plan. So, when they think about how those 2 things come together, there's a need to act with agility, there's a need to act on information that's presented as quickly as possible. Those are all new types of challenges in that health benefits world. So, employers have really needed to be on top of basically every case that comes through, any concerning symptoms that may walk through that door, and be able to react and respond accordingly.

So, I think that has created some challenges for employers as they look to—how do they get that information? How do they create the environment that's best for optimal health? Many of those things, combined elements that they've looked at separately before.

The other components that I think have moved forward is how individuals are accessing health, and this will come into play as employers think about what is the most efficient and optimal way that our employees and their family members are going to be receiving that care. So, we've seen ready adoption, quick adoption across the board with telehealth and other virtual modes, and we think those are there to stay. So, as employers are thinking about next generation health benefit plans, it's really good to be taking into account—hey, how's that experience for our employees? Are they accessing the right level of care through those modes? Are their experiences that are better that they will adapt more quickly?

So, I think for those elements, there'll be a whole new spotlight cast on some technology and some other aspects of virtual care. I think, finally, the other element that employers are really going to need to think about is how are they working with and identifying and supporting those individuals who are vulnerable for elevated COVID risk?

So, those vulnerable populations that have the comorbidities and the chronic conditions that make them more susceptible to complications, what does that mean from a chronic condition management program? How can they augment what they're doing with wearables or other monitoring devices? How do you monitor those individuals in a real-time basis to make sure that they are as safe and as healthy as they can be, in this unprecedented situation?

AJMC^®: Artificial intelligence and the use of detailed databases have become great necessities for employers who are seeking to return safely to the workplace and cater to employees who may be at great risk of COVID-19 complications. How have these technologies been leveraged by health care providers like Paladina Health, and how can it assist in delineating those at greatest risk of COVID-19 complications?

Rosin: Great question. As we've seen, there's so much data available, it can be overwhelming. The average employer just really isn't sure where to start. So, as we think about as an organization that works with entire populations and entire workforces for employers, we have relied on data and artificial intelligence and algorithms that we've created in order to look at the data and really extract relevant timely information.

So, as we've worked with hundreds of employers that have maintained active work sites throughout this pandemic, we've used the claims data, the other lab data, pharmacy data, in order to identify individuals who may be at greatest risk. When we looked across a number of factors, we were able to identify that across our population, 19% of our patients were at an elevated risk. When we cut that down into certain demographics, so unions it was about 34% of the population, 24% of manufacturing patients, 19% of those that worked in education, were at higher risk.

So, we are an organization that not only focuses on individuals that walk in and present into our health centers, but also the entire population as it exists outside of our health centers. So, what we needed to do was outreach to those individuals that were at highest risk for complications, and we conducted virtual visits with 85% of the high risk population on a proactive basis. So, we had conversations with diabetics to make sure they had sufficient insulin, to make sure that they understood about self care, to remind them about the precautions that they would need to take in order to minimize the risk for contracting the virus, and then also working with them around their worksite concerns.

How can we understand what's happening in the worksite? What's happening with population health within the work environment, and what can be done in conjunction with that employer to alleviate those concerns. So, as we had those preventive conversations, it was really our ability to isolate that population across the hundreds of thousands of data points that we had and identify them based on their cohort identity, and really have some personalized conversations.

What was incredibly well received was the fact that those patients really felt like their provider understood them—they understood the concerns. In a time where access had been limited for many individuals around what was going on in acute care settings and other fee-for-service primary care offices, we were in a spot where we could proactively outreach and let our patient panel know exactly where we were, and be available to them. So, it was very timely and it was all enabled through data and the ability to identify those folks.

AJMC^®: Can you discuss how data warehouses are formed and managed?

Rosin: Absolutely. In general, data warehouses are ways to organize vast amounts of data so that it’s informative, it's searchable, and relevant information can be extracted. Jumbo employers have used data warehouses for decades as a way to more deeply understand the health of their population. They've used it to help them design future benefits or other health program features in order to meet the needs of that population.

Insurance carriers have used it to mitigate health risks or outreach to individuals who may need additional support and that sort of thing. Where it needs to be managed is that there needs to be someone monitoring the continuous inputs, and how can you organize those continuous inputs in a way that makes sense. So, data warehouses are taking claims data, prescription drugs, labs, and even now, with the proliferation of wearables and other monitors, that information can be brought in as well.

So, the amount of data in these warehouses has never been greater, but nor has the need to effectively organize, mine, and keep up to date on what's in there as possible. We as an organization have taken the approach that a data warehouse is also incredibly valuable in a provider stance. So, when you think about a provider, they're typically waiting for some patient to present in their office, and you can talk about that specific challenge or that specific health concern, and that is the focus of the visit.

What we have found by working with employers and our ability to aggregate that data at an employer level, we now have a view into the entire population. So, it's not just those people, those patients that are walking through the door, it's the individuals that aren't getting their prescriptions refilled. They're the patients that continuously visit the urgent cares. It's the other patients that really need the attention that we're able to identify as well.

So, what we've been able to do from a data warehouse management perspective is bring that warehouse function in conjunction with a primary care service to employers of all sizes. So, it's not just the jumbos that are using this now to effectively deliver care and deliver more proactive care, it's every size organization that wants to be part of this new, different, and informed primary care model.

AJMC^®: In partnering with employers, can you speak on the process of working to ensure that each employee is accounted for and provided with their own individualized care?

Rosin: Absolutely. So, our model is a little bit different, and it is data informed. I think the key to ensuring that each individual is accounted for is to have a view into that entire population on any given day, not just whoever walks through the door of that provider office. Our model, because we are able to aggregate at that employer level and we are able to take in claims data, prescription data, and labs data across that population, we have that comprehensive view of what's going on in that employer's realm.

So, for us, it's really looking across the entire spectrum, being able to stratify those individuals who are at higher risk or happen to be going through the health care system in a haphazard or random or some optimal way, and being able to outreach and give them guidance. So, when we think about our ability to have those conversations and our ability, from a convenience standpoint, to give a higher level of access to employer populations, we're seeing about 85% of an employer’s population visit our health centers in the first year.

When you think about how that compares to the broader population, where in about half of the general population has an assigned primary care physician, we're achieving a much higher engagement rate because we have that information, we're able to expand our hours so that employees can readily access our providers. We're giving multimodal access in terms of in person visits, video visits, text, email, everything is really on the table from an access standpoint. So for us, it's making sure that wherever that individual is and whatever their health needs are, we're able to interact with them in a way that works for them.

The other component of our model is that it is 100% value-based. We are not operating in a fee-for-service environment, and that affords us some luxuries. It affords our doctors the ability to see fewer patients on a daily basis. Our appointments can last up to 90 minutes in length, and so when you factor in that is 8 to 10 times the length of a traditional primary care visit, we're in a spot where we can have some really meaningful conversations.

In addition to having the data on that patient and understanding the gaps in care that need to be closed, we can have very candid conversations about the challenges that those patients are facing in achieving their health goals, and the additional time affords us the luxury of understanding what those challenges are, understanding what will work from a health plan perspective for that patient, but also gives us the time to follow up with that individual to check in. How's that going? We talked about a very personalized plan, this is how we were going to execute it over the past couple weeks, how's that going?

So for us, it's really having those proactive, preventive, and healthy lifestyle conversations that becomes part of that trusted relationship that we have. It develops a much different cadence and a much different conversation by simply that luxury of time. So, as we look at our model, it does take data in, but it also has a very personal approach, and that's something that has worked across employer populations.

AJMC^®: What are the long-term financial benefits that would result from placing a more distinct focus on population health?

Rosin: So, as we think about population health, we've traditionally looked at the end of the spectrum with the highest risk, and how are we managing those folks that are today the highest cost type and most complicated patients in the population. While that still remains a focus and something that we do very well, population health also means engaging the lower end of the risk spectrum in a much more proactive and preventive way. What we've seen over time is that the impact of having those conversations early, before a situation becomes dire or more complicated, results in lower health care costs.

As we have seen across population health and really how primary care is in an optimal seat to deliver on population health, we've seen investment in the model in a different type and more informed view of primary care has resulted in lower specialty spend, it's resulted in lower urgent care visits, lower ED [emergency department] visits, we've seen reduction in inpatient admissions based on improved health status. So, when we think about the entire spectrum, investment in some of those upfront conversations, tends to snowball throughout the entire spend of that organization.

Population Health, as I said, does focus on that highest risk component. When we've seen our model that's data informed that has the access to the individuals that need the care on a 24/7 basis, we've been able to manage the highest risk population at a cost point that's 79% lower than if those individuals were to go through and follow their own care protocols in different care settings. So, that's significant.

When we go into a situation where we are looking across the entire population, and we're able to engage not only the highest risk individuals, but the other individuals who may be at an increasing risk or are trying to stay healthy, we've seen the employer save anywhere from 25 to 40% of their overall health care costs by simply funneling their employee population to Paladina primary care center.

AJMC^®: Lastly, what further steps are needed either by health providers or employers to address health concerns precipitated by the pandemic and beyond?

Rosin: What I think is that we are transitioning from health care through employers being a benefit to being a health decision. So, what I expect is that there will be a certain degree of data informed flexibility in real time information that needs to be built into these plans and programs because what we've seen is that waiting for a quarterly report or waiting for an annual report in order to make decisions, that just doesn't work anymore.

So, it really will be an active monitoring of exactly what's going on health wise, how can we optimize care, what resources are available, and how can we support our employees in their understanding of how to access the appropriate health care resources. So, I think it really—this whole situation has elevated the awareness of infectious disease transmission and other types of health situations in a way that it has become a frontline type of fight for many employers.

So, I think the additional passive hey, we'll figure it out next year, when we get the information on what happened with our population—I think that passive approach to health care delivered by employers is a thing of the past and it must be an active, in real-time type of monitoring and surveillance and understanding, but then the flexibility to adapt on the fly. So, I think it will be more of a point in time type of decision versus an annual benefits type of decision which it has been in the past.

AJMC^®: To learn more, visit our website at ajmc.com. I'm Matthew Gavidia. Thanks for joining us!