This is correct. For example, in the old WW program, if your daily point limit is 26 points, and a slice of pizza is 11 points, you could eat two slices of pizza and nothing else all day. You’d stay “under a number of points,” but no one at WW would claim this is a healthy diet or a good strategy. Mindy Grossman, WW’s president and chief executive, said that the change is a “360-degree approach to ‘healthy,’ no matter how you define that for yourself.”
Our own behaviors in the context of our specific social and environmental factors have a larger impact on our health than genetics and direct healthcare services. Addressing the social, mental, or economic barriers to health are necessary to achieve sustainable and positive outcomes; however, traditional healthcare providers and payers lack the systems and practices to implement often simple benefits that would engage younger people earlier in their own health or prevent costly health conditions for others.
Let’s take the case of a 30-year-old healthy woman, Lily. Lily works full-time, and she’s also enrolled in a graduate program at a local state college. She is moderately active, trying to fit in exercise 2-3 times per week. However, Lily has a hectic schedule and is often rushing out the door. Her on-the-go diet consists of protein bars, coffee, and frozen meals. Lily appreciates and recognizes the value of good health insurance, but frankly, she doesn’t get much benefit from it. She feels healthy enough where she doesn’t have a need to see a physician and currently does not take any medication.
Her company’s health benefit will provide coverage if she gets sick, but at her age, it’s unlikely. However, given her lifestyle, she does have health risks. Her diet and stress could lead to a stomach ulcer. Her schedule means she’s likely suffering from sleep deprivation; combine that with stress and it could contribute to mental health risks.
Like most medical problems, these are all underlying triggers to eventual issues that don’t get attention until the problem arrives. This is currently what is broken in our health care system and what reform efforts are working to change—and yet, commercial insurance benefits are slow to respond here. Lily’s health plan doesn’t provide access to services that would take care of these early triggers and her doctor isn’t equipped with tools to address them either.
Expanding to a 360-degree view of health
Like WW, we need a 360-degree approach. We need to find ways to engage Lily, and others, in a lifestyle that would reinforce healthy behaviors, and therefore prevent future risks. A central aspect of value-based care is to allow healthcare organizations to reallocate resources to programs and services that would address these non-medical needs if it can result in better health outcomes. This has resulted in innovative community partnerships to provide housing to the homeless, fresh vegetables from local farms to patients needing improved diets, and home care support for those without a family caregiver.
Operationalizing this expanded view of healthcare requires changes to traditional processes, technology infrastructure and systems. Here are some important tips that can help organizations build and deliver options uniquely designed for their patients and/or members.
Identify what you want to know about your patients and/or members
The amount of personal information on any given individual can be immense and could quickly snowball out of control. Start with the basic characteristics of an individual that often don’t get captured, such as marital status, employment status, or living situation.
Collaborate with your team and decide what data matters by looking at existing analytics of your patients or members as well as trends in the broader population of your region or service area. Select the characteristics that are impacting current health outcomes, quality measures or benefit utilization.
In addition to information that you can collect directly from individuals, combine self-reported information with third-party data to build comprehensive profiles of patients and members.
Construct a process for capturing the data about your patients/members
Whether it is an eligibility and enrollment system or an EMR, neither collect or store personal information that can be used to understand individuals’ social and environmental situation. Data governance and master data management principles should be part of your process for expanding your patient and member data. These each considers the process you identify for collecting the info, who collects it, and who acts when changes occur.
For younger populations, social and environmental factors can change more frequently than health information. Single people get married; people change jobs, and some move from living alone in an apartment to living in a house with a partner or group. At the very least, incorporate a process for updating information to ensure accuracy in your ongoing data analytics.
However, your organization can unlock even more potential from managing this dynamic data effectively if you opt to engage individuals when changes occur. These changes–or life events–can occur at any point and can have an impact on benefit utilization or directly affect our health.
If Lily loses or changes her job and needs to move, her routines will need to change. She may live further away from her physician, lose access to a convenient gym, or be financially constrained due to a change in housing costs. Any of the changes can be triggers to change her behaviors or choices related to her health benefits and ultimately her health condition.
Build a network with community-based programs and resources that align with your patients’ needs
Your patients and members live in a larger community that offers an array of programs, resources, and services that would be costly to replicate. For both providers and payors, partnerships with existing community-based care services, recreational programs, fitness centers, and activities that can encourage healthy decisions. Examples can include farm share prescriptions that provide vegetables at a discount or free passes to state parks for persons who need more activity. These partnerships help reinforce the association between your organization and making healthy choices, which can strengthen the value your patients and/or members perceive in their relationship with you.
In a 360-degree view, there are more options to engage your patients and members that will develop the relationship with them and build loyalty over time.
Include options in benefit designs that address non-medical determinants of health
Integrating programs and services that address healthy behaviors and offer services to support environmental well-being are more than enticing marketing incentives to attract young and healthy members. These benefits are precisely what health looks like for some segments of the population.
For the young and healthy segment, like Lily, you may be inclined to create member-only events. Nutritional cooking classes (especially meals in 30 minutes or less) may prompt Lily to change some of her habits and develop new skills.
When taking the long view, benefit designs such as these are teaching people how to take better care of themselves, reducing the risk of future chronic illness in the population, and engaging people as active participants in their health.
WW recognized that a singular focus on weight loss and diet was leaving many of their customers underserved and lacked the ability to create long-term relationships when persons reached their goal. These are the same consequences that many providers and payors face when they limit their role in a person’s health to the old medical model.
Archetype is helping healthcare payors and providers identify, manage and use patient and member data to provide a more consumer-centric approach while also meeting goals for quality care, positive patient experiences, and appropriate utilization of services. The tips outlined here are based on our framework for a mature data analytics lifecycle.