Total Health Management
Health care spending in the United States continues to rise, with expenditures consistently outpacing inflation and workers' earnings. Slowing the trend by negotiating with providers, managing high cost cases, shifting cost to participants, and increasing employer contribution rates cannot - in and of itself - solve the problems facing health and welfare plans.
Segal's Total Health Management (THM) is a new approach to lowering trend, improving employee health and strengthening health-care quality. This approach includes the following:
- Using plan data to identify individual participant and system-wide disease patterns
- Reviewing benefit plan design to remove barriers and encourage the use of needed care
- Creating appropriate interventions to support healthy behaviors and life choices
While practical at its core, Total Health Management is more than just another set of tools and approaches. It is nothing less than a fundamental change in the role and perspective of those tasked with the responsibility of overseeing health and welfare benefit plans.
Gathering Plan Data
The Total Health Management data gathering or "mining" process obtains relevant and timely information, which we then use to find patterns in the data and translate them into action steps that plans can take to get ahead of trend patterns.
Segal's Total Health Management approach emphasizes "real time" claims data from participants themselves (rather than aggregate, population-based data) to identify plan participants who account for high health resource utilization and sizable health care costs and help plan sponsors remove barriers to more efficient treatment. Our approach also uses predictive modeling to help predict future utilization and determine appropriate early intervention.
The Segal Total Health Management approach recommends clients focus on:
- Services and disease states that are driving trends in plan costs
- Other factors driving health-care cost increases
- Plan participants who are utilizing health care services extensively
- Plan participants who will likely be "heavy" users in future
- Benchmarking key cost and utilization results to peer groups
We can assist plan sponsors by looking at the data they already have and suggesting program revisions that balance vendor and design changes against an objective assessment of the best opportunities for plan cost and performance improvements.
In addition to profiling the medical needs and health utilization of employees, Total Health Management results can be used to evaluate whether your vendors are performing at optimal levels.
Revising Plan Design
After gathering and analyzing the data, Segal uses the resulting understanding of prevalent health risks and medical needs to make recommendations to plan sponsors that help them:
- Redefine the vision for the plan
- Articulate a multifaceted multi-year strategy with tactical follow-up
- Measure results
- Establish landmarks for successful implementation
To specifically help employees, strategies and recommendations are developed to:
- Close the gap between best practices and the actual pattern of interventions for employees who require the most care
- Identify and communicate the value of early intervention for employees at high health risk
Even for small organizations, we can work with the plan sponsor and the plan's current carriers and vendors to be sure that the elements of Total Health Management are in place and being utilized.
Improving Participant Health
Last, a Total Health Management approach addresses how plans can serve employees and dependents who are not being treated now for health problems but exhibit health risk factors and behavior that can lead to serious illness.
A person's lifestyle and behavior can have a large effect on their health, particularly with diseases such as heart disease and diabetes. A well designed, targeted and communicated wellness program - an organized initiative that assists employees in making voluntary behavior changes - can reduce controllable health risks, improve employee health and, over time, reduce costs to the plan.
With Total Health Management, Segal can help you:
- Customize a health promotion "menu" relevant to your employees
- Help shape effective communications to maximize awareness and utilization of wellness programs
Implementing Total Health Management does not require a radical overnight change. In fact, there is not a single approach or even just one best place to start. Recommended interventions and initiatives are offered for incremental or full implementation, depending on the needs and circumstances of your plan. Just taking some initial steps into Total Health Management can bring noticeable changes that can help derive cost savings.