ActiveHealth, Author at ActiveHealth Management

Fully digital well-being programs are very popular at the moment. Many of them have attractive user interfaces, gamified experiences, connect to wearables and integrate incentives. These solutions have a natural appeal to people who are already using wearable devices and apps to manage their health.

When employees get emails about digital well-being solutions from their employer and then opt-in digitally, we must ask ourselves if they’re most likely to attract those who are already engaged in a similar way and relatively healthy. There’s room for health improvement among these members to be sure. However, most of the significant opportunity for health improvement spreads across the broader employee population.

A successful well-being program needs to be able to outreach to and engage vulnerable and at-risk members in multiple ways, including digital support, for the member and coach, as engagement progresses. Let’s look at how that might work.

Marie is in her mid-50s. She has type 2 diabetes but she’s not seeing her primary care provider (PCP) regularly. She’s had a series of minor infections and recent labs show her blood sugar is high. We can capture all of this information about Marie with our CareEngine® technology. We compare what we know about her to thousands of evidence-based clinical rules and what emerges is higher personal risk due to unmanaged diabetes. We can help with that, assuming we can get her to engage.

Marie has seen the emails from her benefits team about the workplace wellness program available through ActiveHealth. She knows it includes a rewards program for things like connecting a fitness device – a device she doesn’t have and doesn’t want. She already feels overscheduled between her responsibilities at work and home and doesn’t want to make time in her schedule for one more thing.

Marie also knows that she hasn’t been feeling good lately. She’s tired all the time and she was recently in the emergency department for a urinary tract infection. So, when she gets a call from Jim, a nurse coach at ActiveHealth, she decides to take the call.

Jim has a lot of information about her, but he doesn’t yet know why she isn’t managing her health or why Marie wants to make a change. ActiveHealth analytics give him the information he needs to see what her most important next step would be. However, he knows that the most important accomplishment for their first call is to establish a rapport, a relationship.

Once the personal connection is in place, Jim can, along with Marie, uncover her why – her motivation for engaging with her health. He can then weave in digital health tools to help Marie achieve short and long-term health goals. He can use a shared electronic health record to set up Marie’s appointment with her PCP, and he can see that she doesn’t fill her prescription and help her set up mail order delivery. She can use secure messaging in the mobile app to check in with him when she needs a boost of confidence or has a question. He can send her links to digital coaching content, including videos and recipes, to support what she’s working on at the moment.

Our members come in all shapes and sizes, and their willingness or ability to use digital tools varies widely too. Some members are self-directed and a robust suite of digital tools and resources gives them sufficient support. However, as prevalent as smartphones and computers are, there are still areas of the country that don’t have ready internet and cellular service.

Well-being solutions must have the capability to engage with members in multiple ways using more than just digital tools. At ActiveHealth, we built our well-being solution with that in mind, so our members can reap the benefits that digital health tools can offer while connecting and being supported however they feel most comfortable as they set out on their path to better health.

A major building materials supplier has over 11,000 employees in almost 400 locations with ages ranging from late teens to 70-plus. So, designing a well-being strategy that inspires all employees to take control of their health was no easy task. But their Wellness Benefits Manager was equal to the challenge.

How member advocacy plays a key role in utilization management

The gatekeeper style benefit plans of the nineties, with closed provider panels, arbitrary notification policies and tight preauthorization lists left a bad taste in the mouth of health care consumers. Many of the most problematic features aren’t widely used anymore, but utilization management (UM) programs can’t quite seem to wash out the stain those features left on their reputations.

Houston, we have a PR problem

Too often the media portrays health care coverage decisions as if they’re made by bureaucrats with calculators. Saving money is the only goal, and the patient and health plan are adversaries.

Advocacy-driven UM is the opposite. In this model, UM nurses advocate for members to have timely, evidence-based care in settings that are medically appropriate and cost-effective.

We know that higher health care spending doesn’t guarantee better health outcomes.¹ Advocacy-driven UM uses data to help patients get outcome-focused, scientifically sound and financially responsible care. Let’s look at the numbers.

The survey says

A survey² of over 2,000 physician members of the American Medical Association showed that:

65% of respondents believe that 15-30% of medical care isn’t necessary
If we can eliminate even half of that, we’d save over $105 billion dollars a year

This begs the question, why are physicians prescribing unnecessary care? The same survey sheds light on that too. The top answers were:

85% fear of malpractice
59% patient pressure or request
38% difficulty accessing medical records

Physicians are busy

It’s a fast-paced world and we’re all only human. The average primary care physician has between 1,000 and 4,000 patients in their panel.³ In 2020, the US Food and Drug Administration approved 53 new drugs.⁴ There were over 400 new treatment guidelines last year. That is a lot of new information for doctors to keep up with and still stay focused on providing the best care possible for patients.

This is where advocacy-driven UM comes in. UM isn’t a barrier to health care. In many cases UM nurses and medical directors help overwhelmed physicians confidently follow established clinical guidelines. They also help members receive care in-line with latest science. Many times, following evidence-based guidelines costs members and plans less. Sometimes it costs more. Either way, advocacy-driven UM nurses prioritize quality and patient outcomes.Ideally, advocacy-driven UM programs are integrated with case management solutions. This integration promotes care in the highest quality care settings, ongoing care coordination and care access support. This seamless transition is critical to avoiding readmissions and putting preventive measures in place for members.

When it’s done right, UM should feel like a great customer service experience to the provider. Reviews are more than a mixture of clinical guidelines, benefit coverage and network access. They represent real health care issues for real people and must be handled with care and attention.

Advocacy-driven UM supplements and supports physicians

Health care providers want what’s best for their patients. They are also highly data driven. This is why, in the advocacy-driven model, we focus on clinical evidence and what’s best for the patient. If there’s a question about what that is, we go looking for more information.

Every provider that submits a request can have a peer-to-peer conversation with a medical director about the case. When the best health outcome for the patient is the end goal for both parties, transparency is a must.

In summary

The best utilization management experience is invisible to the patient. Member advocacy doesn’t just peacefully coexist in this experience. It’s essential to it. There’s collaboration between their health care provider, their health plan and the reviewer. The outcome is a treatment plan that reduces unnecessary services and spending and delivers the right care, at the right time in the right setting.

¹ Tikkanen R, Abrams M. U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? Available at https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019?gclid=EAIaIQobChMIipX81q6l7AIVCa_ICh33aQusEAAYASAAEgILZPD_BwE Accessed September 15, 2021.

² Lyu H, Xu T, et al. Overtreatment in the United States. PLoS One. September 6, 2017. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/ Accessed April September 15, 2021.

³ Paige NM, Apaydin EA, Goldhaber-Fiebert JD, et al. What is the Optimal Primary Care Panel Size?: A Systematic Review. Ann Intern Med. 2020; 172:195-201. Available at: https://www.acpjournals.org/doi/10.7326/M19-2491 Accessed September 15, 2021.

⁴ US Food and Drug Administration. New Drug Therapy Approvals 2020. Available at: https://www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/new-drug-therapy-approvals-2020#:~:text=In%202020%2C%20CDER%20approved%2053,Biologics%20License%20Applications%20(BLAs).attention. Accessed September 15, 2021.

I began my love affair with data and computers in college in the mid-1970s, programming on an IBM mainframe with punch cards. From my residency through my time as Chief Medical Officer of a hospital, I stayed involved with innovation in the realm of data and information technology.

Eventually, I decided to dive completely into the world of health care data analytics. Nothing makes me happier at work than to be knee deep (or deeper) in data. Whether it’s assessing quality, answering a question or solving a problem toward improving population health. That’s really the heart of my work now – proving to clients that we’re improving the health of their population.

What is health?

Describing health to our clients isn’t easy. We have terabytes of data about our members. We can tell them about the prevalence of chronic conditions. We can point out lifestyle and biometric risks. We can describe clinical outcomes. We can identify gaps in care. We can literally show tables and tables of data. At the end, they have trouble putting it together and still don’t really understand what all of that means for the overall health of their population. We needed some sort of metric that could simplify, aggregate and describe health.

The Spectrum of Health

The Spectrum of Health was our first attempt. It looked at episodes of care and put members in one of 6 categories:

Healthy
Healthy with risk
Minor chronic conditions
Major chronic conditions
Complex chronic conditions
Catastrophic – high-cost claimants

We described the health of the population by how members fit in those categories. Notice that by and large, we were looking only at physical health. And we viewed wellness in terms of lifestyle risks and other health issues that can be risk factors of chronic conditions, like cholesterol, smoking and stress.

The shortfall of the spectrum was that it’s not an outcomes measure. People thought we were going to shift their population from less healthy categories to more healthy categories. Not true. Think about a person with kidney disease. We can help them manage it, but we’re not going to cure it and move them out of the major chronic category. So, while the spectrum gave us a picture of health, it wasn’t the metric we were looking for.

Multi-dimensional health

Now, the hot topic in our industry is well-being. The concept of well-being says that it’s not enough to be just physically healthy. There are other factors – emotional health, social connectedness, financial security and so forth. But even just within the category of physical health, we can still look at it in terms of a multi-dimensional perspective.

This thinking led us to develop the Active Health Index. It’s a much more sophisticated tool than the Spectrum of Health and considers ten dimensions of health – six of which are impactable. The Active Health Index addresses three fundamental questions of interest to our clients.

What is the health of my population?
What are the opportunities to improve their health?
How much did health improve between two points in time?

So, not only does it measure health, but it’s an outcomes tool as well. We can measure the changes we are making in the impactable dimensions over time. We’re excited about it, and so are our clients.

Check yes or no

Our patented CareEngine® technology is the foundation of the Active Health Index. It ingests a massive amount of information about our members and creates an enormous, longitudinal database.

All of this data passes through thousands of clinical rules. We distill it into markers. Markers are basically a yes/no about things related to a member. Are you a smoker – yes or no? Do you have diabetes – yes or no?

We took all of these markers and looked at the most logical way to organize them. What we saw was that they seemed to fit naturally into ten dimensions. There are four non-impactable dimensions – things we can’t change but that do impact your overall health, like your age. The other six dimensions are impactable. They’re things like medication adherence and lifestyle and biometric risks, even the member’s self-perception of health.

At ActiveHealth, we believe in a personalized approach to population health. We know that members with diabetes don’t all need exactly the same support. The Active Health Index helps identify areas for improvement that are specific to each person. This data threads through every interaction the member has with us. It prioritizes what appears to the member in our digital experience. And it’s part of the individual care plans that our coaches and clinicians develop for our members.

As members act on their opportunities for improvement, we can see it. We can measure the change over time, and we can report on it at a population level to our clients. It gives them a simple, aggregated picture of the health of their employees. From there, they can create the population health solution that will have the most impact on the health and well-being of their employees.

If the key to successful population health management is what you know and how you use it, the Active Health Index can be the foundation of both.

Dr Lia Rodriguez

By the age of 8, I knew in my heart I wanted to be a doctor – a pediatrician, to be exact. As I achieved this goal and began my practice, it was rewarding to help my young patients live their healthiest lives. I checked their growth and vaccinated them during checkups, treated ear infections and prescribed treatments for asthma attacks. As much impact as I could have on their individual needs, I realized that the people with the greatest impact on their health were their caregivers. They had the best chance to shape the development of healthy habits that last a lifetime.

Children are guided by a wide variety of stakeholders in their community ecosystem. They take their cues from the adults in the expanding world around them – initially from their parents and family members, then from teachers and coaches. As they grow older, they look up to athletes, celebrities and, in the age of social media, influencers. They model their choices, what’s fashionable, what to eat and how to act. I came to realize I could have a much greater impact on the well-being of children if I affected the lives of the adults supporting them as well. This realization lured me away from the exam room. I made it my career goal to improve the lives of people at scale thus having the greatest impact on children – the adults of tomorrow – and perpetuating a chain of healthy people.

Joining ActiveHealth as the Chief Medical Officer felt like a natural next step on my path toward this goal. Our members often talk about the ripple effect of our work together. As one member put it, “I never realized how unhealthfully I and my family were eating. They have followed my lead with eating healthier, making healthier choices and being more physically active.” This is the beginning of the creation of a new legacy of healthy choices for this family. It’s the start of generational health. This is exactly what we’re trying to accomplish – better health for the people who engage with us and for all the people they care about.

Health care has traditionally focused on the body. There is now a growing emphasis on the mind. At ActiveHealth we take this a step further, understanding that we must honor the mind, body and spirit in our work with members. Our spirit, that invisible string that pulls us and connects us to each other, is crucial to whole person health. This is at the center of everything we do at ActiveHealth and I look forward to continuing to champion this on a larger scale.

As the year comes to an end, it’s natural to look back on what we’ve accomplished and to begin to set goals for the coming year. The more I learn about our staff, and the more clients I meet, the more energized I am about being part of this team and about what we’ll accomplish together in 2023. We all share the common goal to help people create a vision of health that honors the lessons of the past while embracing a healthier future.

I wish you all a happy holiday season and the very best for a healthy new year.

With our Active Health Index, we can personalize a plan for each person in a population, and for the population as a whole. Are you ready to put data to work for you? Watch this one-minute video to learn how.

The number of available primary care providers is dropping, and wait times for appointments are getting longer. ActiveHealth can help preserve and enhance the patient-provider relationship by finding opportunities to improve health and by helping to make appointments more efficient and effective.

At ActiveHealth our goal is to exceed your expectations right from the start. There are five key components to our implementation process that help set you and your members up for success.

Get our infographic to learn more.

Is your data working for you? Catch up on our webinar with The Conference Board from September 2022.

In this video, you’ll hear from ActiveHealth’s Dr. Bani Vir and Scott Sobocinski, Pharm. D. They discuss one of today’s most compelling issues facing human resource leaders: how big data and advances in technology can help achieve better health outcomes.

They also share the results of an independent third-party validated study demonstrating the cost savings that can be derived from the effective use of clinical insights.

Awareness leads to engagement: Learn how one client tripled engagement with a comprehensive communications plan.

Beyond digital engagement

How one wellness manager engaged over 73% of at-risk employees

Supporting the provider-patient relationship

How member advocacy plays a key role in utilization management

Houston, we have a PR problem

The survey says

Physicians are busy

Advocacy-driven UM supplements and supports physicians

In summary

The quest to quantify health

What is health?

The Spectrum of Health

Multi-dimensional health

Check yes or no

Get to know our new Chief Medical Officer

Learn about the Active Health Index

Protecting, preserving and promoting health outcomes

Implementation: Configure your solution & leave the rest to us

Webinar: Is your data working for you?

Be flexible. Be strategic. Be collaborative.