Medicaid programs serve an ever-widening range of people and an equally wide range of health, social and lifestyle concerns. This challenge is compounded with increasing budget pressures. Programs need a new approach to work with transient populations and to address high membership churn, difficulties in accessing care and the complexity of navigating programs.
Addressing the federal mandate for quality outcomes and better coordination of care requires health risk assessments. These HRAs establish a comprehensive view of the individual, create a healthcare itinerary and help members navigate through their healthcare journey. Armed with this information, programs can better direct resources where they’re needed and implement timely interventions to avoid long-term clinical and financial issues.
Knowledge is power
Health management is tricky, especially when addressing costly chronic conditions in a highly mobile population. States need actionable data to manage health costs more effectively. At-risk members need to be assessed and connected with care before they develop serious conditions – or end up in the emergency room.
A health risk assessment aggregates health, lifestyle and behavioral data and cross-references them against condition profiles. This provides a clearer picture of program members and connects them with resources outside the scope of managed care organizations.
There are several approaches to administering health risk assessments today. What should a healthcare program consider to get the most information and value from an assessment?
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More state control
Medicaid programs should centralize and control the data in order to use it more effectively. They need immediate access to the big picture of their members’ health. They also need the ability to track members’ conditions as they move throughout the Medicaid system, and avoid information gaps that could lead to less effective care plans. Data centralization also provides a solid foundation for analytics that enable programs to observe what’s happening at the population-wide level and determine the appropriate course of action.
The Care Integration Services group at Xerox offers this centralization, which makes it possible to track long-term changes and uncover potential high-risk health issues. Our solution also enables the state to see which managed care organizations are most effective at treating particular conditions.
This approach to health risk assessments help states guide their program goals more actively, and gives them more control over how these goals are achieved. Each Medicaid program needs to improve access, quality and outcomes – all while controlling costs. Each program should be able to determine specific objectives and care strategies (such as lowering rates of diabetes, reducing stroke risk or encouraging healthier pregnancies) from the start. These objectives and strategies are then used to set the benchmarks for the assessments, ensuring that clinical and socioeconomic information is gathered consistently.
Successful healthcare programs are adept at treating health issues effectively. This takes a certain amount of personalization, developing specific treatment plans rather than “checking a box” and applying the same approach to all conditions. To meet a program’s goals effectively, health risk assessments must account for the many differences between individuals – especially when collecting information about chronic conditions that can vary widely in severity.
Xerox enables programs get to know their members and have meaningful interactions. Our approach uses trained medical professionals to conduct outreach and assessment. They explain the benefits of the programs in which the member has enrolled and answer questions before conducting the assessment. This creates a dynamic conversation that encourages members to open up about their conditions and provide better information. Each assessment garners more complete information so that programs can develop the most effective interventions and determine risk stratifications accurately.
Our assessments are unique in that they don’t follow a strict script. While we include standard questions, our solution generates follow-ups based on the member’s responses that are attuned to medical, social and other factors. This personalized approach pulls more details from members and coaches them to provide in-depth background on their condition. It also bypasses irrelevant questions that could take up valuable time for the member and the program.
Perhaps the greatest advantage of our assessment is the ability to immediately prioritize risks and connect a member with a healthcare specialist for a consultation. Our “warm transfer” feature connects at-risk members, directly and in real time, to the specialists who can help them. What’s more, the health risk assessment system can immediately transfer the member’s information to the provider so valuable time isn’t wasted re-interviewing the member. This timeliness makes for healthier members and lower costs for the healthcare program.
More and more, states are being asked to address health outcomes on a population-wide basis. Doing that takes understanding exactly what health issues their citizens face from every angle. The right health risk assessment gives programs the key to unlocking that holistic view and connecting people with the care they need.
To learn how Xerox supports health risk assessments, visit the Care Integration Services group online.
About the Author
Vice President of Market Management, Government Healthcare SolutionsMore Content by Steve Reynolds