Midland Health · Whitepapers

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How do You Measure and Manage the Cost of Illness in Your Organization?
By Strategic Benefit Solutions

Definition: Population Health Management (PHM) - the management, integration, and outcome measurement of any program that affects the health and productivity of your organization, i.e. corporate wellness, disease management, catastrophic case management, utilization management, EAP, disability,and/or worker’s compensation programs.

SBS is the leader in procurement, implementation, oversight, and outcome measurement of population health improvement (PHM) programs. Between the leadership of Dr. David Rearick, VP of Medical Management and Stephen Cherniak, our Wellness Director, SBS has 50+ years of corporate wellness and medical management experience. SBS is one of the very few benefit consultancies Certified by the Disease Management Purchasing Consortium in all three areas of PHM measurement: 1.) Small Group PHM Reporting, 2.) Critical Outcomes Report Analysis, and 3.) Certified in Health Enhancement Savings Measurement. SBS can insure you are receiving value from your investment in PHM programs. It is our belief, that improving the health and productivity of your organization is the only long term strategy to effectively control health care costs. The indirect benefits of improved productivity and employee morale, decreasing absenteeism and presenteeism outweigh the reduction in direct medical costs-especially for the employer with less than 10,000 employees. Measuring this value is critical and SBS has a proprietary Value on Investment (VOI) methodology created in conjunction with the Milliman actuarial firm and Al Lewis, President of the Disease Management Purchasing Consortium. Many of our outcome measurements are based on the work of Dee Edington, PhD, Director of the University of Michigan’s Health Management Research Center.

Our Population Health Management (PHM) capabilities include:

• Risk Factor Identification using health assessments (subjective) and claim (objective) data.
• Intelligent benefit design based on your data focused to improve health and productivity.
• The ability to do oversight on all vendors, measure their performance, and meet contract performance guarantees.
• Integrate your overall health improvement goals into payroll and benefit design to better motivate and reward employees for making the right life-style choices and reward improvements in health status.
• A three year strategic health and benefit plan strategy that proactively helps you manage rising benefit costs building employee personal responsibility into the health benefit area.
• Population Health Management RFP creation with quality of care guidelines and performance measures negotiated into contracts.
• Predictive modeling of your medical/Rx claims to identify your real cost drivers and individuals needing medical management (available only for self-funded clients).
  o Tracking by quarter medical and Rx costs by disease, service provider, service category and procedure o Identification of members that should be in disease/case management
  o Identification of over 100 quality of care gaps in your membership
  o Benchmarking medical/Rx costs and utilization statistics
• An annual PHM scorecard that measures outcomes for,
  o Utilization performance measurements
  o Quality of Care performance indicators
  o Financial performance measurements
• The ability to integrate all data elements affected by health status, providing you a comprehensive outcome measurement and management strategy for wellness, disease management, disability, absence management, EAP activity, and worker’s compensation claims.
• Developing and overseeing an annual corporate health improvement program with incentives.

Strategic Benefit Solution’s PHM expertise helps you manage the 85% of your health care dollar spent on care delivery. We believe what gets measured, gets managed and if you are not currently measuring the opportunity cost of sick employees, you probably are not managing this cost effectively. If you are self-funded, this is a risk you need to manage. If you are fully insured, managing this area will result in lower premiums. Both self-funded and fully insured clients benefit from a healthier workforce in improved productivity, better morale, decreased absenteeism and presenteeism. Good Health is Good Business.