Why population health matters

Helping members receive the best care means connecting them with the right resources at the right time. And that’s what the population health program at Sanford Health Plan aims to achieve by using a systematic approach to health care that evolves to meet member needs.

When employers partner with a health insurance provider implementing a population health strategy, it can help members achieve better health, experience lower health care costs and encourage them to play an active role in their own health and wellness.

“You want a solution that’s going to address all the needs of a population,” said Barb Vandonslear, director of care management at Sanford Health Plan. “You want to focus on those who are at the highest risk, but also on those who are at a rising risk and lower risk because you don’t want them to move into the high-risk categories.”

To do this, the care management team at Sanford Health Plan manages the health of each member across a variety of areas.

Lifestyle medicine and wellness

By taking steps now to lower their risk of developing health issues later, members can improve their overall health and reduce the cost of care.

To help members start practicing a healthy lifestyle, the care management team can connect them with a variety of resources, including diabetes prevention programs and nutrition consultations.

“Health care can sometimes be overwhelming, and people may not know where to start,” Vandonslear said. “But even lower-risk patients can get connected to resources before they become part of our program.”

For members who are leaving the hospital, care managers can help them transition back home during their first 30 days of recovery.

Care at this level could include helping members understand discharge plans and medications, scheduling follow-up appointments and regularly calling to check in on recovery progress.

“We really want to prevent readmissions by helping them be successful in those first 30 days,” Vandonslear said. “If they still need assistance after that, then we can transition them over to another care management program.”

Specialty case management

When members have advanced health needs, specialty case management comes into play. At this level, members are connected to specialists to receive expert care for more complex needs, such as after a cancer diagnosis or during a high-risk pregnancy.

“It’s about meeting people where they are, addressing the needs they have and then pulling in the right resources by collaborating with their provider,” said Vandonslear.

Complex case management

The last two areas of population health support members who have multiple ongoing health conditions or a life-changing event where they may not return to a previous state of health.

This could include those who are recovering from a heart attack, stroke or a traumatic injury. At this stage, members require the highest level of medical attention, palliative care or hospice care.

Advancing care

Data-driven analytics is playing a significant role in advancing population health. By using claims or authorization data and a severity score that shows each member’s risk, the type of care and resources a member needs can be pinpointed.

But Vandonslear emphasizes that although data can show which resources may be most helpful, care is still focused on each member’s individual health goals.

“Our goal is to graduate people from whichever care management program they’re part of so they’re successful beyond the program,” she said.

Improving the delivery of health care at each stage of a member’s life improves the entire health of a population. Everyone wins when health care resources are used more effectively and efficiently.

“Getting to make a difference in people’s lives – even if that’s simply helping them feel like their health is under control – is what gives me energy,” said Vandonslear.

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