At Elevance Health, chronic disease management isn’t just a medical issue — it’s a population health issue
Spiking rates of chronic illness is a pervasive problem nationwide. According to the Centers for Disease Control and Prevention, 75% of American adults have at least chronic illness
For Shantanu Agrawal, Elevance’s chief health officer, that’s reframed how the payer approaches the issue
“That already sets up chronic disease as a population-level issue for us,” Agrawal said in an interview
Elevance has observed rising chronic illness rates across demographics, from young patients to old and poor to rich. The issue spans across plan type, from Medicaid to Medicare to commercial insurance
“Because those populations have different access to reo challenging,” Agrawal added. “What affordability or accessibility looks like for a Medicaid member is very different perhaps for a Medicare member.”
Put simply, there can’t be a one-size-fits-all approach to chronic disease management
That’s why Elevance has developed a menu of chronic disease management programs tailored for different member needs and preferences. A member might engage with just one program, or maybe they utilize two or three to create a more wraparound experience. This allows the payer to curate chronic disease management based on patient needs and clinical complexity
Still, simply creating multiple population health programs isn’t a panacea. In fact, it can be a lot to orchestrate and could easily become disjointed and ineffective for members
According to Agrawal, Elevance wanted to be strategic in how it designed its chronic disease management programming, focusing on strengthening member relationships with primary care and multimodal approaches that fit member preferences
The making of a chronic disease management program
Elevance doesn’t start from scratch when building out new chronic disease management programming; it starts with data
Member data helps Elevance get to know its high-risk populations and therefore create programs that meet their needs
“It’s really focusing on identifying a member population that is frankly not achieving those goals that we would have for them,” Agrawal explained
Those goals center on having a relationship with a primary care provider and regularly visiting them. Additionally, it means taking medications as prescribed and completing preventive and primary care services aimed at chronic disease prevention and management
This data analysis is important for finding non-engaged members, specifically, because Elevance does not want to replace the relationship other members have with their primary care providers
Patient-provider relationships are meaningful, especially in chronic disease management, he suggested. That’s not to mention it’d be an unwise use of Elevance’s ree
But the reality is, there are a lot of members that aren’t hitting those engagement benchmarks, Agrawal said. According to the Peterson-KFF Health System Tracker, around a tenth of the U.S. population lacks any usual
For these members, Elevance’s member engagement strategy centers on one core mission: How can it better connect members to a primary care provider? Using that philosophy, the payer designs multi-modal patient outreach programs
“Proactive member engagement uses both digital and non-digital means,” Agrawal noted. “We start first with digital, see if the member will engage with that and then we move up from there if we don’t get the engagement,” meaning Elevance uses more analogue engagement tactics, like phone calls or phone visits, to draw in the member
Engaging the member in chronic care management programs
This approach has landed Elevance on a few core chronic disease management programs:
- Proactive Member Engagement: This system uses health data analytics to assess medical, pharmacy, behavioral and social needs to flag potential medical issues and care gaps. It then sends personalized outreach over the member’s preferred channel.
- Concierge Care: This is Elevance’s program for members with complex medical needs. It connects members to a care team that develops personalized care plans, teaches members how to track their own symptoms and facilitates 24/7 nurse support.
- Sydney Health: Sydney Health offers tailored nudges based on a member’s benefits, medical care history and current health needs. The system helps inform members about care gaps, certain services to manage their care and other steps in their care plans. Sydney Health can also help members schedule appointments.
- Total Movement Care: This is tailored for members with musculoskeletal care needs. TMC enables virtual-first physical therapy and guided care navigation to in-network specialists.
What makes these programs run smoothly is care coordination, Agrawal stressed
“There might be multiple teams that would want to reach out to a member for a particular reason,” he explained
“We want to make sure that there are warm handoffs and that the member is not experiencing this as a lot of different outreaches from the company. We want them to know and feel that it’s coordinated so that ultimately we can kind of work on the totality of their health together.”
Moreover, Elevance wants to ensure members are in the right program, if they need to be in a program at all
Determining the best outreach for each member
Even within a single population, there’s still no single approach that’s will “fix” chronic disease management
“We outreach to members sometimes through multiple different channels to understand their preference,” Agrawal stated. “What do they really respond back to? Do they respond to the notification on the Sydney app or are they more likely to pick up the phone? Part of it is just that we work to engage until we get engagement and then we know going forward what that member’s preference is.”
Agrawal said Elevance does do some population-based engagement to get the ball rolling. If there is an overwhelming trend within a population, the payer can make an educated guess about how to first begin nudging the member
“We know from a lot of historical work that Medicaid members do engage over their phones,” Agrawal offered as an example
Medicare members, too, often opt for phone calls or even home visits, he added, especially when the member is medically complex
Still, the payer employs different engagement tactics across population in a trial-and-error effort
“Then, once we find an avenue that works for a member, we really try to stay with that avenue and do as much direct coordination with them as we can,” Agrawal noted
Of course, Elevance wants to see key clinical quality metrics for individual chronic disease states to improve with these programs. But it’s also critical that these programs boost patient experience with Elevance and their clinicians
“We want to make sure they feel good about the care journey that they’re on, because that’s often a performance indicator,” Agrawal concluded. “If they don’t feel good about their care, that something needs to be corrected and changed.”
Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT
Dig Deeper on Healthcare member experience and engagement
CMS releases new payment model to support lifestyle medicine
By: Jacqueline LaPointeMedication management, follow-ups top telehealth use cases
By: Anuja VaidyaWhat Are the Benefits of Predictive Analytics in Healthcare?
Elevance Health Plans to Acquire TX-Based Infusion Therapy Provider
By: Victoria Bailey
