Population Level Health Management and Predictive Analytics

There has been much discussion of population health management coupled with predictive analytics recently in the health care field. Why? Most who are discussing these topics see it as a means of improving the health of patients while reducing the costs of doing so. Providing better care at lower costs is becoming necessary as payers are beginning to pay for quality outcomes as they move away from fee-for-service.

What is population health and how does predictive analytics fit in? Let me begin by defining population health and illustrate predictive analytics. In statistics, population refers to the complete set of objects of interest to the investigation. For instance, it could be the temperature range of adolescents with measles. It could be the individuals in a rural town who are prediabetic. These two are of interest in healthcare. Population also applies to any other field of research. It could be the income level of adults in a county or the ethnic groups living in a village.

Typically, population health management refers to managing the health outcomes of individuals by looking at the collective group. For instance, at the clinical practice level, population health management would refer to effectively caring for all the patients of the practice. Most practices segregate the patients by diagnosis when using population health management tools, such as patients with hypertension. Practices typically focus on patients with high costs for care so that more effective case management can be provided to them. Better case management of a population typically leads to more satisfied patients and lower costs.

Population health from the perspective of a county health department (as illustrated in last month’s newsletter) refers to all the residents of a county. Most services of a health department are not provided to individuals. Rather, the health of residents of a county is improved by managing the environment in which they live. For instance, health departments track the incidence of flu in a county in order to alert providers and hospitals so that they are ready to provide the levels of care needed.

You should be able to see that the population whose health is being managed depends upon who is providing the service. Physician practices’ population is all the patients of the practice. For county health departments it is all residents of a county. For the CDC it is all residents of the United States.

Once the population is identified, the data to be collected is identified. In a clinical setting, a quality or data team is most likely the body that determines what data should be collected. Once data is collected, trends in care can be identified. For instance, a practice may find that the majority of the patients who are identified as being hypertensive are managing their condition well. The quality team decides that more can be done to improve the outcomes for those who do not have their blood pressure under control. Using the factors from the data that it has collected the team applies a statistical approach called predictive analytics to see if can find any factors that may be in common among those whose blood pressure is not well managed. For instance, they may find that these patients lack the money to buy their medication consistently and that they have trouble getting transportation to the clinic that provides their care service. Once these factors are identified, a case manager at the clinic can work to overcome these barriers.

I will finish this overview of population health management and predictive analytics with two examples of providers using the approach correctly. In August 2013 the Medical Group Management Association presented a webinar featuring the speakers Benjamin Cox, the director of Finance and Planning for Integrated Primary Care Organization at Oregon Health Sciences University, an organization with 10 primary care clinics and 61 physicians, and Dr. Scott Fields, the Vice Chair of Family Medicine at the same organization. The title of the webinar was “Improving Your Practice with Meaningful Clinical Data”. Two of the objectives of the webinar were to define the skill set of their Quality Data Team, including who the members were, and describing the process of building a set of quality indicators.

The clinics were already collecting a large variety of data to report to various groups. For instance, they were reporting data for “meaningful use” and to commercial payers as well as employee groups. They decided to take this data and more and organize it into scorecards that would be useful to individual physicians and to practice managers at each clinic. Some of the data collected was patient satisfaction data, hospital readmission data, and obesity data. Scorecards for physicians were designed to meet the needs and requests of the individual physicians as well as for the practice as a whole. For instance, a physician could ask to have a scorecard developed for him that identified individual patients whose diabetes indicators showed that the patient was outside of the control limits for his diabetes. Knowing this, a physician could devote more time to improving the quality of life of the patient.

Scorecards for the clinic indicated how well the physicians at the site were managing patients with chronic conditions as a whole. With predictive analytics the staff of the clinic could identify which processes and actions helped improve the health of the patients. Providing more active case management may have been demonstrated to be effective for those with multiple chronic conditions.

Mr. Cox and Dr. Fields also stated that the quality data team members were skilled at understanding access, structuring data in meaningful ways, at presenting data to clinicians effectively and in extracting data from a variety of sources. The core objectives of the data team were to balance the competing agendas of providing quality care, making sure that operations were efficient and that patient satisfaction was high.

A second example of population health management focuses on preventing cardiovascular disease in a rural county in Maine-Franklin County. Over a 40-year period, starting in the late 1960’s, a volunteer nonprofit group and a clinical group worked together to improve the cardiovascular health of the residents of the county. As the project advanced, a hospital joined in the efforts.

At the beginning of the prevention efforts, the cardiovascular health of this poor county was below the state average. As volunteers and clinical groups became more active in improving the health of its residents, various cardiovascular measures improved significantly and actually were better in some respects than more affluent counties in the state that had better access to quality health services. The improvements were driven by volunteers who went out into the community to get those identified as being at risk of developing cardiovascular problems involved in smoking cessation classes, in increasing their physical activity and in improving their diets. This led to lowering blood pressure, lowering cholesterol rates and improving endurance.

The results and details of this 40-year effort in Franklin County has been published in the Journal of the American Medical Association in January 2015. The article is “Community-wide CVD prevention programs linked with improved health outcomes”.

As you can see, a population level approach to healthcare provides effective results. A clinic can improve the outcomes of its patients with chronic diseases while balancing costs through improved efficiency by focusing on data at the population level. A community can improve the lives of its residents by taking a population level approach to preventive care. Population level approaches to healthcare are varied and can be very successful if population level theory is correctly implemented. Better results can be obtained pairing it with predictive analytics.

Donald Bryant helps healthcare providers meet their challenges. Go to http://www.bryantsstatisticalconsulting.com to get the free article “7 Challenges in Healthcare and How to Solve Them” with tips you can use to start improving patient health, improving the bottom line, finding more time to get things done and to learn more about Lean Healthcare. Mr. Bryant is a certified Lean Healthcare facilitator.

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Is Mental Health Covered Under Health Insurance?

For people who depend on any type of private or company insurance to cover the cost of their health needs, the question of whether or not the health insurance policy covers mental health problems is a crucial one for a number of reasons.

The idea of a split between physical health and mental health is an old one, and is a fairly arbitrary decision as to which is which some of the time. From a point of view of health insurance, classifying illnesses or diseases can determine whether or not the insurance company will pay for them, and for many people with mental health issues that can literally be a life or death process.

The term mental health can relate to a condition ranging from a fairly mild form of depression through to serious conditions of clinical depression, schizophrenia, alcoholism, full-blown psychotic episodes etc.

Any health insurance policy should specify exactly what types of illness or disease it is willing to provide cover for and those which it is not. This will also include what it specifies as a type of mental health problem or issue and whether or not the insurance policy provides any type of cover for it.

One of the reasons people are wary of health insurance plans with relation to mental health issues, is that often any type of treatment for a mental health issue relates either to what is known as a talking therapy, or some type of pharmaceutical drug based regime.

Any type of talking therapy that is likely to be effective is likely to be a relatively long-term process, depending upon the nature and seriousness of the illness. Any insurance policy that does cover specified mental health conditions will also provide very strict criteria as to what type of talking therapy is covered, for how long and by whom the talking therapy can be carried out by.

The other issue to be really aware of when looking at any type of mental health coverage under a health insurance plan is the nature of deductibles, co-pay and co-insurance. These terms are essentially ways of getting the person who is insured under the policy to bear some of the cost of the treatment on an ongoing basis in relation to the insurance company.

Most people are familiar with the idea of a deductible, sometimes called an excess, in a policy, but any health insurance policy needs to be looked at carefully in terms of what it’s deductibles are. This is because there are often several different deductibles applicable to the same policy, each for differing amounts and applying to different sections of the policy.

This means that a health insurance policy could have both an individual and a family deductible. This deductible could be separate from another deductible that would apply to specific types of drugs, normally where a distinction is made between a generic and a brand-name drug. The amounts involved in terms of these deductibles can be significant, and when taken in addition to any co-pay or co-insurance amounts can stack up into a sizeable burden that the individual will have to carry for themselves.

In summary, as with any insurance policy, it is important before taking out the policy to have complete clarity about what is and is not covered, as the level of coverage and the specifics of what is and is not covered will vary widely between health insurance policies.

Peter Main is freelance writer who writes extensively about health, healthcare and health insurance with a particular focus on current issues and debates, such as the state of healthcare reform and how it impacts on peoples lives.

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The Impact Of Shift Work On Health

The health and motivation for shift work has been known to have its own peculiar demands. This has set it apart from jobs that have traditional hours of work. Shift work has its own health merits. The shift work has been created to aid workflow processes between employer, employee and tasks at hand. Over the years, it has been noticed that workers identified in shift work often receive better health plans, health products and remuneration and by this, give shift workers time to do other tasks or personal chores while being watchful of individual mental health.

However, the scientific and medical communities report continually that shift workers concerned stand an increased risk of certain health disorders and mental health challenges that have severe negative impact on the general well-being of work shift staff which may not be achieved until the right health products are used.

There is a concern for the 9 to 5ers, as one sees a case of the health of those who barely get by with the hard life of routine which most times is viewed to compensate only the boss at the top. Furthermore, we sought to consider those who work less conventional hours that include working shifts at night. Any way it is looked at, an adequate welfare plan should be in place for them while introducing supplements of health products.

Researchers have discovered that those more at risk of suffering certain mental health challenges and chronic ailments or diseases, are shift workers, such as flight attendants, police officers, doctors, bartenders, nurses, and the like. Shift work can be classified as any type of work schedule that involves hours that are uncommon, or unusual when comparing this type of work schedule with the traditional work schedule that occurs within the day between 6 am and 6 pm.

For clarity, the term shift work can refer to rotating shifts, working overnight, evening shifts and other flexible shift patterns desired or arranged by the employer that also addresses the challenge of mental health in shift work platforms. In other to assist shift workers, first aid boxes can be kept handy and filled with health products for shift workers.

It’s been recorded by the Bureau of Labor Statistics (BLS), that over 16.8% salary workers and full-time wage workers are employed to work alternative shifts. Another interesting discovery made is that evening shifts are the most common alternative shifts, which have their working hours starting at between 2 pm and midnight. Work schedules may also constantly change as a result of irregular work shifts that also result in mental health and hormonal imbalances.

In this article, we take a look at what the resultant effects of what shift work are, what shift workers can potentially do in other to lower their risks of diverse health problems and what salient reasons could possibly be behind these findings. The mental health and prescribed health products of shift workers should not be left unaddressed as this plays an important role in the health and total well-being of the workers.

At first glance, it appears as though shift workers have and work different hours compared to the regular workers’ typical 9-to-5 routine. Reports also show that this is not the only underlying factor, as one key factor also is an increased risk of some diseases.

Some medical associations such as the Medical News Today have reported on studies that relate lack of usage of health products and increased risk of certain health problems with shift work. These relationships have seen discoveries ranging from the predictable to the most amazing jaw-dropping situations.

A reputable medical journal published a meta-analysis in 2014 which suggested that shift workers face an increased risk of type 2 diabetes. This is a red flag. Taking into consideration, shift workers rotating shifts also face an increased risk of 42%. So we see a need for the inclusion of health products as ready supplements for shift workers.

Interestingly, shift workers who rotate night shifts for 15 years and above were found to potentially increase the health risk of lung cancer mortality and poor mental health. The use of health products will aid these situations enhance longevity and maintenance.

Another likely factor that shift workers have in common is disruption to the sleep-wake cycle. Many have lost their basic means of livelihood because they had mental health conditions. Shift workers have been noticed to sleep at strange times of the day. This eventually results in their having reduced amounts or in severe cases they suffer insomnia. For such cases, health products can be recommended. Read more at http://www.fitnesshealths.com

If you are a shift worker, you need to take care of yourself. Get supplement that can help you keep fit and healthy always.

Article Source: http://EzineArticles.com/expert/Okewale_Nathaniel/789119

 

Retiree Health Care Benefits Continue to Decline

Employer-based retirement health care insurance benefits continue to decline, according to recent industry reports.

Many retirees have been able to rely on private or state employer-based retirement health benefits for supplemental health care coverage while on Medicare in the past, but this is becoming less common.

Employer-based health-related benefits can provide important coverage for the gaps that exist in Medicare programs. Additional coverage benefits can alleviate the cost-sharing requirements and deductibles associated with Medicare. Caps on the amount that can be spent out-of-pocket, often associated with supplemental coverage, are also often helpful for retirees.

Overall, supplemental retiree health and medical benefits sponsored by a private or municipal employer have helped many retirees cope with high medical costs often incurred in retirement.

The Kaiser Family Foundation recently reported, however, that the number of large private employers-considered employers with 200 or more employees-offering retiree healthcare benefits has dropped from 66 percent in 1988 to 23 percent in 2015.

Companies that do continue to offer retiree health benefits have been making changes aimed at reducing the cost of benefits, including:

  • Instituting caps on the amount of the provider’s financial liability
  • Shifting from defined benefit to defined contribution plans
  • Offering retiree health care benefits through Medicare Advantage plan contracts
  • Creating benefit programs through private health insurance exchanges

State employers have also not been immune to the trend, but the type and level of coverage being offered by most states is significantly different than retirement health care coverage being offered by large companies.

Unlike many private employers, state governments continue to offer some level of retiree health care benefits to help attract and retain talented workers, according to a report titled “State Retiree Health Plan Spending,” published by The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation in May, 2016.

With the exception of Idaho, all states currently offer newly-hired state employees some level of retirement health care benefits as part of their benefits package, according to the report. Of the states offering retiree medical benefits, 38 have made the commitment to contribute to health care premiums for the coverage being offered. State employers are, however, also making changes to the retirement health care insurance benefits they provide to state workers.

Significant among these changes for the states is at least one driving force-the Governmental Accounting Standards Board (GASB) now requires states to report liabilities for retirement benefits other than pensions in their financial statements. The changes were required from all states by the end of 2008. As a result, the increased financial transparency forced states to review the cost of their other post-employment benefits (OPEB) and address how they plan to pay for them.

Because retirement health care benefits account for the majority of the states’ OPEB obligations, many states have made policy changes to address the upcoming obligations. Factors such as date of hire, date of retirement or vesting eligibility, including minimum age and minimum service year requirements, are now being used by states to vary or limit retirement health care benefits.

Overall, from 2010 to 2013, the states saw their OPEB liabilities decrease by 10 percent from $627 billion after inflation adjustments. While this may sound contradictory, the declines are attributed to a slowdown in the growth of health care costs coupled with benefit modifications aimed at cost reductions.

To look at one state as an example, California’s recent budget revealed that health care benefits for retirees are costing the state more than $2 billion a year for an 80 percent increase over the prior 10 years. Although the situation recently changed, California was previously one of 18 states that had nothing set aside to cover its future retiree health care benefit costs of $80.3 billion.

It should be noted that retiree health care plans are typically funded by plan sponsors on a “pay as you go” basis, meaning that monies to pay current and future health care obligations are taken from current assets and not set aside in advance. This differs significantly from pension plans governed by ERISA, which are subject to funding guidelines.

In response to California’s unfunded OPEB liability, employees and the state are now paying into a fund for future retiree health care benefit costs. The state is also matching $88 million in employee contributions and paying an additional $240 million to prefund future retirement health care benefit costs. The changes are impacting retirees as well as state and private employers.

Overall, employer-based retirement health care benefits, once important for supplementing Medicare for retired seniors, continue to decline.

The Potential Impact of Eroding Employer-Based Health Care Retirement Benefits

Many baby boomers who are currently covered by retiree medical plans and plan to rely on future employer-paid medical benefits, are likely to be disappointed to learn that these benefit plans can be changed or terminated. ERISA-governed benefit plans typically contain a “reservation of rights” provision allowing the plan sponsor to change or terminate all or parts of the plan. Many private and state employers are reducing or terminating retiree health benefits due to the increasing cost of insurance premiums, rising health care costs, and increases in longevity.

Since the early 1990s there have been many cases where unexpected changes to post-employment pension and medical benefits have resulted in lawsuits. Typically, the key issue is the reservation of rights language and/or collective bargaining agreement language for employees who were covered by a union contract which referenced retiree medical benefits.

Beneficiaries who have questions about their retiree medical benefits should speak with their plan sponsor to learn about the specific benefits available to them and have a contingency plan for bridging their medical coverage to Medicare, if they are considering early retirement or want to better understand future benefits.

May, 2016

Mark Johnson, Ph.D., J.D., is a highly experienced ERISA expert. As a former ERISA Plan Managing Director and plan fiduciary for a Fortune 500 company, Dr. Johnson has practical knowledge of plan documents as well as an in-depth understanding of ERISA obligations. He works as an expert consultant and witness on 401(k), ESOP and pension fiduciary liability; retiree medical benefit coverage; third party administrator disputes; individual benefit claims; pension benefits in bankruptcy; long term disability benefits; and cash conversion balances. He can be reached at 817-909-0778 or via http://www.erisa-benefits.com.

Article Source: http://EzineArticles.com/expert/Mark_Johnson,_Ph.D.,_J.D./661269

 

How Does Your Mental, Physical and Spiritual Health Affect Your Relationships?

Your physical health’s effect on your relationships with your spouse and friends: Conquering your physical health

From my perspective, the most important piece affecting our relationships with our loved ones is our physical health. Our physical health affects our mental health and our spiritual health. Our physical health is determined by our life style. This involves our daily diet and our daily activity or the lack there of. If we don’t have righteous thinking and discipline, our physical health will suffer dramatically. If we don’t live a healthy life style, then we are going to age quickly with poor health physically and mentally. We have to maintain a healthy body and mind in order to be happy and our happiness determines how well we relate to our loved ones.

Our body speaks to us 24/7, 365 days a year and the problem is that we don’t listen. If you feel an ache, feel sluggish, feel lack of energy and if you are a little heavier than you would like to be, don’t ignore what your body is saying to you. Get off your backside and do something about it. Our outlook in life is more positive and more God like when we are feeling good. As we become more negative about life because of our physical health, we become less God like.

Your mental health’s effects on your relationships with your spouse and friends: Conquering your mental health

It is a snowball effect in that our physical health affects our mental health, which in turns affects our spiritual health. All of this has an effect on our relationship with our loved ones. If we are feeling good about ourselves, then we are going to be more caring and compassionate with our spouses, family and friends. Aside from personal and employment issues, our mental state is closely related to our physical state. So, it benefits us to make every effort to stay healthy physically and mentally. Our physical and mental health will help us deal better with any stressful situation that may arise from our daily interactions. Keep in mind that time is not on your side because if you are procrastinating as to when you are going to start some form of exercise and make changes in your life style, you are kidding yourself. The longer you put off getting your body and mind in shape, the worse your situation is going to get. The healthier you are mentally, the healthier you will be in your daily interactions.

Your spiritual health’s effect on your relationships with your spouse and friends: Conquering your spiritual health

For the love of God, anyone who is reading this article, if you are active physically, mentally and spiritually, please continue to do so and if you are not active physically and mentally, do yourself a favor and become more active because you don’t want to die a slow death physically and mentally in your golden years. Do this for yourself and for your loved ones. The culmination of your physical and mental health is your spiritual health. This God-like state of mind is what allows you to live a wonderful life. A life that is full of love, caring and compassion is a spiritual life. This is what Jesus teaching was all about. It is the feeling of loving life, respecting life, treating everyone and every living being with reverence that makes us a spiritual being in the likeness of our creator. It makes no difference whether you attend a house of prayer on a weekly basis or not as long as you meditate/pray in your secret place (the kingdom within) and keep a constant relationship with God in your own way. Your spiritual health will determine the health of your relationship with your spouse, your children, your friends and your community.

For more information, please read Mindful Loving by Henry Grayson and Sermon on the Mount by Emmet Fox.

For information that can help you save time and money on your education, go to the website below: http://www.collegeadmissionsandfinancialaid.com copy and paste if the link is not alive

Leonel R. DaRosa, M. Ed. Guidance Counselor

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