Situation

One of our corporate wellness providers provides a “high-touch” intervention model for complex cases. Without clear insights, uncovering the right members to target is an art more than a science. One of their clients has requested that the wellness provider increase program engagement for the interventions. The main issue that they are facing is difficulties in getting their members enrolled in wellness programs. Other major issues faced by the end customer are not being able to see the ROI of the programs and not able to identify members with future risks.

Approach and Outcome

We decided to stratify the population to get to the root of the problem. We took two years worth of data to analyze and uncover chronic conditions and co-morbidities in the member population. We identified the top seven chronic conditions for the employer as well as calculated individual risk scores for each member, plus a trajectory for future risk and costs. We identified 6-7 times the number of people with multiple chronic conditions in their population along with gaps in care and their future risk scores.

Armed with this information, we were able to filter a thousand members that were not enrolled and we identified prime candidates for the program. This data is being used to craft targeted campaigns to enroll new users into the wellness programs.

Here’s an example of how we identified the prevalence of top diseases in the population.

diabetes

According to the chart above, there’s an increase in members under the mental health disorder category including affective psychosis, depression and eating disorders. Obesity has shown 46% increase – this is alarming, as it is anticipated to influence future growth in diseases of the vascular axis (like CAD, CHF) and should be targeted to positively impact long-term outcomes.

The outcome of understanding the prevalence of disease was helpful in tailoring wellness or coaching protocols.  Certainly, from a disease management perspective, it was relevant to understand what could be managed medically, and what could be managed by keeping members compliant with medications, screening, and other interventions that can help manage or reduced the incidence of the disease.
We were able to improve enrollment by 50% and increase outreach through telephonic conversations and messages. The higher outcome-based incentives worked for the client as they were able to enroll more members. We’ve calculated the projected impact if a member’s conditions are managed to meet median costs. We have also provided support to get as many members enrolled into wellness programs through our outreach program (text, email, and letter) and to drive change. We’ve suggested age-appropriate screenings, enrollment for diabetes program and finally to closely monitor inefficient use of healthcare services.

 

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