Population Management Initiative Design and Implementation

Phase 1: HES Advisors worked with its client, a major East coast based Academic Medical Center, to re-design its population management initiative serving the uninsured and homeless within its market. HES Advisors was asked to assess whether the care management model that the Medical Center was looking at implementing would be able to address the Medical Center’s dual goals of increasing access to care for those in most need while reducing the unit cost of providing that care. Additionally, HES was asked to develop the resource requirements and cost savings estimates of implementing such a model.

HES consultants formed a close team relationship with members of the Program Unit focused on revamping the Population Management Initiative (PMI). HES Advisors led the Team’s thorough assessment of the environment in which the care management model would be working as well as analyses of the resources available to operate the model and a review of the patient population to be managed. HES Advisors made several recommendations to enhance the care management model. The major recommendations included the specific design and application of a risk stratification methodology to ensure that the Program’s limited resources could be applied to the largest volume of high cost and most complex patients to obtain the cost containment goals. HES Advisors also made several operational recommendations to enhance the workflow within the Program. HES Advisors recommendations were contained within a business plan that defined the model, the resources and the cost savings that could be expected if implemented successfully.

Phase 2: After a hiatus of 3 months, HES Advisors was engaged again to assist Program Management in the implementation of the model. As a result of changes in the resources available to operate the Program as originally designed, HES Advisors recommended additional refinements to the risk stratification model and to the care management staffing model to increase administrative efficiency and to better focus on identifying impactable patients. HES also provided recommendations regarding the integration of the care management model within two designated PCMH’s – one for complex patients with no behavioral health involvement and one for patients with significant behavioral health involvement. HES Advisors also designed a Physician Pay for Performance (P4P) approach that could be integrated into the Population Management approach allowing for incentives to participating physicians for enhanced engagement with the Program, improved quality and reduced costs. HES Advisors developed an interactive model for the Program that could provide insight to cost savings and impact to physicians through scenario development. HES Advisors then provided the client with detailed data and analysis, identifying specific areas to target cost savings as well as studies of the cost effectiveness of the physician network. Reporting templates were developed to provide cost and utilization data compared to benchmarks to the physician community as well as detailed medical cost performance reports for internal management purposes. HES Advisors worked with the Program Management to document the workflows for several key care management and enrollment processes and to provide further documentation of the programs key attributes.