The fee-for-service health care system has created an environment in which even the most basic care can be either ignored or delayed. This happens for a variety of reasons, whether it be due to cost, inconvenience, or simple conditioning to not access the healthcare system until there is a catastrophic issue to address.
From a population health perspective, this approach can be devastating. Any effective population health management approach relies on providing effective and appropriate care to all segments of a population.
We call the segment of the population that actively delays and defers care the apparently healthy. They make up the vast majority of any population (75%) while costing the least to care for (20% of the costs for a whole population).
In this post, we’ll explain why effectively engaging with this population is the key to driving long-term cost savings for a population and how the Vera Advance Primary Care (APC) model does just that. But first, let’s briefly review how we segment a typical member population.
The makeup of a typical member population
Every population is broken up into three segments:
Polychronic: 5% of the population, 45% of the cost: Patients in this segment are managing major health issues like cancer, congestive heart failure, and more.
At-risk: 20% of the population, 35% of the cost: At-risk populations are dealing with one or more underlying conditions, but they can still benefit from interventions.
Apparently health: 75% of the population, 20% of the cost: Apparently healthy members show no outward sign of health issues on the surface. As their name suggests, some of them are only apparently healthy. These members belong in the at-risk segment.
With these common definitions, let’s turn our focus back to the apparently healthy.
Why apparently healthy” members are the key to cost control
Apparently healthy members are just that: apparently healthy. The very reason they are the most cost-efficient portion of the population is also why they are the key to cost control. Because they typically exhibit no outward signs of major health issues, they tend to skip preventive care.
When an apparently healthy member skips a screening or an annual physical, they’re missing a chance to catch a major health issue early that, if left unnoticed, could move them into the polychronic segment, significantly impacting their health and driving up their overall cost of care.
Keeping as many people as possible from moving to the polychronic segment is the best way to keep the total cost of care down.
This is why actively providing care for the apparently healthy segment and quickly identifying those who are at-risk will have the greatest impact on the total cost of care.
How Vera APC effectively cares for the apparently healthy
The Vera APC model ensures that the apparently healthy population receives appropriate care through five specific tactics. This type of engagement leads to early diagnosis of any potential issues, reducing the long-term total cost of care for the population. Let’s take a look at each one:
1. Encouraging Visits: The biggest challenge for this population is getting their attention and motivating them to come into a care center. We use a combination of incentives, targeted marketing, and increased access to care through telehealth to get a member to engage. All of these efforts are designed to motivate the member to walk through the door for the first time. After that, the rest of the system kicks in.
2. Annual Whole Health Evaluation: The typical annual physical lasts about 20 minutes. It includes some conversation about health issues that have come up throughout the year, a review of bloodwork, and maybe some simple advice that likely won’t be followed. Then, it’s “see you next year” time. The AWHE is different. During the AWHE providers spend a full hour with members, not only reviewing bloodwork and discussing simple issues but delving into the member’s goals and the underlying roadblocks that they face to achieving those goals. Then, the member also meets with a health coach to develop a plan to meet those goals.
3. Focus on whole health: APC focuses on not only physical health but also psychological and social health. This is important because behavioral health issues can also be long-term drivers of disease. That’s why we staff both health coaches and behavioral health professionals in our care centers to ensure that members can find the care they need in one place.
4. Co-developed care plan: The outcome of the AWHE is a care plan that is co-developed by the member, the provider, and the health coach. Because they have actively participated in the plan development, the member is far more likely to adhere to any advice they receive from their provider. There’s a simple reason for this, they’ve been listened to and now they’re committed.
5. Easy access: Once a member has experienced the Vera APC model, they have a high propensity for return visits. This likelihood is further increased by convenient, low to no cost access to care centers. All of this especially matters when it comes time for screenings. Someone is far more likely to get them if they are easy.
This five-part approach allows Vera’s providers and care teams to identify potential health issues in apparently healthy members far before they become major concerns. As a result, some can be addressed by lifestyle changes, others by some type of medical intervention. The bottom line is that none of these issues will be left unnoticed until they become catastrophic and the member finds themselves in the polychronic segment.
Controlling total cost of care is all about more intentionally caring for the population segment that is apparently healthy so they never progress to more costly segments. The Vera APC model is ideally built to do just that.