Monday, March 12, 2012

Guest Commentary: Reflecting on The Twelfth Population Health and Care Coordination Colloquium

Paul Terry, PhD

There were two intrepid features of The Twelfth Population Health and Care Coordination Colloquium that I found refreshing. First, the notion that population health and care coordination leaders can leave their respective worlds to present each other with a cogent case for better integration certainly is timely.

As much as one presenter joked that an ACO is an HMO misspelled, I’d venture that most who chose this conference came with an abiding belief that improving population health while reforming health care delivery are overlapping, if not mutually dependent, movements that will require the kind of transformative leadership Dr. Nash brought to this discussion. The ACO movement may eventually be viewed as the turning point for collaboration between public health and medically trained leaders.

Second, I appreciate that this was a colloquium, Latin for discussion, not a conference. An open sharing of ideas will be required if we are to discern what components of an ACO can foster innovation and avoid ACOs becoming HMOs warmed over.

My presentation at the colloquium focused on the role of financial incentives and the policy issues emanating from section 2705 of the health reform act, which provides for medical premium reductions for employees attaining a health standard such as a healthy BMI. I’ve published elsewhere on “progress based incentives” which StayWell believes represent a fairer and more effective strategy for supporting behavior change than the outcomes-based approach enabled by this new legislation.

It was easy to exchange ideas about the best use of incentives for employer health management programs in my session because we had examples to work from provided in presentations earlier in the day. The medical director from Perdue Chicken disavowed use of incentives in his employee health programs and asserted that his 80% participation rates were a function of smiling nurses and a caring, high-touch approach. He acknowledged the chickens in their “disassembly plants” weren’t quite so lucky. In contrast, a human resources leader from ARAMARK food services described how incentives increased health assessment participation rates to 60% from 20%. Though she didn’t explain whether they based their communications on behavioral economics principles, their employee communications about the loss of premium credits for non-participants suggest they were playing to the principles of “a bird in the hand” and “loss aversion” that I explained in my session.

Finally, Johnson and Johnson, the “granddaddy” of wellness programs, showed how their $500 incentives were yielding consistent 80-85% participation in a range of wellness offerings, which was up from the 26% participation they experienced in the years prior to incentives. For a deeper dive into the science behind best practices in the use of incentives, StayWell has produced a white paper on “The Role of Incentives in Improving Engagement and Outcomes in Population Health Management.”

Each of these progressive company presenters had inspiring success stories to share backed up with impressive metrics. But what I found most attention-getting about these presentations was that they were featured as examples of employers building a “culture of health.” Yet, all of the metrics shared were traditional participation rates, biometric outcomes, or other measures related to individual choices.

We lack a common language for describing our workplace culture of health, not to mention tools for measuring the same. Therein resides a challenge for those of us ready to embrace Dr. Nash’s daunting idea that population health can intersect with care coordination. Culture is defined by how we communicate with each other, our daily rituals, foods we eat, how we treat each other, and what we value and believe in, just to name a few potential measures.

We’re getting increasingly sophisticated about designing individual-level incentives to increase engagement. And as the ACO movement foretells, we’ll continue innovating with pay-for-performance systems and cost-sharing schemes. Our greatest challenge yet will be to define a “culture of health,” invent metrics that quantify its progress, and create incentives that compel organizations to build environments that inspire and support healthy living.

Paul Terry, PhD, is CEO of StayWell Health Management.

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