How Payers Transition from Reactive to Preventive Care

August 13, 2019 - In the midst of the transition to value-based care, healthcare payers are looking for key strategies to keep their populations healthier at a lower cost. To that end, most have realized that a transition to preventive care, as opposed to reactive care, will be essential to addressing disease.

Although the Affordable Care Act (ACA) made preventive care protocol a requirement, many of these major payers have been covering preventive care for some time.

However, although the industry has spent the last decade moving from reactive to preventive treatments, it is still learning the benefits, challenges, and best practices of preventive care.

There are some leaders within the payer landscape that are successfully employing preventive care strategies among their populations. Tapping community interventions, community activation, community screenings, and health technology, these groups have worked to transition from reactive to preventive beneficiary care.

Implementing community intervention

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UnitedHealthcare (UHC) has a history of preventive intervention. In July 2019, UHC tackled an overlooked healthcare challenge: hearing loss among firefighters.

Firefighters work in high volume environments that can result in being unfit for duty or, in extreme cases, can lead to fatalities, according to a 2017 study.

To address this, the company created the UnitedHealthcare Hearing program, distributing 20,000 silicone-based earplugs to police and firefighting departments in ten major cities across the nation.

UHC’s opioid disposal kit is another recent example of the payer’s intervention approach to prevention.

Studies show that keeping unused opioids can endanger those who may be at risk for addiction, 70 percent of whom first obtain drugs from a family member or friend.

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UnitedHealthcare Community Plan, which serves 270,000 members across Pennsylvania, donated 2,000 opioid disposal kits in May 2019. UHC partnered with the Byrnes Health Education Center and the Mural Arts Philadelphia’s Porch Light Program.

Each kit can dissolve 45 pills or less or six opioid patches through a four-step process, with warm water as the sole ingredient.

“These kits provide Pennsylvanians with a safe way to dispose of unused pain medication. We know that safe disposal is an important step in preventing opioids from being misused, and ultimately, in saving lives,” said Allison Davenport, CEO of UnitedHealthcare Community Plan of Pennsylvania.

Creating community activation

Centene’s strategy to prevent the opioid crisis from spreading further engages the community directly. In April 2019, this took shape in the OpiEnd Youth Challenge Program.

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“We are excited about the potential from this program, engaging both providers, educators and students in a meaningful way, supporting our prevention efforts across the country," said Mary Mason, MD, senior vice president, chief medical officer of corporate health initiatives for Centene.

The challenge involves a school curriculum that helps students ages nine to fourteen identify opioid misuse. The students demonstrate their awareness by creating a marketing campaign reviewing preventive measures.

The youth challenge is just one facet of the company’s overall opioid substance abuse prevention approach. For example, OpiEnd uses data analytics to predict members at risk of addiction and target Centene’s clinical interventions.

Conducting patient screenings

Aetna pursues preventive care by hosting health screenings within the community.

“CVS Health is committed to expanding access to quality and affordable care, both through our retail footprint and with national and local non-profits and organizations who share our belief that better health starts at the community level," said Garth Graham, president at Aetna Foundation, vice president, community health and impact at CVSHealth.

In May 2019, Aetna announced that it would be hosting 32 health screenings at CVS Pharmacy locations in Sacramento. The screenings are part of CVSHealth’s Project Health.

The patient can enter a CVS retail health clinic without an appointment to be screened for chronic illnesses such as diabetes, hypertension, and heart disease. Blood pressure readings, body mass index, and glucose and cholesterol levels can indicate the patient’s risk.

The structure of these events moves patients through each stage of care in a smooth, quick way to facilitate the best patient experience.

Based on the screening’s results, the patient may be directed to an onsite nurse practitioner or physician assistant who is bilingual. For further care, the CVSHealth clinic may refer the patient to a no-cost or low-cost medical facility or the patient’s primary care physician (PCP).

The medical facility or PCP can more consistently track the patient’s chronic disease prevention or chronic disease management in order to ensure the best patient outcomes.

Sacramento’s June screenings represent a small fraction of the 256 Project Health screenings that CVSHealth has planned in five cities across California. The events will continue through to the end of 2019.

Leveraging data and technology

Technology is continually evolving to meet the diverse needs of the healthcare industry, including preventive care. And although several payer organizations have tapped technology to engage high-risk populations, they are still learning lessons about which tools and approaches will be most effective.

Such was the case at Independence Blue Cross, a Pennsylvania-based payer that learned not all younger patient cohorts are willing to use health IT to manage disease risk.

Independence Blue Cross found that the older millennial population ages 34 to 36 had a higher prevalence for the top ten chronic conditions than their Gen X predecessors did at the same age.

Working with a national retail company with a predominantly millennial workforce, Independence employed IBX Wire, a tool the payer originally launched in 2013. The app sends texts or emails to guide employees in taking preventive action against chronic diseases. With over nine in ten Millennials owning a smartphone, an app for chronic disease prevention seemed like a natural choice for reaching this population.

However, the payer encountered unexpected results.

“What we have found is that [Millennials are] not taking advantage of all these programs available to them,” explained Christine Young, RN, an Independence customer information consultant. “In the Millennial’s mind, if they don’t have a chronic condition yet, they don’t see themselves as needing to get preventive care.”

While Millennials were seven percent more likely to opt for text messages, they were four percent less likely to take action on the alerts.

Moving forward, Independence is collaborating with employers to redesign the appearance of the alerts in order to blend into the company’s culture.

With a more minimalist, inviting design and a data-backed strategy, the payer hopes to increase their patient engagement more effectively.

While these are not the only approaches to transitioning into preventive care, payers are finding that community intervention, community activation, screenings, and effective use of technology can produce positive patient experiences and enduring patient outcomes.