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The Impact of Population Health Management: A Q&A with CDB’s Director of Medical & Risk Management Featured Image

The Impact of Population Health Management: A Q&A with CDB’s Director of Medical & Risk Management

Our team members are the heart of everything we do at Custom Design Benefits. People like Alberta Manga, RN, B.S.N., M.S.A., CRRN, LSSBB, Director, Medical & Risk Management, are the reason we can offer exceptional service to our customers. We sat down with Alberta to explore the impact of our population health management strategy.

Q: How do you determine who can benefit from Population Health Management services?

A: Our Population Health Program identifies at-risk individuals through predictive modeling to assess chronic illnesses and to identify employees most likely in need of a personal health management program to keep them healthier. We follow the strengths-based case management model where care plans are designed around the unique strengths of the member.

When a nurse sees a member has been hospitalized for three or more days, we implement our Transition of Care Program. We call the member to go over discharge instructions and answer any questions or concerns, as quite often discharge is a stressful time. This allows us to make sure the member understands any post-hospitalization care needs so we can reduce the risk of readmission.

Q: What goes into a population health management care plan?

A: Care plans are created to set goals for improving a member’s health. As nurses, we identify barriers in health care and deficits in health education. Then, we create a plan and assist the member in reaching their goals.

Q: What does a case manager do as part of population health management at CDB?

A: Our case managers reach out to members with high risk of inpatient admission. We assess potential barriers in their health care, such as access to community resources, finding a provider or any general health care questions. We also reach out to members following discharge on complex hospital stays to ensure they understand their discharge instructions and have everything they need, like durable medical equipment, home health care, and follow-up appointments.

Q: How does population health management impact overall health care costs for a business?

A: Ensuring that a member understands their discharge instructions can decrease the chances of hospital readmission. Educating a member on the importance of preventative health screenings and medication compliance can save money through early diagnosis and decrease the chance of late-stage diagnosing that can result in long hospital admissions and costly treatments.

Q: What are the benefits of working with a benefits administrator that uses population health management strategies?

A: Population health management offers proactive cost containment and dedicated case managers. Our program uses available claims data to identify at-risk members and personalize their care. By engaging with these members, we can triage and guide them through the proper treatment protocols as designed by their doctors. We support them in navigating the health care system for specialists and appointments. Members get case manager support when managing a chronic diagnosis, which includes directing them to community resources to address areas not covered by their plan. This helps ensure they can maintain a healthy lifestyle successfully despite their chronic disease.

Q: What kinds of resources do you help connect people with?

A: We help members access community resources such as food, emergency shelter, mental health support, transportation, utilities assistance, clothing, and health care diagnoses education.

Q: What are some examples of how CDB’s population health management program has impacted members?

A: In July 2023, one of our members had outpatient knee replacement surgery that got infected. After a 23-day hospital stay for antibiotics and physical therapy, he was given instructions to continue physical therapy at home. We reached out to him at discharge as part of our Transition of Care program protocol and discovered he had not been able to schedule physical therapy with the at-home health care agency. The case manager encouraged the patient to continue the exercises he learned in the hospital so he did not lose progress while she investigated. It turned out the home health care agency hadn’t received notice of authorization. The case manager was able to resubmit it, and the member was able to get his physical therapy scheduled. He expressed great appreciation for the timely intervention on his treatment plan.

Another example that comes to mind is when a member with multiple myeloma required a stem cell transplant. This treatment requires collaboration between the transplant rider, member, and plan. While the member was hospitalized, his wife called the case manager with questions about access to medications after discharge. Our case manager let her know that we would find the answers so she could focus on her husband’s health. After many calls and emails with the transplant rider, they contacted the member’s spouse directly with detailed information for treatment after discharge. The case manager ensured they would leave the hospital with all discharge medications and refills would come from the rider. The member and his spouse were incredibly grateful that CDB worked quickly and diligently to get the answers they needed during this difficult time.

Interested in exploring CDB’s Population Health Management program? Contact your Account Manager to find out more.

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