How Population Health Tactics Fortify COVID-19 Member Engagement

As the healthcare system reels from the coronavirus, payer success in member engagement relies in part on effective implementation of population health management strategies.

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At Oscar Health, this means borrowing the epidemiological approach population surveillance for its member engagement during the crisis, according to Kurt Herzer, MD, Oscar Health’s head of population health. The payer employs both passive and active population surveillance by allowing patients to assess their own risk and ensuring that high-risk members are being reached.

At the beginning of the epidemic, Herzer and his team knew that Oscar Health, as well as other payers like it, were faced with two basic questions. The first was how to address the needs of populations at risk for coronavirus. The second was how to address the needs of patients with other non-coronavirus, serious health concerns.

These strategies often rely on advanced analytics tools and specialized teams to execute.

To address the first question, Oscar Health developed a publicly available risk assessment tool to help identify members’ risk level. The tool helped the payer segment at-risk populations into major groups, from high-risk and symptomatic to low-risk and asymptomatic, and groups that fell in between these ends of the spectrum.

Based on the results of the risk assessment survey, the tool recommends members take certain actions. The payer also segmented out 10,000 of the most high-risk members to call and engage with directly.

For members with serious health concerns that are not coronavirus-related—chronic diseases, for example—the payer created tailored messages for different populations falling into this group and also placed resources on the Oscar Health website.

The processes that the healthcare system usually relies on are strained.

New care sites that open up to meet the high demand for coronavirus testing and treatment also disrupt the normal processes. Providers are under pressure to meet the demands of a severe spike in coronavirus-related inpatient cases as well as address the needs of patients who are stuck at home. Many new regulations have gone into effect to alleviate the administrative burden off of providers, but this can also interrupt typical procedures.

Community-based organizations, too, which payers frequently turn to for non-coronavirus social determinants of health, are buckling. Particularly organizations that serve older populations are key to the coronavirus response efforts, as indicated by CMS guidance at the very beginning of the outbreak.

Member engagement is most effective when the payer can stay one step ahead of their patient’s care journey, but how do payers effectively stay ahead of a novel and changing process?

Herzer outlined a couple of key principles to keep in mind when navigating this new care space.

“First and foremost, keep your members or your patients as a Northstar,” he emphasized. “Our member is also a doctor's patient, and it's someone else's loved one. And we need to keep that in mind always.”

Second, he stressed that the payer response to this challenging environment must be reinforced by a population health management approach. This involves defining populations and accurately stratifying members into those populations for the best outreach.

Finally, payers should know the strengths of their provider network and leverage those specialties. Supporting—instead of supplanting—providers’ in their strengths is key.

Across these strategies, Herzer added, payers must prioritize identifying patient risk, managing that risk, which is where telehealth comes into play, and mitigating risk, especially in high-risk populations.