5, 50 and The Role of Precision Targeting in Care Management
by Michael Hollenbeck, Proskriptive CEO
Let’s say for a moment that you’re watching your favorite football team play their arch nemesis. The stakes are huge, and team pride is on the line. The ball is snapped, the wide receiver goes long, the quarterback drops back, the blockers hold off the defense… and then the quarterback turns to the sideline and throws a 40 yard pass to a fan in row 29 of the lower deck of the stadium. “What the heck!?” you think to yourself. Now imagine this happens 8 of 10 times the quarterback is given the ball. Frustration, confusion, bewilderment and even anger would be likely emotions for anyone watching such odd behavior. The quarterback’s actions are just so contradictory to the goal of winning the game, it doesn’t make sense.
Back in the healthcare world we know that 5% of members account for 50% of the total healthcare spend. If we try to lower these costs by managing historically high utilizers with the expectation that we’re preventing tomorrow’s costly problems, then like the quarterback, we are merely hurling away any hope of winning our own very important game.
Here is another critical number to consider, 80. If the care management strategy for your population health program is anchored to managing historically high cost members, you are throwing away 80% of your opportunity to bend the cost curve. An internal study of 3 separate managed cohorts showed that on average only 20% of the previous year’s high utilizers were represented in the following year’s high utilizers. I’ve heard statistics cited that range between 15% and 40% for the same analysis, but in all cases, we’re hurling far too many opportunities to deliver impactful interventions into row 29 when our members are depending on us.
Care managers guided by precision member targeting technology, on average, reduce costs by more than double their peers managing historically high utilizers, or those with polychronic conditions. That’s approximately $4,000 additional dollars per managed member each year.
As you look for ways to reduce costs and increase productivity, improving your care manager’s ability to reach out to the most impactable members before they become high utilizers may just deliver ROI numbers everyone can get behind. Your members will enjoy improved health AND decreased healthcare costs.
Touchdown! Now, that’s way more satisfying.