Joseph Berardo

Managing health in an age of reform

January 26, 2011
This report originally appeared in the January 2011 issue of DOTmed Business News

By Joseph Berardo

The good news about health care reform is it provides new reimbursement models and behavior incentives for both patients and physicians – paving the way for innovative wellness and prevention strategies. Specifically, new grant programs support the delivery of evidence-based and community-based services aimed at reducing chronic disease rates and addressing health disparities.

This gives businesses, organizations and communities an opportunity to jumpstart cost-cutting initiatives. In terms of health care, the critical focus lies in controlling chronic illness and adopting health information technology that generates supportive data. With this in hand, it’s much simpler to track individual health costs and implement appropriate interventions or behavioral changes.

For example, consider two patients with diabetes: The first one manages his diabetes well. He gets his hemoglobin A1c levels tested; he exercises; he watches what he eats. As a result, his monthly costs are roughly $147 for the plan. The second diabetic patient is a different story. He does not watch his diet, exercise or take any other steps to manage his illness. He has admissions to the hospital and other co-morbidities as a result. His price tag is closer to $1,800 a month.

Two people with the same disease can exhibit different behaviors, resulting in a huge cost differential. A strong technological infrastructure provides health data that are easy to use when assessing individual health needs. It’s the first step toward helping every individual make better health and lifestyle choices, from a quality perspective as well as a cost perspective.

The role of health management
A physician’s ability to closely monitor a patient, including an individual’s progress over time, can improve an individual’s care and the overall health of a population. With the right data analytics, health managers can determine gaps in care and intervene when necessary by, for example, prescribing appropriate medication, recommending a diet or outlining an exercise program.

A robust health management program combined with data analytics technology optimizes fiscal sustainability over the long run. Health information can be quickly sifted and sorted by age, medical conditions, chronic illnesses, risk factors, lab results, and drug interactions. On a large scale, this allows health managers to take action and provide optimal prevention and wellness programs.

The point of data analytics – and health management based on data analytics – is to ensure that every communication about patient health is personal, relevant, and effective. Success often stems from finding the right health management partner to provide a strategy based on data analytics that provide comprehensive health information, a complete analysis of the data and potential individual and organizational solutions.

The ability to personalize medical care allows patients and physicians alike to make better health care decisions and tailor preventive, wellness and treatment methods. Data analytics also provide decision-support tools, remote monitoring tools and real-time care when it is needed, based upon the idea that effective care continues even after the patient leaves the doctor’s office.

As workforce health begins to improve, companies, organizations and communities will be able to use data analytics to reassess individuals and key health issues, whether it’s diabetes, obesity or chronic heart conditions. Population performance can be reported on a monthly or quarterly basis for maximum effectiveness. At-risk individuals can also be identified and monitored. Ideally, individuals previously enrolled should be reclassified into lower-risk categories as their health improves. In this way, the severity of at-risk health categories and health care costs diminishes overtime.

Going forward
Despite the uncertainty surrounding health care reform’s future, companies, organizations and communities are more motivated than ever to implement wellness and prevention programs for their workforce. Collaborating with a health plan management partner that relies on powerful data that can be consistently refreshed and reanalyzed makes all the difference. Together with predictive modeling, it enables health issues and cost drivers to be identified so that effective, long-term wellness strategies can be designed and implemented for healthier individuals, lower claims costs, and increased productivity.

Joseph Berardo Jr. is chief executive officer and president at MagnaCare. He is responsible for the strategic management and financial performance of MagnaCare's business operations.