Population Health has been a pervasive topic -- and lens through which healthcare has been viewed – for many years now. It has been defined as "the health outcomes of a group of individuals." This framing refers to the goal of identifying and addressing pervasive challenges faced by groups of people. By understanding the common issues faced by larger groups, we have the opportunity to improve outcomes.
In a recent Fierce Healthcare interview, Mark Ganz, former Cambia CEO and the longest tenured Blue Cross plan CEO, discussed what he sees as the limitations of the Population Health approach. “Whole-person health, at an individual level, is the more valuable paradigm for considering care, rather than grouping people into broader populations.” Population Health has distinct advantages, and its focus on building partnership and integrating the community has moved healthcare in our country forward. But it also has its limitations. At BeneLynk, our services are built on a member-centric platform. We believe that healthcare starts with an individual, not with a demographic group. To improve healthcare outcomes and serve the needs of our clients, we believe that one-on-one conversations are needed.
When considering SDoH barriers, of course there are commonalities within large groups. And just as there are many commonalities, there are a wide range of approaches to removing SDoH barriers in communities. The reality across all of them, though, is that ultimately, you need the members to understand the resources that are available to them and utilize these services to live healthier lives.
The Triple Aim, a rubric developed by the Institute for Healthcare Improvement (IHI) has become the centerpiece of the nation’s efforts to reform our health care system. While Benelynk agrees that Population Health initiatives are crucial to improving the infrastructure of our communities, we also agree with Ganz that healthcare must start with addressing the unique challenges of each individual.
When seeking to address barriers to healthy living, we want to first understand and document each member’s SDoH needs. We then want to optimize their quality of life by getting them enrolled in programs that help them financially or that remove barriers to care.
At Benelynk we do this work by linking Medicare and Medicaid with a variety of impactful benefit programs. According to the 2017 Medpac updated study, enrollment in Medicare Savings Programs continues to be low. Less than 50% of eligible members are enrolled. These programs help members with cost and access to care. They also generate a meaningful return for payers by ensuring accurate risk adjusted revenue. In much of our work, we use Aunt Bertha’s community program database. We lead with help to engage members. In so doing we seek to understand the particular challenges of each member, and to build the kind of human-to-human connection that enables real improvement.