Vice President, Health Informatics
Improving patient outcomes and controlling costs
HealthPartners saves millions of dollars - and lives
Quality health care and cost effectiveness need not be mutually exclusive. Using SAS® Business Analytics to fuel data integration and analysis, HealthPartners has created innovative programs that have reduced yearly costs by $137 million – and helped members stay healthier at the same time.
US health reform efforts are encouraging health insurers to measure quality and cost-effectiveness. HealthPartners has been doing that for more than a decade. It serves 1.25 million members and is the largest consumer-governed, nonprofit health care organization in the nation.
The insurer has won awards from the Health Industries Research Companies for its disease management programs and has one of the lowest administrative costs of insurers nationwide. The HealthPartners Research Foundation studies issues, like the role of decision-support systems to control diabetes and hypertension, with grants from organizations such as the National Institutes of Health and the Agency for Healthcare Research and Quality.
SAS is very integral to our success. It has the processing power and the flexibility.
"Our philosophy is to simultaneously improve health outcomes, manage our patients' and members' experiences, and deliver services that are affordable,'' explains Sue Knudson, HealthPartners Vice President for Health Informatics.
HealthPartners uses SAS to provide the analysis necessary to create a tiered product that offers customers lower copays if they choose providers who rate highly in quality and cost-effective treatment. It also uses SAS to efficiently deploy disease and case management resources, and to drive research via its Health Assessment Database. "SAS is very integral to our success. It has the processing power and the flexibility,'' Knudson says.
Engaging the consumer in choosing the best provider
HealthPartners members can select any provider, but the insurer tries to steer members toward higher quality, more cost-effective providers by offering lower copays to customers choosing highly-rated providers. To rate providers, the company uses SAS to pull data on costs, prices, clinical quality information (using both national and internally developed standards) and patient survey information.
"There are about 80 to 90 measures that we aggregate and score providers on - that's just the quality side. Then we look at total cost of care to look at affordability and cost-effectiveness. A provider has to meet both hurdles to be in our preferred benefit,'' explains Chad Heim, Senior Director of Health Informatics.
Quality indicators include factors like routinely offering patients flu shots, encouraging diabetics to control blood sugar and referring back pain patients for evidence-based patient treatments. It also looks at costs per patient per diagnosis.
And the reasons are clear: HealthPartners knows that a patient with, for example, uncontrolled vascular disease means $25,562 a year in medical bills. By controlling vascular disease, costs decrease to $20,261. This is significant not only from an affordability perspective, but ultimately it's good news for HealthPartners, whose efforts helped more patients achieve improved health.
Deploying disease and case management services effectively
Enrolling at-risk members in disease and case management services can be highly cost-effective – and benefit the patient – if deployed to the right members at the right time.
Not every diabetic or heart-failure patient needs a case manager. Yet locating the members whose health care can be managed better with intervention isn't always simple. Patients might be on all the right medications but not be meeting their personal health goals.
HealthPartners uses SAS to mine every last bit of data – from diagnoses to prescriptions, hospitalizations to tests – to find patterns that surface patients who need disease and case management help.
The result: 99 percent of the members identified benefit from interventions. "We've found members who we've moved to optimal control for their diabetes. This means savings at an average of $6,000 a member - and more importantly, better health for the patient because they are able to avoid the complications of the disease,'' says Jason Gallagher, Director of Informatics.
Studying healthy lifestyles and the payback for members and insurers
What makes up a healthy lifestyle? Understanding this is critical to controlling costs. HealthPartners uses SAS to mine data and member surveys to better understand what impact lifestyle choices like diet, exercise, non-tobacco use, moderate alcohol consumption and emotional health have on health and insurance costs.
“What we’ve found is that the relationships between optimal lifestyle and health costs are very powerful in establishing the business case for improving health,’’ Gallagher says.
And HealthPartners doesn’t just use the information to manage costs or create wellness programs. The insurer has two articles accepted for publication in Population Health Management. By sharing the information, the organization hopes to help others learn how to reduce costs through improved health and increase health benefits.
The insurer is also working on a study - with funding from the National Institutes of Health - to develop and implement an electronic health record (EHR)-based, clinical decision-support system to help reduce patients' risk from diabetes and hypertension.
Sticking with SAS®
Over the 20 years that HealthPartners has used SAS, the company occasionally looks at other solution providers. "But our department just circles right back to SAS as being that core processing technology,'' says Gallagher.
HealthPartners has more than 100 SAS users. "It's a tool that is easy to learn for new hires, it's easy to manipulate and modify as the dynamic business needs change. It can handle quick turnaround situations and rapidly shift directions and strategies. From my perspective, SAS is irreplaceable.''
Identify high-quality, cost-efficient providers; pinpoint patients who need case management; and analyze, connect data from medical records and lifestyle characteristics to spot trends and factors that suggest better health outcomes.
The insurer has saved $137 million dollars by helping members stay healthy.