BEDFORD, NH – By most estimates, the cost of chronic disease care in the United States accounts for about 80 percent of each health care dollar. Chief among those costs are the so-called “lifestyle” conditions such as heart disease, diabetes, hypertension and lung disease caused by tobacco use. In addition to the literal cost of care, these diseases can have a crippling downstream impact in terms of work and school days lost.
To define and address this issue from a holistic perspective, health care providers, insurance carriers and others utilize the term “population health” referring to determining and managing the health outcomes of a group of individuals. Beyond that, many are using analysis of health care outcomes to drive treatment strategies. The overall hope of this approach is that by understanding and improving overall health among the larger population, costs can be lowered.
Formed three years ago, Bedford-based Benevera Health is taking a team approach to bigger picture health via an innovative insurer-provider collaboration to better manage its shared population. Benevera is a joint venture among insurer Harvard Pilgrim Health Care (HPHC), Dartmouth-Hitchcock Health, Elliot Health System, Frisbie Memorial Hospital in Rochester and Nashua’s St. Joseph Hospital.
According to Benevera CEO Corbin Petro, all the entities share the risk – meaning the accountability for overall health of the shared population as well as the profit and loss for Harvard-Pilgrim business in the state.
“In a sense they all own the business and participate in a lot of the insurance business decisions such as product, pricing, sales and marketing … what that does from an insurance product and insurance design perspective is that really brings the local perspective of the people that are actually treating patients to bear. That is a real benefit to consumers,” Petro said.
The second part of the collective involves population health.
“Through the joint venture – because we are taking on this unprecedented risk – we created a population health entity,” said Petro, adding that the entity included shared technology and data from electronic medical records (EMRs) and claims data from Harvard-Pilgrim.
“This really gives you a rich picture of the patient,” she notes, “and we are able to run data analytics enabling us to risk-stratify patients.” Through this process, Benevera can identify “rising risk and rising need” and use predictive modeling to identify patients who are needing more services. This process in turn can drive a discussion about treatment options and opportunities for outreach through the company’s patient engagement team. “The patient engagement part is probably what most impacts the consumer,” she said.
Petro noted that the process also helps identify provider practice patterns for any anomalies and works with the provider organizations on improvement opportunities.
She’s quick to point out that Benevera, which takes its name from the Latin terms “good” and “true,” views its patient through a lens of social determinants of population health. This can include lack of access to transportation which causes missed medical appointments, English as a second language, domestic abuse situations, health literacy, social isolation and food insufficiency. By taking all of this issues into account alongside a person’s clinical needs, Benevera seeks to provide a single point of contact for its patients.
“Our goal is to provide the person with the resources they need to be healthy,” Petro said. “We even help connect people with fuel assistance programs if needed.” She said her team is regionally located around the state, so they can go to a person’s home if needed.
“We can also meet them in the community and go to the doctor’s office with them, we call it the ‘Whole-Person, In-Person’ approach,” Petro said. Outreach staff for the plan numbers about 35 and is comprised of nurses, pharmacists, social workers, community health workers, patient engagement specialists, and physicians.
For some patients, the healthiest steps can happen outside of the doctor’s office. Petro described one encounter her team had in which a patient reported getting in fights with a roommate. The team was able to find the person new housing in a safer, healthier environment. “We try to remove barriers to good health even if they’re non-clinical,” she said.
The program serves all of Harvard-Pilgrim’s fully-insured members, who get the service automatically. It is offered on a case-by-case basis to self-insured companies. All told, Benevera currently serves about 100,000 people across New Hampshire. Of the 100,000 covered lives, about 10 percent have been identified to have a condition or conditions which require intervention.
And as Benevera enters its third year, how are trends to date?
“We’ve seen significant reductions in costs – between 25 and 35 percent for the patients we are able to engage in the program,” says Petro.
The plan also measures NPS (Net Promoter Score). NPS gauges customer satisfaction and Benevera is pleased with their score of 75. Anecdotal feedback from patients includes positive feedback, in that they felt they were being listened to when they shared health concerns.
When asked about the feedback from the employer community in the Granite State, Petro notes that there is a general concern about the increasing cost and utilization of health care and its impact on the bottom line.
“They are looking for creative solutions to fixing that,” she said. “They also don’t want to push too much of the cost onto their employees.”
While hospitals and insurers have business relationships, a less common trend is the type of partnership that Benevera represents. What sort of lessons learned have come to light since the work started?
“The complexity of running a joint venture is certainly a challenge,” Petro says. She also stated that among the pleasant surprises was the degree to which they could engage the patients in need around social determinants of health.
Talk to leaders in the health care field and you’ll often hear the phrase “value-based care.” In short, this means reimbursement based on clinical outcomes – hopefully favorable ones – and patient satisfaction levels among other things. This differs from the “fee for service” model in which reimbursment was simply based on the literal amount of services provided. Petro says the trend toward value-based care is growing in New Hampshire and will be pivotal in the process going forward.
Petro, who served as the Chief Operating Officer for the state of Massachusetts Medicaid Department prior to joining Benevera, says that the engagement process is definitely supporting the rise of the health care consumer.
“Broadly, consumerism (in health care) is a great thing … the more exposed patients are to the true cost of health care, the more consumer-oriented they’ll be,” Petro says. At the same time, she cautions that cost is not necessarily a determinant of quality so it’s important that consumers factor that in when shopping for services.
As far as the company’s future plans, Petro said that Benevera will be rolling out a digital platform this summer as part of an effort to provide further resources for those they serve.
To learn more about Benevera’s programs and services, please visit www.beneverahealth.com.
Chris Dugan is Principal at Dugan PR, where he provides strategic communications, public relations and marketing/communications support to a broad range of non-profit and for-profit clients across New Hampshire. Prior to starting his consulting practice, Chris held senior leadership communications roles at Anthem Blue Cross Blue Shield, the American Lung Association of NH, Optima Health and St. Joseph Hospital. A New Hampshire native, Chris is an active community volunteer and is a member of the Queen City Rotary Club, where he chairs the Marketing/Public Relations Committee. He has been recognized by the American Academy for Health Services Marketing and the NewEngland Society for Health Care Communications. He is a graduate of Leadership Greater Manchester and Leadership Greater Nashua.