POPULATION HEALTH MANAGEMENT

Deploy deep population insights across demographics, cost, quality and utilization metrics to segment and successfully serve population cohort needs

Population Health Management programs are a core competency for health plans with interventions targeted to the unique needs of specific member cohorts to address increasing medical costs. Best in class programs are shifting away from the traditional programmatic approach to integrated medical-behavioral-pharmacy-SDOH models.

Optimized programs can drive ~1-4% savings on medical and pharmacy claims within 6–18 months depending on the portion of the population managed. These programs can additionally drive competitive differentiation with customers.

Common issues we help our clients solve

Where is there the most opportunity in our population? Are we deploying our resources against the highest impact members for management?

How are our care management and wellbeing programs performing relative to best practices?

How should our population health management approach vary by line of business?

How do we ensure our operating model to deliver clinical and PHM programs is is efficient and purpose-built?

How can we ensure my clinical team is enabled to drive maximum value from my program?

Do our clinical teams have the right Learning & Development and Talent Management model foundation to succeed?

Payer Care Management is evolving to an integrated, member-centric model

Features of enhanced payer led population health models and care management functions

Traditional Care Management Models

Discrete, narrowly focused, and siloed programs that do not manage a member holistically or engage with provider partners efficiently

Program centric

Nurse-driven

Fragmented member management

Functionally oriented

Telephonic outreach only

Disconnected with the provider

Enhanced Care Management Model

Integrated Medical, BH, Rx, social program with teams deployed by region/community

Member/population-centric

Multi-disciplinary team

Holistic member management

Community-centric

Member preference-sensitive engagement channels

Coordinated with the provider

Optimizing clinical workforce performance

We have unique experience and assets to create a strategy-backed, data-driven approach to improve the performance of the clinical workforce.

Talent baseline measured against Care Management role competencies model. We use our proprietary Career Development Tool to gather a robust fact base and baseline for your workforce. Mapping individual clinicians baseline against Oliver Wyman’s competency framework of behavioral and functional skills specific to Care Management identifies areas for focused development
Talent insights and patterns to match talent “supply” with “demand”. We have developed skill-based role requirements for multi-disciplinary care management team roles through collaboration with industry experts. Our algorithm matches current clinical talent profiles to target roles to optimize role fit and identifies areas with talent pool gaps
Training evaluation and redesign to increase alignment between Learning & Development practices and desired business outcomes. We have extensive experience and Learning & Development specialists to assess current practices and provide recommendations aligned to cross-industry trends and best practices

Oliver Wyman has extensive experience with helping plans optimize and redesign their population health management functions and operating models
across all lines of business including ACA, Medicare, Medicaid, and Group Commercial taking into account unique population dynamics, regulations and compliance considerations, customer expectations, and product structures.

Deployed our proprietary Career Development Tool across the care management workforce of a national health plan to develop a comprehensive and unified view of talent to identify strengths and gaps and prioritize opportunities, resulting in a roadmap of efforts to achieve target state; included collecting data from 4,000+ clinical and non-clinical participants across the organization to inform the recommendations. Read more

Created a new integrated medical-pharmacy-behavioral-social operating model, redesigned the care management team structure, and identified $60M+ savings with a significant ROI for the Medicaid line of business; resulted in designation as the best practice model for the state. Read more

Designed and implemented a next-generation care management and wellbeing offering and operating model for the Commercial, Medicare Advantage, and ACA lines of business. Secured approval and 100M+ in new investment for implementation and execution of new model, which is slated to drive $200M in annual savings. Read more

Designed a best practice set of algorithms to target and prioritize members for care management outreach, including creation of 15+ cohorts for the client’s care management program, design and implementation of a three-step stratification methodology, and design of the end-to-end stratification logic to rank-order prioritize all identified members. Read more

Evaluated the effectiveness of clinical team training, resulting in focus area recommendations designed to increase alignment between L&D training practices and desired business outcomes. Read more

Behavioral Health

Care Delivery

High Cost Claim and Member Management

Medical Cost Action Planning

Member Advocacy and Concierge

Network and Product Design

Pharmacy Management

Population Health Management

Provider Performance Management and Risk Enablement

Quality Improvement and Medical Policy

Social Determinants of Health

Utilization Management