Evidence to support health system prioritization of health behaviors in the COVID-19 era.

BACKGROUND: Since the COVID-19 pandemic health systems have shifted necessarily from chronic to infectious disease treatment, but chronic disease remains critical. One large health system uniquely tracks member health behaviors. This analysis compares data from select months of an ongoing monthly cross-sectional survey before and during the pandemic. METHODS: Responses in April 2019 (pre-pandemic), April 2020 (early pandemic) or April 2021 (later pandemic) were included in the primary analysis (N = 252). Differences in meeting health behavior guidelines were analyzed via logistic regression. RESULTS: A significant decline was seen for physical activity (19% not meeting guidelines pre-pandemic vs. 41% later pandemic) but not fruit/vegetable, alcohol, or sleep from early to later pandemic. Prevalence of women not meeting tobacco guidelines increased from early (5%) to later pandemic (10%) while prevalence in men decreased (10% vs 4% respectively). The percent of people not thinking about the good things that happen to them fluctuated closely with reports of new COVID-19 cases. CONCLUSIONS: Findings show the nuance of changing health behaviors throughout the pandemic. Results should be used by health systems to tailor support based on insights from the pandemic experience.

A strategy to promote population-wide life satisfaction while advancing equity.

OBJECTIVES: To develop a strategy to promote life satisfaction with equity for a diverse insured population. STUDY DESIGN: Cross-sectional survey and claims analysis. METHODS: We conduct an ongoing survey of a stratified random sample of adult plan members. Among other questions, the survey asks about adequacy of physical activity, healthy eating, abstinence from tobacco, limited alcohol consumption, adequate sleep, and whether the respondent takes time to think about the good things that happen to them (hereafter referred to as "healthy thinking"). We assessed the association of demographic characteristics and the 6 behaviors with life satisfaction. RESULTS: We found that although all 6 behaviors were positively associated with life satisfaction, healthy thinking was the behavior associated with the greatest difference in life satisfaction between individuals who did and those who did not practice the behavior. We also found that although members insured through Medicaid or who had a psychosocial diagnosis tended to report significantly lower levels of life satisfaction, two-thirds of the opportunity to improve life satisfaction across the member population was among individuals with neither of these attributes. CONCLUSIONS: The most effective strategy to promote both overall life satisfaction and equity will address social determinants for members with unmet social needs, provide the behavioral and mental health services that benefit members with these needs, and promote healthy lifestyles with an emphasis on healthy thinking for the entire population.

The Predicted Impact of Adopting Health-Promoting Behaviors on Disease Burden in a Commercially Insured Population.

OBJECTIVE: The aim of this study was to better understand, in a commercially insured population, the potential impact of adopting six health-promoting behaviors relative to treating diseases and conditions. METHODS: We combined survey and insurance claims data to compare the potential benefit from adopting behaviors relative with the burden from 27 groups of diseases and conditions. RESULTS: If every member adopted all six behaviors, an 11.6% reduction in disability-adjusted life years (DALYs) might be expected, and a 7.6% reduction in DALYs might be expected if they adopted the one most impactful behavior that they did not currently practice. These amounts are, respectively, greater than the DALYs attributed to all but the two and five most burdensome groups of diseases and conditions in this population. CONCLUSIONS: The potential impact of adopting health-promoting behaviors is large relative to the burden from most medical conditions.

The health and well-being of an ACO population.

OBJECTIVES: To identify opportunities to improve the health and well-being of members of HealthPartners, a health plan based in Minnesota. STUDY DESIGN: Cross-sectional analysis of insurance claims, death records, and survey data. METHODS: We calculated a current health score from insurance claims and death records for all 754,584 members 18 years and older who met inclusion and exclusion criteria for the period January 1, 2015, to December 31, 2015, and/or January 1, 2016, to December 31, 2016. Adjusting responses to represent the member population, we calculated a future health score based on 7 items and a 1-item well-being score from survey data that we collected between July 1, 2015, and December 31, 2016. RESULTS: Forty-four percent of the loss to the current health score among HealthPartners members is attributable to musculoskeletal, psychosocial, and neurologic conditions. Among the 7 components of the future health score, the greatest opportunity for improvement (31% of the total potential) is increasing dietary fruits and vegetables. Although 42% of the members reported high levels of well-being, 14% reported low levels. On average, members with the lowest levels of well-being were insured by a Medicaid product and had low educational achievement. CONCLUSIONS: By applying the summary measures of health and well-being to the HealthPartners member population, we identified opportunities to address conditions that created a high burden on current health, opportunities to improve prospects for future health, and subpopulations who would benefit from interventions that would increase their sense of well-being.

Validating a method to assess disease burden from insurance claims.

OBJECTIVES: To validate a method that estimates disease burden as disability-adjusted life-years (DALYs) from insurance claims and death records for the purpose of identifying the conditions that place the greatest burden of disease on an insured population. STUDY DESIGN: Comparison of the DALYs generated from death records and insurance claims with functional status and health status reported by individuals who were insured with one of HealthPartners' commercial products and completed a health assessment in 2011, 2012, or 2013. METHODS: We calculated values of Spearman's ρ, the rank-order coefficient of correlation, for the correlation of DALYs with self-reported function and self-reported health. We did the same for the number of medical conditions per member and the cost of claims per member. RESULTS: The Spearman's ρ values for the correlation of DALYs with function were -0.241, -0.238, and -0.229 in 2011, 2012, and 2013, respectively (all P <.0001). The respective Spearman's ρ values for the correlation of DALYs with health were -0.197, -0.189, and -0.192 (all P <.0001). These Spearman's ρ values were similar in magnitude to those for the correlation of the number of medical conditions per member with function (-0.212, -0.213, and -0.205) and health (-0.199, -0.196, and -0.198) over the 3 years. The Spearman's ρ values for the correlation of DALYs with function and health were greater than or equal to those for the correlation of cost of claims per member with function (-0.144, -0.193, and -0.186) and greater than those for the cost of claims per member with health (-0.126, -0.150, and -0.151). CONCLUSIONS: Health plans can use DALYs calculated from their own health insurance claims and death records as a valid and inexpensive method to identify the conditions that place the greatest burden of poor function and ill health on their insured populations.

Comparing Population-based Risk-stratification Model Performance Using Demographic, Diagnosis and Medication Data Extracted From Outpatient Electronic Health Records Versus Administrative Claims.

BACKGROUND: There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, however, have been traditionally derived from claims or encounter systems. This study evaluates the challenges and opportunities of using EHR data instead of or in addition to administrative claims for risk stratification. METHODS: This study used the structured EHR records and administrative claims of 85,581 patients receiving outpatient care at a large integrated provider system. Common data elements for risk stratification (ie, age, sex, diagnosis, and medication) were extracted from outpatient EHR records and administrative claims. The performance of a validated risk-stratification model was assessed using data extracted from claims alone, EHR alone, and claims and EHR combined. RESULTS: EHR-derived metrics overlapped considerably with administrative claims (eg, number of chronic conditions). The accuracy of the model, when using EHR data alone, was acceptable with an area under the curve of ∼0.81 for hospitalization and ∼0.85 for identifying top 1% utilizers using the concurrent model. However, when using EHR data alone, the predictive model explained a lower amount of variation in utilization-based outcomes compared with administrative claims. DISCUSSION: The results show a promising performance of models predicting cost and hospitalization using outpatient EHR's diagnosis and medication data. More research is needed to evaluate the benefits of other EHR data types (eg, lab values and vital signs) for risk stratification.

Concordance Between Life Satisfaction and Six Elements of Well-Being Among Respondents to a Health Assessment Survey, HealthPartners Employees, Minnesota, 2011.

INTRODUCTION: We assessed and tracked perceptions of well-being among employees of member companies of HealthPartners, a nonprofit health care provider and health insurance company in Bloomington, Minnesota. The objective of our study was to determine the concordance between self-reported life satisfaction and a construct of subjective well-being that comprised 6 elements of well-being: emotional and mental health, social and interpersonal status, financial status, career status, physical health, and community support. METHODS: We analyzed responses of 23,268 employees (of 37,982 invitees) from 6 HealthPartners companies who completed a health assessment in 2011. We compared respondents' answers to the question, "How satisfied are you with your life?" with their indicators of well-being where "high life satisfaction" was defined as a rating of 9 or 10 on a scale of 0 (lowest) to 10 (highest) and "high level of well-being" was defined as a rating of 9 or 10 for 5 or 6 of the 6 indicators of well-being. RESULT: We found a correlation between self-reported life satisfaction and the number of well-being elements scored as high (9 or 10) (r = 0.62, P < .001); 73.6% of the respondents were concordant (high on both or high on neither). Although 82.9% of respondents with high overall well-being indicated high life satisfaction, only 34.7% of those indicating high life satisfaction reported high overall well-being. CONCLUSION: The correlation between self-reported life satisfaction and our well-being measure was strong, and members who met our criterion of high overall well-being were likely to report high life satisfaction. However, many respondents who reported high life satisfaction did not meet our criterion for high overall well-being, which suggests that either they adapted to negative life circumstances or that our well-being measure did not identify their sources of life satisfaction.

New Summary Measures of Population Health and Well-Being for Implementation by Health Plans and Accountable Care Organizations.

Health plans and accountable care organizations measure many indicators of patient health, with standard metrics that track factors such as patient experience and cost. They lack, however, a summary measure of the third leg of the Triple Aim, population health. In response, HealthPartners has developed summary measures that align with the recommendations of the For the Public's Health series of reports from the Institute of Medicine. (The series comprises the following 3 reports: For the Public's Health: Investing in a Healthier Future, For the Public's Health: Revitalizing Law and Policy to Meet New Challenges, and For the Public's Health: The Role of Measurement in Action and Accountability.) The summary measures comprise 3 components: current health, sustainability of health, and well-being. The measure of current health is disability-adjusted life years (DALYs) calculated from health care claims and death records. The sustainability of health measure comprises member reporting of 6 behaviors associated with health plus a clinical preventive services index that indicates adherence to evidence-based preventive care guidelines. Life satisfaction represents the summary measure of subjective well-being. HealthPartners will use the summary measures to identify and address conditions and factors that have the greatest impact on the health and well-being of its patients, members, and community. The method could easily be implemented by other institutions and organizations in the United States, helping to address a persistent need in population health measurement for improvement.

HealthPartners' online clinic for simple conditions delivers savings of $88 per episode and high patient approval.

The delivery of health care online is relatively new. However, early indications suggest that it can improve the experience of care for patients and the health of populations, along with reducing per capita health care costs. HealthPartners in Minnesota launched an online clinic called virtuwell in late 2010. After more than 40,000 cases, we report an average $88 lower cost per episode compared with care received in traditional settings, strong indicators of clinical effectiveness, and a 98 percent "would recommend" rating from customers. The possibility of extrapolating such savings to larger volumes of cases is compelling. We suggest a need for regulatory reform, particularly around state-level statutes that create barriers to the expansion of online care delivery, such as those that require clinicians to be located in the same state as the patient and those requiring clinicians to have had a previous face-to-face visit with a patient. Such reforms would encourage further innovation and lead to cost reduction and improvements in access and convenience for consumers throughout the health care system.