Engage moderate-risk members to lower costs


When insurers identify and engage their members with moderate risks--who consume healthcare up to six times more often than lower cost members--they can reduce costs, concludes an issue brief from Humana and DPS Health.

Moderate risk individuals, who are in the early stages of preventable chronic diseases, comprise an estimated 35 percent of the population. And 18 percent of the moderate-risk population shift to high-risk members each year.

By addressing their risk factors early on, including obesity, diabetes, sleep apnea and hypertension, insurers can help lower costs and utilization rates.

"Given the surge in chronic conditions and the aging of our population, payers and providers must tackle modifiable risk factors as quickly as possible or the situation will get worse before it gets better," Todd Prewitt, director of chronic care strategies for Humana, said in a statement.

First, insurers must identify this population group through their conditions, visits to doctor offices and increased use of medications. The issue brief notes these members often have higher than average medical claims, but they don't usually frequent hospitals or emergency rooms.

Interventions geared toward the moderate-risk member population should offer support to set goals, monitor personal performance and provide social support. In particular, insurers should combine interventions like automated reminders with health coaches who can educate and support members.

"Modifying the disease trajectories of individuals within the moderate-risk cohort will reduce healthcare utilization and impact costs in the short term," Neal Kaufman, founder and chief medical officer at DPS Health said in the statement. "Over the long-term, taking action against modifiable risk factors will lessen the chances that moderate-risk individuals will become part of the costliest, sickest cohort."

To learn more:
- here's the Humana/DPS Health statement and issue brief (.pdf)

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