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The American Journal of Managed Care April 2019
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The Health and Well-being of an ACO Population
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The Health and Well-being of an ACO Population

Thomas E. Kottke, MD, MSPH; Jason M. Gallagher, MBA; Marcia Lowry, MS; Sachin Rauri, MS; Juliana O. Tillema, MPA; Jeanette Y. Ziegenfuss, PhD; Nicolaas P. Pronk, PhD, MA; and Susan M. Knudson, MA
Among HealthPartners plan members, musculoskeletal, psychosocial, and neurologic conditions create the greatest burden to current health; diet offers the greatest opportunity to improve future health scores; and 42% report a high level of well-being.

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.

Am J Manag Care. 2019;25(4):182-188
Takeaway Points

We assessed HealthPartners members’ health and well-being for the period July 1, 2015, to December 31, 2016, and found that:
  • Three broad classes of conditions—musculoskeletal, psychosocial, and neurologic conditions—are responsible for 44% of the loss in the current health score.
  • Increasing healthy eating is the greatest opportunity to improve the future health score.
  • Although 42% of the members reported a high level of well-being, 14% reported a low level of well-being.
These data provide a baseline and strategic guidance as HealthPartners works to improve the health and well-being of its members, patients, and community.
Although valid measures of health and well-being have been proposed, tested, and implemented by various organizations, HealthPartners has been unable to find a feasible set of measures that would meet its needs as a health plan striving to improve its performance on the population health component of the Triple Aim.1 Therefore, the health plan developed its own summary measures of health and well-being for adults that are composed of 3 scores: a current health score, a future health score, and a well-being score (Table 1). The current health score is the complement of disability-adjusted life-years (DALYs) and is composed of the disease burden due to mortality before age 75 years and morbidity.2,3 The future health score has 2 components. One is based on 6 member-reported behaviors (physical activity, eating fruits and vegetables, tobacco use, alcohol use, adequate sleep, and healthy thinking). The other is an age- and sex-specific preventive services score that is based on the performance of the medical group to which the health plan attributes the member. The elements of this measure are consistent with the Healthcare Effectiveness Data and Information Set 2016 preventive services measures. The well-being score is based on a single question that is used by the Organization for Economic Co-operation and Development and is considered valid by experts in the field of subjective well-being: “How satisfied are you with your life?”4,5 Because HealthPartners can link survey responses to claims data, the summary measures of health and well-being allow it to measure its performance in greater detail than is possible with publicly reported measures like the County Health Rankings or proprietary measures like the Gallup-Sharecare Well-Being Index.6,7 HealthPartners will use the measures to guide its strategic planning of health and well-being initiatives and to track its progress on the population health component of the Triple Aim.


The HealthPartners Member Population

We conducted the analyses that we report here to improve HealthPartners’ operations, quality management, and member care and experience. They are based on 754,584 health plan members who met the following criteria: (1) continuously enrolled (with allowance for a 30-day gap in insurance coverage or discontinuance of enrollment due to death); (2) enrolled during the period January 1, 2015, to December 31, 2015, and/or January 1, 2016, to December 31, 2016; and (3) 18 years or older without upper limit. Among the members meeting these criteria, we excluded (1) members known to prefer a language that is not English; (2) members with an address of a correctional facility, nursing home, or hospice; and (3) the 0.2% of members whose names appear on the health plan, research, or related do-not-contact lists.

We based the current health score on all member insurance claims and death records for the defined period. We based the future health score and well-being score on responses to the member survey. Each month, we asked a stratified random sample of members who met the inclusion and exclusion criteria described above to complete a mail survey. We contacted nonresponders by telephone. We designed the survey sample to account for differential nonresponse (ie, by gender, age, and type of insurance product) that was present in a pilot survey of a similar population. We oversampled Medicaid members so that we would have an adequate number of responses to compare with those of members insured through commercial products or Medicare. We asked the survey respondents to self-identify their ethnicity, race, and education. However, we only report non-Hispanic white versus all other categories at this time because the number of respondents is not large enough to make more detailed ethnicity or race comparisons meaningful.

Over the period of interest, the survey response rate averaged 39.0%. We based our current analysis on 9144 survey responses and insurance claims of 754,584 individuals. We reweighted the survey responses to reconstruct the member population that met our inclusion and exclusion criteria. The attributes of the reconstructed population fall within 0.3 percentage points of the actual population, except for insurance product, for which the difference is 1 percentage point.

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