LOS ANGELES, March 26, 2014 /PRNewswire/ -- Population health management requires payers and providers to manage the healthcare utilization and costs of low, moderate and high-risk cohorts. To provide insight into the moderate risk cohort, DPS Health, a provider of lifestyle and self-management interventions, and Humana Inc. (NYSE: HUM), have produced an issue brief on how to identify and manage moderate risk individuals.
The Moderate Risk Individual: Not Yet Sick Enough to be Very High Cost explains the need to address the moderate risk population and how to pinpoint and manage these individuals with early stage chronic disease and modifiable risk factors. The DPS Health/Humana issue brief addresses a serious challenge. Moderate risk individuals, who are estimated to be as much as 35 percent of the population, consume healthcare at a rate of four to six times higher than averages seen among lower cost members, according to data from the Centers for Medicare and Medicaid (CMS). As a result, population health managers must zero in on the moderate risk cohort's modifiable risk factors, which include obesity and challenges with self-management, in order to impact conditions such as pre-diabetes/diabetes, sleep apnea, hypertension, metabolic syndrome and hyperlipidemia. "Modifying the disease trajectories of individuals within the moderate risk cohort will reduce healthcare utilization and impact costs in the short-term," says Neal Kaufman, MD, MPH, founder and Chief Medical Officer, DPS Health. "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." The issue brief sites recent data and studies from Humana that define levels of utilization and cost within the moderate risk cohort, approaches to identifying these individuals, and challenges and opportunities in engaging and intervening.