MADISON, WI – With a Health Insurance Risk-Sharing Plan, or HIRSP, in place since 2006 to manage the health of its high-risk population, Wisconsin is now targeting diabetic residents.
HIRSP has partnered with LifeMasters Supported SelfCare to provide disease management services for its diabetic population, said HIRSP CEO Amie Goldman.
Rather than choose a chronic condition based on its prevalence, HIRSP analyzed historical data to look for the lowest compliance population, which would present the greatest opportunity to benefit from evidence-based care management, she said.
Of the 16,500 policy holders, approximately 2,600 members will be targeted and stratified in this three-year program. HIRSP’s goal is to reduce emergency department visits by 7 percent, Goldman said.
Other objectives include holding costs and trends down, delivering patient and provider satisfaction and showing clinical improvement, including achieving measurements within the standards and test and screening compliance, said Christobel Selecky, CEO of LifeMasters.
While the industry continues to focus on wellness and prevention, Selecky said the financial crisis has sharpened the focus on intervention programs that will have a more immediate clinical and financial impact on sicker populations.
“By definition, the individuals we are serving are high risk from a medical standpoint because of their complex chronic conditions,” Goldman said. “If you can affect behavioral change, it can be transferable to others.”
“In general, high-risk pools are an important opportunity for disease management and care coordination,” added Tracey Moorhead, president and CEO of DMAA: The Care Continuum Alliance.
Approximately 200,000 high-risk individuals nationwide suffer from four or more chronic conditions, she said. As the population ages and more individuals present themselves to healthcare facilities with multiple chronic conditions, state high-risk agencies are going to shoulder this burden, Moorhead said.
Their challenge is to address both cost containment and health improvement. Colorado, Tennessee, Kentucky and Mississippi are adopting similar types of intervention for high-risk pools.
“Wisconsin’s program will be a good learning experience for us to look at this population,” she said.