An innovative, integrated approach to population health has improved employee engagement (four-fold), reduced short-term disability days, and saved close to $2,000 per episode at the University of Pittsburgh Medical Center UPMC. Listen in for details from Kristen Hasley, Senior Director of Health and Productivity Integration and Maria Henderson, Vice President of Workforce Health Strategy and Innovation, University of Pittsburgh Medical Center UPMC.

DMEC: Welcome to Absence Management Perspectives. A DMEC Podcast. The Disability Management Employer Coalition, or DMEC, as we’re known by most people, provides focused education, knowledge and networking opportunities for absence and disability management professionals. DMEC has become a leading voice in the industry and represents more than 160 professionals from organizations of all sizes across the United States and Canada. This podcast series will focus on industry perspectives and provide the opportunity to delve more deeply into issues that affect DMEC members and the community as a whole. We're thrilled to have you with us and hope you will visit us at dmec.org to get a full picture of what we have to offer, from webinars and publications to conferences, certifications and much more. Let's get started and meet the people behind the processes.

Maria Henderson: Thanks, Heather. This is Maria, and like many employers that are listening in today, UPMC has invested over the years in onsite clinics with the main goal to improve workforce health and productivity. But when Covet hit, we had to pivot to an almost 100% virtual care model, and many of the clinicians that were working in those clinics were really focusing on covert exposure and COVID management. So we really had to take a step back and reimagine our model and try to figure out how to use very limited resources in the most impactful way to help our business with the challenges they were facing. So we were able to work with a targeted population health management strategy, which Kristen is going to talk about, to really help us focus those resources in a way that allowed us to integrate across multiple areas of our organization and improve engagement and improve clinical advocacy for our employees.

Heather Grimshaw: That's really helpful. Thank you. So you talked about a targeted population health approach that allows better integration across the entire spectrum of short-term disability leave, workers’ compensation, wellness care management, and advocacy during the presentation, and I'm hoping you'll explain the term targeted population health and what that approach looks like from a practical perspective?

Kristin Hasley: Sure, I'll be happy to take that one. For our targeted population health approach, we designed an operational model to deliver services to members that mitigate risk as well as capture opportunity in ways that generate an ROI. So, practically speaking, we laid out five steps. The first is to define the population of interest. Second is to identify target population. Third is to characterize specific services that we would deliver to that population. Fourth is to define key performance indicators so you can track your success. And then lastly, step five is monitoring those key performances over time so that you can improve or change your model from a practical standpoint UPMC. Through our integrated analytics supplied from our internal group were partners, we were able to identify our target populations so that we can affect our outcomes. Those included five groups, specifically with our employee group, and that included our new hires. I'm sure in the past two years, most employers have seen such a change over in their workforce. And for us, we saw a huge increase in our new hire population, which gave us an opportunity to really affect what those folks were learning and engaging in their first year of employment. It was a good opportunity for us to work on retention and reduce that turnover phenomenon that we had seen with COVID. And then if you look at our chronic absence population, of course we have folks that are experiencing chronic disease and may not be utilizing care in the way they should. So it was an opportunity for a health literacy moment in that regard. And then elevated risk. We definitely wanted to target in on our folks that are costing the system as well as their livelihood. In terms of their level of engagement, we call them elevated risk. It's about 5% to 20% of our population, and it gave us an opportunity to really affect at a larger scale. And then behavioral health is something that is definitely a hot topic in conversations across workforces. Definitely seeing a surge in behavioral health needs across the system, which are my health at work clinics are doing some innovative work to help increase access in that regard. And then lastly, we have folks within a polypharmacy group who may be on multiple medications that don't need to be, and we can help them talk with a pharmacist and adjust what they're doing so that they can have better life outcomes.

Heather Grimshaw: Thank you, Kristen. It's really helpful to hear that context and also interesting to hear the different benefits from retention to improving that health literacy piece. I so appreciate that. What are some of the toughest health and wellness challenges facing employers today? And how does the virtual clinic approach health employers get a better handle on them?

Maria Henderson: Yeah, Heather, this is Maria. I'll take that. In terms of employers in overall health and wellness, the remote workforce, how do you get people that aren't coming into the office every day? How do you get them engaged? How do you make that employee experience something that they feel connected to the workplace and challenges, team challenges, and all kinds of ways that we have in the past relied upon to get people engaged. And so the telehealth or the virtual clinic approach allows us to do that. The third kind of silver lining that we saw is prior to COVID, we were having a really hard time getting spouses and dependents engaged in our onsite clinics because they weren't coming into the work site. So access to them was not improved just because we had an onsite clinic. But by really seeing an uptick in people's willingness to use telehealth and virtual clinics, we've been able to engage those spouses, which for most employers tend to be your most expensive subpopulation. So some of the bigger challenges of cost, engagement, retention and employee experience can all be really mitigated and improved through virtual clinics and virtual engagement.

Heather Grimshaw: I really appreciate that, Maria, and I do think that it's easy to forget the spouse and kid component, child component, I should say, and how that influences that employee. So can you provide a time frame so listeners get a sense of how long this type of work takes to see a result?

Maria Henderson: I think for any employer of any size, you should be able to start seeing early leading indicator results in six months if you do some of the things. And Chris is going to go into some of the ways that we have been able to significantly improve engagement, getting to the right person at the right time, those leading indicators you should see maybe even in three months. Kristen, we've done some stuff where we've seen increased engagement in three months.

Kristin Hasley: Absolutely.

Maria Henderson: Yeah. So I think it's very promising and employers at any level, any size can use some of these techniques.

Kristin Hasley: I would say with our virtual clinic model and what we learned from COVID, it was an opportunity to expand the role that we had as clinicians and to go beyond that model, and one of which we began to utilize our health educators in a way that we never had before. When folks were coming to work, our health coaches were mainly used to do group sessions to get a department, for example, excited about learning about mindfulness to reduce their stress, for example, or how to eat a better lunch or reduce your sugar intake. And of course, with COVID, things shifted and folks weren't really able to go on the floors and do that anymore because of safety reasons and keeping folks from getting exposed. So we had to come up with a creative way to reuse our health educators to maximize their strengths. And what we found with our clinical model, our clinicians weren't really trained in their traditional education environment to invoke change with their patients. So when we're talking about motivational interviewing and engaging in conversations to help them understand that things aren't going so well for them for a health perspective and that they need to take ownership of that and make changes that will be impactful to them and not just be told that this is something they need to do. And it was hard to train our providers to do that. So one of the ways we addressed it was to bring our health educators into the clinical conversation. So when folks would have a visit with our practitioners, we actually put the health educator on the front end on this virtual visit to allow them to have like an intake experience and talk to the employees level set with them on what's going on, whether they're there for a cold or maybe they just have some questions about mental health, for example. So we have screening tools and ways for them to engage in meaningful conversations that would then tee up to the provider who would kind of bring it to a head. So obviously, if that person had some chronic disease or some concerns the practitioner had, they would be able to leverage what the health coach converse with the patient and have them engage in healthier behaviors and connect them to resources that they may not have otherwise. But the biggest piece on that is how do you continue the story, how do you do an integration and continuum of care that makes sense for a user, for an employee and that really is doing everything in real time. So it's almost like a one stop shop. So from that health educator conversation to diving into their clinical metrics with the provider and the recommendations they have and the plan they set forth, they can then connect them with one of our schedulers and those schedulers or our member services team, they're excellent at what they do. They know everything about our health plan coverage as well as our resources available from a clinical sense. And they could actually work with the employee, get things scheduled. So whether it was a mammogram that was overdue or maybe they do need to talk to a counselor because they're concerned about their kids behavior at school, there are ways that they can then schedule them and get them adjusted in real time so that things are teed up for them for success. And by putting that into our model for our virtual My Health at Work Center has really shown great outcomes. Like Maria mentioned earlier, in terms of our engagement percentages, we do track that and what we started to see was an increase and folks engaging in these resources post clinical visit and that was what we were hoping to achieve. And then as we continue to watch this model mature over time, we'll begin to see some of those ROI pieces that those bosses like to see in black and white, how are you saving our company dollars? And that's where we'll get some of that data. But we feel like this is an early win and a success that we can continue to monitor and improve.

Heather Grimshaw: Both the health educator and the schedulers sound like such integral roles to this process. And I do hear that people, even once they recognize the need for a medical intervention of some sort, that ability to schedule the appointment can be so difficult. And so it's wonderful to hear that that's a piece of this process. And I wonder how vital would you say these two rules are to the integrated processor approach?

Kristin Hasley: I think it is imperative and wish we would have thought of it sooner. But when you're faced with pandemics such as COVID, like Maria mentioned earlier, you got to look at a silver lining in this. And what we discovered is got to increase access, we got to create real time opportunity. If we want folks to be able to engage, we got to make it so easy for them that they don't have to think about it. And that is what we kind of opened up and realized what our consumer group needs. And if you actually go through those steps, as opposed to saying, okay, follow up with your PCP in a few days, they're going to forget about it. They have life coming at them in different directions and they're going to forget it as soon as the visits over. So if we can get it all cleared up before they get off the call or the virtual platform, that's a win, right? Let's just create an easy access environment.

Maria Henderson: Yeah. And Heather, the only thing I would add to that is I think the other part about integrating with the people that manage your health care benefits because this is free. And that's another piece that we found in the pandemic, is that a lot of employers were seeing their lowest wage ban, lowest salary folks jumping and leaving for a job across the street that pay 25 cents more an hour, or 50 cents more an hour. So how do you figure out how to provide these services, not just for health advocacy and absence management, but as part of that employer brand and total reward that this is free, we care about you, we support you. You can get this amazing complete health review for free on your phone and so can your spouse. So I think it's all connected and all part of that broader employer strategy.

Heather Grimshaw: So, Maria, thank you for that. You just used a magical word, free. So can you talk a little bit more about that? That is something that I think will resonate with several listeners just to hear a little bit more about that.

Maria Henderson: Yes. Well, I mean, depending on the type of healthcare plan that your employer provides, as long as it is kind of like a PPO and HMO, some sort of plan, you can provide clinic services free of charge. I think where it gets tricky and I know over the years a lot of the large consulting firms have really been pushing health savings accounts with the higher deductible and those definitely save money. I think the double-edged sword of those is that you can't provide these services free. You have to provide some sort of you have to have a fee so that it counts against the deductible, but you can still make this something like $25 for those folks within the health savings account. You know, bucket we at UPMC took the road less traveled recently and it's worked out so well for us as we actually added a health reimbursement account for our lowest band wage earners. And from an HR, a perspective, they don't have to worry about a lot of the IRS guidelines and high deductible requirements. So we can still provide all of our health management and our onsite clinic, virtual clinic options for free and still have them have that account through the HRA. So having that financial incentive is very important. So you can either do it for free, you can try to make it cheaper than if they're in the HSA, maybe try to make it cheaper than some of the normal cost of going to your primary care or whatever, or you could provide wellness incentive points to folks to incentivize it, but definitely think through the financial piece and how that employee experience is going to be.

Heather Grimshaw: That's really helpful. And I do think that thoughtful process is incredibly valuable, really to everyone involved, both, as Kristin mentioned earlier, that easy access as well as that ability to look at this as a true benefit, that my employer cares about me and my health and is offering these services to me in an easy way that doesn't cost me more than I can afford to utilize. One of the things that you both have touched on in previous answers is that the ability to really show the success of a program. And so it was interesting to hear about integrated data analytics that were mentioned during the presentation to identify a population and the comparison which actually showed, if I'm remembering correctly, that only 40% of employees would have been identified by group health data. Can you talk a little bit more about this and what identifying the top 5% of members or employees who are driving health and absence risk has done for UPMC?

Maria Henderson: Let's talk about the data. So most employers out there will look at their medical and pharmacy data in some sort of data warehouse or maybe their health care benefit managers will put their data together. And the normal definition of high risk is usually driven off of just that medical and pharmacy and it's high cost and you'll hear people talk about the top 5% of spent. But at UPMC, working with our internal partner, work partners, and having access to an integrated data warehouse, we bring in all of the aspects of absence and disability into this data warehouse, short term disability workers, comp, FMLA, various types of leaves, incidental absence, et cetera. We actually bring in a lot more performance and all kinds of things. But when we mix the medical and pharmacy piece with the integrated absence, we start identifying a much larger group of individuals that are truly driving kind of an integrated high cost. And we think of them as our highest health and absence risk population. And so when you look at just medical and pharmacy data, we would identify maybe around 40% of this high cost population. But when we layer in all of the other data, we actually start we're actually able to predict an additional large percentage, almost double the amount of individuals that are going to be absent and are going to be driving that benefit cost. Then when you do know they're going out and they're going to be really expensive, what's the best way to engage them?

Heather Grimshaw: That is very helpful and I appreciate your reference to the doors, and I'm using air quotes here. As I recall, that was explained as looking at different leave types such as short-term disability, as an opportunity to talk potentially about a lifestyle programming or something similar. And we'd love to hear more about how that approach has informed your engagement strategy.

Kristin Hasley: Yeah, I'd like to talk about that. So with our door strategy, it just gives us an opportunity to reach our population in a variety of ways. We don't rely on one method to our madness. So obviously there are you can picture a number of doors that you would choose to walk through based on whatever needs you had. And we have several of those. And that might be, as Maria had mentioned, it might be an STD leave, or we might be experiencing a work comp-related injury or they're out on leave for FMLA, or they're accessing our virtual onsite clinic for a cold. So we kind of categorize those as doors. So our employees might walk through any of those at any point during their career journey with us, and it could be multiple times at that. So through our integrated data analytics. We're able to provide information in real time to any of our absence specialist practitioners or health coaches to access that information. To be able to identify that that person is someone of elevated risk. And that we have an opportunity beyond what their immediate need is. To get rectified whatever situation they're in. But just to further dive in to see what else is happening with them. Whether at home or at work. And ensure that those needs are being met. And so by entering one of those doors and I'll use that clinic example, so someone going on to a virtual visit with one of our my health at work practitioners and they talk to the health educator and explain why they're there for that day and that visit. And maybe they're looking for an antibiotic. But because of the questions and be able to access the flagging mechanism in our data warehouse to know that there's more to the story than just maybe a cold that day and those things come out in those intakes and then they're able to then warm transfer them either through that scheduler component or if they are doing a call. We have workflows that we can connect folks directly old school through a phone system and say as a next step. Now that we've gotten your claim put in and you're all squared. Squared away with that. You had mentioned that you're struggling with making payments on your rent. I have somebody that can really help through that process and encourage your efforts and even take some of that burden off of you. That's where we kind of open up those engagement opportunities and because they're warm transferred, they're not cold, they're not just saying like I mentioned earlier, or follow up with your PCP in a couple of days, that doesn't work. We need to give them an opportunity in real time to connect with those individuals and perhaps if they are short in time, they can always touch base with them and schedule for a further visit. But this opportunity and this methodology has really increased engagement fourfold. Now, I will also add to you, you also have to be careful. You don't want to double dip. So if a person is going through multiple doors in a matter of two weeks and it does happen, what's really nice about our integrated data warehouse is once they get connected to those resources, they kind of fall off the to do list, if you will, so that they're not going to get an additional call. Because we do still believe in outreach and cold calling. It's just not as effective as that warm transfer experience I just described. So we also don't want to create a dissatisfied and bug or annoy our employees. We want to make sure we capture them the first time and then follow their journey accordingly.

Maria Henderson: And I would add to that Kristen that we've been following for years, kind of the trends and engagement. And as Kristen was mentioning, for some of the programs that we provide to our employees, let's say like a disease management or a condition management, if we do that cold call or that outbound call to the employee, we're going to see 30% to 40% engagement. But when we use this integrated referral door strategy where let's say they're coming through short term disability or workers comp. They're talking with someone and there's a flag in the system that says. This person could really use a referral. Let's say over to a pharmacist because they're taking so many meds. We find that when that individual is offered that service during that call and warm transferred over that we are then seeing 60. 70%. Sometimes 80% engagement on that from that warm transfer and from that explanation. So that's a huge that's double that's double the engagement there. And it's just critically important that you have that cross training in your operations to connect the dots.

Heather Grimshaw: That's quite a testament to the value of this kind of program. And so one of the things that a word that you all have used a few times is integration. And so I'm hoping you'll talk a little bit more about integration and what that looks like in terms of how the approach has influenced different leaves mentioned and specifically some of the costs and work days lost.

Kristin Hasley: Yeah, absolutely. Just to add to our conversation about engagement and the importance in that. When we were looking at lost days and really trying to get a handle on our workforce from an absence perspective. We were able to celebrate the success of the fact that our folks that were put through a clinical decision support resource. More warm or floral process. Demonstrated five less days of durations during their absence than folks that are matched in their cohort but didn't participate. So that was impactful to us on so many levels because we can actually put a dollar value to that from a system perspective, but also to help our departments that are so short staff right now and getting those folks back to work is so imperative. So when we're able to share that data that we were able to save five days of absence was a huge win for us. And that's only looking at the data over the past 18 months. So we expect more outcomes along the way as we continue to monitor it.

Maria Henderson: The other thing to mention… one of the biggest cost drivers is healthcare costs, and I know sometimes disability management workers comp folks, feel like the stepchild that doesn't get the attention… because group health can just be millions and millions and millions of dollars more than what we deal with. But the folks that go through short-term disability, at least for our group, and this is pretty typical for employers of any size, they're driving about 37% of your group health cost. That's over a third. So if you can integrate the right clinical advocacy or get this individual, you know, they're off work, so they're not their job is to get better and recover. So if you can serve up to them, condition management, lifestyle management, pharmacy consult, all of these things, you can also reduce their healthcare spent. And we're tracking that and I don't have any that's a little more complicated of a study to do, but we're looking to publish that and to look at that in the future. But that's a huge piece for most organizations. And so trying to connect the dots. For your leaders on how the work you're doing is helping with retention, helping with the employee experience, helping to reduce healthcare and disability costs, helping to reduce absence in days. That's the case we all have to bring to the table to get these type of programs approved and get that senior leader attention.

Heather Grimshaw: It's a really good point, Maria. Thank you. I think that ability to influence those kinds in that meaningful way, 37% is a number that will certainly get attention. And so I really appreciate you adding that in and really impressive work on the short term disability front as well to save five days is impressive. So I think the last question that I have for you too is really what are some of the takeaways for employers of all sizes? I think sometimes it can be easy to assume that this is something that only large or as some folks say, jumbo employers can tackle. And I'd love to hear your thoughts on that before we wrap up.

Maria Henderson: Yeah, Heather, I'll take a start at that and then whatever I leave out. Kristen, definitely. Please chime in. But I have a couple of pieces of advice in terms of takeaways. One is use your data. Your data will point you in the right direction to help you learn how to engage people better and learn how to focus on that sub population or that target population that is really driving your cost, driving your absence. You can't touch everybody with everything, it's just not cost effective for any employer. So use your data and try to find a way to integrate that data and use your data at whatever level. And then secondly, no matter what size you are, you have vendors or you have people within your organization that are interacting with people or trying to serve people when they're out, when they're absent in many ways. And if you can just educate those individuals about all of the resources that you have available, give them some basic scripts and suggest that they refer, you know, get your vendors to come together for a summit and get them to refer to two or three of the key products or services that you think are going to make the biggest difference. Maybe that's EAP, maybe that's some sort of complex case management, maybe that's some sort of financial wellbeing, whatever your population needs, put your toe in the water toward integrated operations and you will see an immediate lift in engagement which will eventually lead to better outcomes. No matter what your size, it will work.

Kristin Hasley: And I'll just add to that to put a point on it. Once you approach that integrated data aspect, don't be afraid to pivot and get creative on how things have been done in the past. Again, we had COVID hit us, took us by surprise, and we had to think creatively on how we can go about this in a way that can help our workforce stay productive. So don't be afraid of trying new things. A lot of the work that we have done has been experimental. We've made mistakes, we tried something new. And so being in that kind of environment and have gone through that, those ups and downs, I think, are critical. And so, again, just like wrapping this in one big circle. And that's why our presentation was talking about reimagination. Don't be afraid to do that. And think of ways you can leverage your current workforce in different ways, especially with the shortage, and you've got to come up with something different. So good luck to all of you.

Heather Grimshaw: Thank you both so much. This has been a really interesting conversation, and you're doing such meaningful work, and it's wonderful to see that the data really not only supports that but touts the value of this integrative approach. So thank you both for being here with us, and we will look forward to continuing the conversation.

Kristin Hasley and Maria Henderson: Thank you, Heather.