Pop health management can help payers during natural disasters

Care management is an effective tool for payers working toward value-based care, especially when used for high-risk and vulnerable members.

But having a care management team, with all of its technological resources in place, is even more critical in the wake of a natural disaster, says Lisa Doggett, MD, senior medical director at HGS AxisPoint Health, a population health management company that has helped serve health plans in the wake of hurricanes and other disasters for years.

“During crisis, everyone’s needs increase,” Doggett says. “Vulnerable people become even more vulnerable.” There is such a wide range of concerns that prevail after a storm, including mental health, damaged housing, unstable food systems and lack of medication.

AxisPoint Health has five Blues plans and three U.S.-based payers among its clients. The company uses analytics and technology, including apps and digital online tools, to stay abreast of health plan members.

During past disasters, AxisPoint has served as a vehicle for passing messages from members to their health plans and has connected health plan members to FEMA and the Red Cross. In some cases, the company has been able to even locate members on the ground, Doggett says. AxisPoint also uses contacts it stores on members and helps to reunite families after a disaster.

According to Doggett, following Hurricane Ike in Texas 10 years ago, for example, AxisPoint was able to help an older man in a wheelchair who was being cared for by his 16-year-old daughter to get his medication. The company also helped him apply for FEMA support. Also, in the wake of Hurricane Ike, AxisHealth did outreach to find and assist members who were out of their medication.

AxisPoint Health uses a digital health tool called Compass, available as an app or an online tool, to reach members across a variety of communication channels. Compass enables real-time communication between the member, their support circle and their care team. In times of crisis when phones and electricity work, this tool is invaluable.

When Hurricane Maria hit Puerto Rico in September 2017, thousands of people were displaced, and much of the island’s infrastructure was decimated, including healthcare facilities, Doggett says. Between severely damaged hospitals and doctor offices, limited resources, and a significant lack of providers on the island, many people didn’t know where to turn for medical attention and payers were faced with significant challenges in engaging with members and providing them with quality care.

Doggett admits, though, following hurricanes, without phone and electricity, “you can’t do as much as you would like to, immediately.” After Hurricane Maria, some people called AxisPoint because “we were a trusted partner to them. Another important way we helped was through our connections in the community,” she says.

A nurse advice line is helpful for particularly vulnerable populations because hospitals can get overwhelmed during crises. A nurse line can help triage to avoid emergency department visits that aren’t needed. Sometimes after a disaster, people call when they are scared or anxious. “Most of what we use is primarily phone-based in crisis situations,” Doggett says.

In the grand scheme, “care management is an extra layer of support that goes beyond what most doctors and payers can offer,” Doggett says. “I see us as an extension of that overall support network. I think there are so many people that need help, you can’t touch everyone. We are able to use our analytics to determine the most vulnerable. We might send a pharmacist to talk about medications, a health coach to remind someone to take their medications, a social worker to get their housing improved or source of stable housing or a nurse to teach about managing a chronic condition. They have the right background and training.”

In times of crisis, AxisPoint urges payers to allow flexibility—allow members to get their prescriptions refilled early. Cover the replacement of damaged durable medical equipment, if it gets ruined or lost. Allow more time for paying bills. Allow flexibility for in-network out-of-network services, in case the member might not be able to go to their usual physician. Also, train staff to be able to answer questions in advance and post some answers online. Finally, it never hurts to train additional staff to help when you know a storm is going to hit, Doggett recommends.