Health Management Program Provider Evaluation

How can your organization effectively compare offerings and identify the most effective solutions for improving
the health and well-being of your population? What are the most important distinctions among programs and
the companies who provide them?
By asking the questions in this worksheet, you will discover important differences between providers, differences
that effect the likelihood of achieving significant results. Look for responses that exhibit the ability to:

• Support well-being across the total population • Align revenue with customer results
• Identify, prioritize, and prevent the highest-cost • Operate programs without bias toward other
health developments products and services
• Motivate individual change with personalized • Shape solutions to customer populations and
support unique needs
• Deliver truly integrated services • Demonstrate the use of valid, current behavioral
and medical science
• Measure performance with clear metrics linked
to customer priorities

Provider name_ __________________________________ Total Score (from last page; 45 possible)____________

Sa
Savings
How are the greatest opportunities for savings identified within your population?
Eighty percent of a population’s medical costs are typically produced by 20 percent of the people, and that 20 percent
changes each year. Reaching those people before adverse health developments escalate medical costs is critical to
making a significant impact. Consider the following when evaluating a provider:

-- What sources of data are used to understand your population?

-- Are more resources focused on the people who need them most?

-- How are people identified in time to prevent avoidable problems?

-- Please rate provider’s savings opportunities: ........................................................... POOR 1 2 3 4 5 EXCELLENT

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Engagement
What do you do to generate participation and sustain engagement?
People most in need of making healthy changes are least likely to respond to announcements of new programs.
An attractive, functional set of Web resources isn’t enough to involve participants, much less change their behavior.
Personalized outreach is a growing trend. Consider the following when evaluating a provider:

-- What levels of outreach and methods of communication are used to reach people?
(Online only? Telephone? Text messaging? Interactive voice response?)

-- What aspects of outreach are personalized? (Communication vehicle? Message content?

Message frequency? Message tone?)

-- Do interventions reflect an individual’s literacy level, language, personality, and preferences?

Individual risks, goals and improvement plans?

-- Are meaningful rewards and reinforcement incorporated and tailored to the individual, then
adjusted to reflect progress?

-- Please rate provider’s engagement capabilities ................................................... POOR 1 2 3 4 5 EXCELLENT

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Comprehensive Solution
Are services condition-specific or offered to the whole population?
Nearly half of all Americans suffer from one or more chronic diseases, and each year, millions of people are
diagnosed. Health support programs that serve only on a subset of the population, traditionally defined as those
with existing chronic diseases or high health risks, can fail to prevent those new diagnoses and significant associated
costs. A comprehensive, three-pronged strategy—optimizing care for those with chronic conditions, reducing and
eliminating health risks, and sustaining good health—serves the total population and prevents both short- and
long-term avoidable costs. Consider the following when evaluating a provider:

-- Are solutions designed to keep healthy people healthy? Eliminate health risks? Slow or stop the
progression of disease?

-- Are individuals categorized by condition or addressed as a whole person?

-- Are factors beyond physical health taken into consideration, such as emotional health, social
support, and the work environment? How?

-- Please rate provider’s ability to offer a comprehensive solution ............ POOR 1 2 3 4 5 EXCELLENT
Sc

Science
What behavioral and medical science backs the solution(s)?
It’s become popular in the health management industry to talk about behavior change. It’s fundamental to improving
health and preventing costs. Look for substance beneath the speech. Consider the following when evaluating a provider:

-- Do proprietary systems or partnerships exist with recognized behavioral and medical experts?

-- How are these ideas incorporated into daily interactions and program functionality?

-- Who provides oversight and contributes expertise?

-- Are there investments in research and innovation? Pilots for new concepts with academic
institutions or other innovators? Third-party reviews and publication of results?

-- Please rate provider’s performance in science ........................................................ POOR 1 2 3 4 5 EXCELLENT

In

Integration
Are services integrated or coordinated?
Providers may offer an array of services and solutions but fail to deliver the benefits of integrated services to individuals
and customers. Without an integrated technology platform, the conversation that a nurse has with an individual
about recent heart palpitations is not available to the fitness program manager promoting high-energy workouts.
Coordinating services through manual reports or periodic calls can minimize health conflicts but alienate participants
by requiring them to repeatedly share the same information. Integrated services build on every interaction. Consider
the following when evaluating a provider:

-- Are services located in separate or integrated locations?

-- Are systems separate or integrated?

-- Please rate provider’s integration of technology and services ........... POOR 1 2 3 4 5 EXCELLENT
Me

Metrics
What performance metrics are provided?
Many newer providers of health management solutions cite general industry statistics or quote studies of others’
results. The availability of specific, measurable results for prior customers is a good indicator of the information a
company will provide to you. Consider the following when evaluating a provider:

-- What measures of success are used?

-- Is there online access to current aggregate results?

-- Is proof of performance available for other customers?

-- Please rate provider’s performance metrics ............................................................... POOR 1 2 3 4 5 EXCELLENT

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Flexibility
How are your solutions shaped to suit my population and needs?
Customer populations are diverse. Management priorities differ. Health program budgets range in size. Just as
personalized outreach contributes to individual engagement, a solution shaped to customer needs contributes to
overall effectiveness. Consider the following when evaluating a provider:

-- Do programs and systems have the flexibility to address my population’s health history and trends?

-- Can existing health systems and programs be integrated with providers?

-- Address short- and long-term management objectives?

-- Can the provider meet budget parameters?

-- Can the provider accommodate differences in organization by location, country, or work team?

-- Please rate provider’s ability to configure flexible solutions ................. POOR 1 2 3 4 5 EXCELLENT
 Bi

Bias
Could provider’s business bias interactions?
Prescription drugs, medical devices, and home monitoring equipment are helpful resources for particular health
needs and conditions. A health program provider who makes and sells some of these resources may be predisposed
to recommending them. Consider the following when evaluating a provider:

-- What is the provider’s primary business?

-- How are different divisions managed?

-- Does the provider have a solid track record of operating in the best interest of the individual and
other customers?

-- Please rate provider’s ability to operate without bias ................................... POOR 1 2 3 4 5 EXCELLENT

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Cost Structure
Does the cost structure give you a stake in my results?
Many solution providers charge up front, per person, for health programs. Like a fitness center membership that goes
unused, this approach removes the financial incentive to engage members. A health program provider with other
sources of revenue beyond the customer or member—for example, online advertising—is similarly disconnected
from results. Consider the following when evaluating a provider:

-- How do solution costs compare with competitors? What sources of revenue influence your costs?

-- Is revenue linked to measurable customer results—risks reduced, hospital admissions lowered?

-- Please rate provider’s cost structure: ................................................................................... POOR 1 2 3 4 5 EXCELLENT

Total Score (45 possible)

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Strengths and Weaknesses
Take a moment to note provider's strengths and weaknesses
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