As many companies enlist brokers to help them filter vendors, it's ultimately the broker who needs to be responsible for the companies and products he or she recommends, as well as their impact on plan design and the company's bottom line.
The challenge is particularly acute in today's population health and wellness space, given the sheer number of options available—from complete, integrated platforms to programs on everything from sleep management to mindfulness, to the breadth of mobile health and biometric devices.
Making a decision based on “imperfect” information (aka, marketing collaterals) or on backward-looking data (claims data versus wellness data) can lead to very expensive mistakes.
Investing in a failed program or initiative that can't be easily “unwound” will exact a steep price, and quite possibly sour employees on other initiatives going forward.
To avoid these mistakes, the first step is to establish meaningful evaluation criteria that can—and should—be applied to all vendors, holding them all to a single, universal standard.
This begins with a set of best practices in assuring the security, quality and privacy of personal health data, and the ability to measure outcomes and productivity data, which gives you a valid, objective idea of what's working and what's not.
These are the top five items and performance criteria you should always considere when evaluating vendors before and during the engagement:
There are several critical security standards vendors must follow, including HITRUST, SOC 2, PCI, and ISO 27001. If certification is not available, then evidence of policies, enforcements, and third-party security scanning should be made available upon request. Personally identifiable information should only be sent through a secure channel.
Sending Social Security numbers and other patient data through unsecured channels allows unauthorized access to it, which can lead to identify theft. It is the vendor's responsibility to ensure the security of the information; you should regularly monitor that they are consistently using secure channels.
2. Data quality
By this, we mean accuracy, completeness, validity, integrity, and duplication. These criteria should be enforced at the member registration, operation, reports and billing phases.
Vendors should deploy a reliable method to validate member registration in the health and wellness program, and cross reference it with a valid data source for eligibility. The old adage “garbage in, garbage out” applies, as vendors need to be held accountable for data quality since inaccurate information will invariably lead to faulty conclusions and bad decisions.
Transparency in dealing with members’ privacy is essential in member engagement. Members should know who can see their data, where the data is going and how it's being used.
Additionally, they should be able to opt out from certain items (such as outreach efforts and extended personal data capture). Also, it is essential to ensure that vendors are HIPAA compliant and have the ability to notify the affected parties when a violation occurs.
4. Program effectiveness
At the outset of every engagement, the vendor and customer must establish mutually agreed upon criteria for program effectiveness (participating levels, health outcome change, sustained engagement, medical spend, etc.). It is a collaborative approach leading to a successful engagement. Once these criteria are set, the automation and analysis of the data must be in place.
Ideally, the analysis is conducted by a neutral platform that generates objective effectiveness data, rather than relying on vendors who have an interest in reporting certain results; this lets you hold vendors accountable to performance metrics that you lay out and thar are most meaningful to you.
How well and reliably your underlying technology performs is an essential part of evaluating a wellness initiative. To determine the performance of the actual technology, the following should be considered: implementation, member and manager satisfaction, system uptime, scalability, security, and quality.
Other considerations ought to include the speed at which data is moved within the system and the efficiency/accuracy of the automation.
The lingering uncertainties in today's health and wellness market, coupled with the need for patient-centric solutions that make health care more manageable and cost-effective, place brokers in an ever-more-critical advisory role. Organizations need to rely on brokers to make informed decisions, think strategically, and implement practical solutions with the flexibility to support growth—and adapt to change.
To the extent that health and wellness is technology-driven, brokers will need to bring a systematic approach in evaluating the efficacy of the solutions they recommend.
It's important to bear in mind that it's one thing to have evaluation criteria in place, but quite another to continuously monitor vendor performance, which is a challenge.
Systematic monitoring—and scoring—can be done by implementing a more expansive population health framework that functions much like a health operating system (OS) that centralizes all of the component technologies, where performance criteria can be preset, and reports generated on-demand for real-time visibility into each app or technology.
Such a framework should give brokers and their clients the ability to see what's working, what's not, and to make changes on-the-fly to improve performance and, most importantly, demonstrable health outcomes.
Platform technology and vendor integrity are critical to strategy execution. Top brokers provide—at a minimum—expertise in vendor selection.
Equipped with the ability to continuously refine and improve health and wellness delivery, these brokers have a significant advantage in helping clients navigate the complex health and wellness marketplace, offering them stability and flexibility while driving innovation and results.