Healthcare: Road to Value in Healthcare
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Transcript of Healthcare: Road to Value in Healthcare
Healthcare: Road to Value in Healthcare
Hannaford Bros. Co.
Peter HayesMBGH Annual Conference
May 2007
U.S. Operations
Hannaford
• Largest northeast supermarket chain
• 5 New England States
• 26,000+ associatesDelhaize
• Eastern seaboard from Maine to Florida 100,000+ associates
Healthcare Landscape
Healthcare Landscape Overview•National trends still 8-10% with the Northeast Region having the highest costs and trends (2 times the southeast).
•Pressure to eliminate the “transparency” of provider quality and cost from the Bush Administration, Medicare, Coalitions and Consumer Driven Health Plans.
•Accelerating legislative pressure by states to solve the “healthcare crisis”. Massachusetts and Vermont have passed legislation mandating coverage that becomes effective in mid 2007 which will impact our costs and adds tremendous administrative complexity. New York, New Hampshire and Maine have pending legislation.
•Rapidly expanding Medicare/Medicaid programs (i.e., Maine at 25% Medicare) resulting in significant cost shifts. Public pay programs are approaching 50% of the total reimbursement of providers which is resulting in significant cost shifting to our plans (i.e., as much as $1000 per year).
Healthcare Landscape Overview
• Significant regional and global costs along with huge quality variations
• Increasing obesity levels are driving over 40% of the medical trend
• “ Right Care” is still being delivered less than 50% of the time
• 50% of the US healthcare spend is estimated to be unnecessary (waste, errors, poor quality, administrative inefficiencies, etc.)
15
.2%
9.9
%
9.6
%
8.8
%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Uni
ted
Sta
tes
(29)
Ger
man
y (1
4)
Nor
way
(13
)
Can
ada
(12)
Net
herl
ands
(19
)
Por
tuga
l (30
)
Bel
gium
(20
)
Mal
ta (
17)
Slo
veni
a (2
8)
New
Zea
land
(23
)
Japa
n (1
)
Aus
tria
(16
)
Fin
land
(21
)
Lux
embo
urg
(15)
Health Care Spending as % of GDP, 2003*
Disability adjusted, life expectancy rank
United States
#1 in cost
#29 out of 30 in quality
Me rce r Hu m a n Re so u rc e Co n su ltin g 6
$5,500 - $5,999
Less Than $5, 500
$6,000 - $6,499
$6,500 - $6,999
$7000+
Source: 2003 Mercer National Survey of Employer Sponsored Health Plans and other sources
Hannaford’s Population in the higher cost locations
Plans Cost by StateAnnual Medical/RX Costs Per Associate
2006 Estimate
$4,100 $4,300$4,900
$6,400 $6,500
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
An
nu
al C
ost
Per
Ass
ocia
te
(200
6 P
roje
cted
Cos
t)
New York Mass Vermont Maine New Hampshire
Hannaford Average $5600
Health Management 50% Opportunity
• Lifestyle Behavior Changes
• Engaged Consumers/Patients
• High Quality Efficient Care
Plan Review
National Group on Health/Watson Wyatt Critical Strategic Levers
Best Performing Companies 3% trendPoor Performing Companies 11% trend
4 critical attributes of Best Performing companies strategiesProvider Quality Hannaford Practices
Quality – Programs that promote the highest-quality providers and haveemployees that use them.
Providers of Distinction Center of Excellence Aetna Fee Schedule
Health Improvement and Productivity – Programs that help employeesbetter manage their own health.
Healthy Behavior Credit Simple Steps Health Coach Nurse on-site Wellness Program PHR
Data/Evidence – Programs that use data and hard evidence to managehealth care program costs and workforce health.
SHPS data warehouse Maine Health Management Coalition Care Focused Purchasing
Appropriate Use – Programs that engage employees to receive care whenneeded, but not overuse services.
Right Care, Right Place, Right Price Patient Advocacy Consumerism
Medical Trend:
Source: Goetzel et al. (1998), Journal of Occupational and Environmental MedicineMercer Human Resource Consulting
70.2%
46.3%
34.8%
21.4% 19.7%14.5%
11.7% 10.4%
0
10
20
30
40
50
60
70
80
Percent
Depression Stress Glucose Weight Tobacco-past
Tobacco BloodPressure
Inactivity
Impact on Individual Health Care Costs: High versus lower-risk employees
Individuals at high risk for depression have 70.2 higher costs than those at lower risk.
High Risk Employees Cost More
Health Promotion
Aetna Medical Mutual of OhioBaptist Health South Florida Pitney BowesFPL Group Texas Instruments, IncJohnson & Johnson Union Pacific Railroad
AstraZeneca Kellogg CompanyBath Iron Works, A General Dyamics Company Mayo ClinicBlue Cross and Blue Shield of North Carolina MedtronicCigna Morgan StanleyEastman Chemical Company Novartis PharmaceuticalsGE Aviation RaytheonGE Transporation Texas Health ResourcesGlaxoSmithKline Washington MutualHannaford Brothers
Blue Cross and Blue Shield of Minnesota Fiserv, Inc.The Boeing Company Massachusetts General HospitalCampbell Soup Company Quest DiagnosticsCVS Pharmacy Target CorporationGeneral Mills
PLATINUM
2006 NBGH Award
Gold
Silver
Platinum
Hannaford’s Disease Profile Executive Summary
•Hannaford has a 6% higher disease prevalence than benchmarks
• Hannaford has managed that risk significantly better than benchmark (i.e., 24% below) resulting in an annual savings of $6,200,000
• 5 disease states - diabetes, hypertension, high cholesterol, back and coronary artery disease account for 34% of total spend
•Hannaford’s delivery of evidence based medicine “right care” for our most costly disease states (diabetes, CAD, CHF) is significantly below benchmarks and national standards of care. This represents a significant opportunity to improve outcomes and reduce costs.
Hannaford Risk Scorecard Disease Class - Hannaford Incidence Rate Total Risk Score EBM Percent of Total Spend
High Risk Management 0.7% 10.578 0.668 18%Stroke/TIA 0.5% 7.549 1.238 4%Congestive Heart Failure 0.3% 12.396 2.008 3%
Diabetes 6.5% 5.285 14.57 8%Chronic Pulmonary Disease 0.2% 8.840 0.683 1%Coronary Artery Disease 0..9% 7.002 1.258 4%
Atrial Fibrillation 0.2% 4.363 0.495 1%Asthma 2.8% 3.375 0.398 2%Hypertension 6.5% 3.082 0.682 8%Hyperlipidemia 12.0% 1.751 .2000 7%Low Back Pain 5.8% 2.228 .112 7%Maternity/Infertility 1.3% 2.442 0.025 3%Total 38% 3.324 0.563 66%
Disease Class - Benchmark Incidence Rate Total Risk Score EBM Percent of Total Spend
High Risk Management 0.9% 12.530 0.690 18%Stroke/TIA 0.8% 9.003 1.133 4%Congestive Heart Failure 0.5% 12.359 1.646 3%
Diabetes 4.6% 7.403 1.835 9%Chronic Pulmonary Disease 0.2% 9.580 0.551 1%Coronary Artery Disease 1.5% 6.894 1.047 5%Atrial Fibrillation 0.2% 5.027 0.531 0%Asthma 3.4% 3.928 0.363 5%Hypertension 7.5% 3.634 0.571 10%Hyperlipidemia 8.4% 2.770 0.264 8%Low Back Pain 6.6% 2.605 0.077 8%Maternity/Infertility 1.4% 3.048 0.578 3%Total 35.9% 4.360 0.578 72.6%
0.5
Hannaford Health
Dividend
$6,200,000
Every .5 reduction in
total risk score is $3.03 million
annually.
Risk Factors Drive Costs
3432 41306664
9221 10095
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
<35 35-44 45-54 55-64 65+
0-2 Risks
3-4 Risks
5+ Risks
5+ Risks = 582 Hannaford Members
3-4 Risks = 5598 Hannaford Members
0-2 Risks = 10,876 Hannaford Members
Hannaford Opportunity
Move all of 5+ to 4 risks =
Move everyone to 2 or less risks =
$7,000,000(24%)
$1,700,000 (6%)
Health Risk AppraisalBehavior Change 2005-2006
20%
15%
27%
16%21%
13%
26%
20%
65%62%
82%
75%
14%
6%
21%16%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Em
otio
nal
lyU
nfu
lfill
ed
Str
ess
Hig
h C
hol
estr
ol
Ove
rdu
eP
reve
nta
tive
Vis
its
Ph
ysic
alA
ctiv
ity
Poo
r D
iet
Sm
okin
g
Hea
rt D
isea
se
Jun-05 Mar-06
Member EngagementParticipants Enrolled
1.6%
3.3%
7.9%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
% o
f T
ota
l P
op
ula
tio
n
2004 2005 2006
• Introduce $20 Healthy Behavior Credit
• Required to take HRA
• Required to take HRA and participate in disease management
1/1/05 1/1/06TIMELINE
Potential Dividend
1100 members x $1000/yr.
$1,000,000++
“Best in Class” benchmark
Comparison Hannaford, D1, Healthy 2010 Targets and Market
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Diabetes
High Blood Pressure
High Cholesterol
O verweight/Underweight
Physical Inactivity
Tobacco Use
Poor Diet
Market
Healthy People 2010 Targets
D1
HBC
Quality of Care
$7,000
$1,500
$3,500
$2,500
$3,500
$500
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
Congestive Heart Failure Diabetes
An
nu
al C
ost
Medication Company Evidence Based Medicine All Other
$12,000
$6,500
Appropriate Diabetic Care
Savings Opportunity 60% of Cost
Care Management Opportunities
30.2%
52.0%50.0%
69.4%
30.9%
55.5%
52.2%
60.5%
55.2%
80% 80% 80%
60%
90% 90% 90%
80%
90% 90%
70%
80%
62.9%
53.4%
70.0%
41.3%
19.9%
38.0%
41.4%
19.1%
44.5%
62.9%66.4%
38.0%
53.2%
18.4% 21.6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Hannaford 19.1% 30.2% 38.0% 19.9% 41.4% 41.3% 52.0% 70.0% 53.4% 50.0% 69.4% 62.9%
Commercial 21.6% 38.0% 53.2% 18.4% 30.9% 66.4% 55.5% 62.9% 44.5% 52.2% 60.5% 55.2%
Goal 80% 80% 80% 60% 90% 90% 90% 80% 90% 90% 70% 80%
Eye Exam HbA1c Test Lipid Panel Urine Micro ACE Rx Statin Rx Statin Rx Lipid Panel Beta-Blocker ACE/ARB Stress Echo Lipid Panel
Diabetes CAD CHF
EBM Compliance Concerns – Population Based Metrics
Financial UpdatesAnnual Associate Medical/RX costs
$4,764$5,256 $5,220 $5,220
0
1000
2000
3000
4000
5000
6000
Ann
ual C
osts
Per
Ass
ocia
te(d
olla
rs in
mill
ions
)
2004 Actual 2005 Actual 2006 Actual 2007 Budgeted
2004Actual2005Actual2006Actual2007Budgeted
2004 2005 2006 2007
% sales .77% .91% .80% .77%
Annual % Increase - +10.3% <.7%> -
Accumulated - +10.3% +4.3% +1%
186186
165
394
313
259
100
200
300
400
2003 2006 2009
Cos
t Per
Mem
ber
Per
Mon
th
Hannaford Actual National Average
National Trend Projected
(assumes 8% trend)
Forecast
Healthcare Savings
*This was accomplished even with acquisition of Victory’s 20% higher cost structure and 2005 aberrant catastrophic claim year.
Healthcare dividend to date
$82,000,000
Projected additional dividend
$109,000,000
Source: Medical Benefits - volume 24 - 1/15/07
TrendNational
TrendHBC
Actual2003-2006
21% 13%
Projected2007-2009
26% 0%
Need to create a healthcare market with the following characteristics:
– Informed and engaged consumers
– Market Transparency
• Treatment Options
• Outcome and Quality Metrics
• Cost
– Aligned Incentives
– Leverage National and Community Partnerships (medical, education, coalitions, public policy)
Start of a Solution
So. Maine MedME Medical
GoodallMercy
ParkviewMidCoastNo Maine MedPenobscot Bay
RumfordMillinocket
St. MaryBridgton
YorkPenobscot Valley
Eastern ME MedMayo
Maine GeneralSt. Joseph
Inland HosptialCentral ME. MedFranklin
Stephen'sBlue Hill
CalaisWaldoTAMC
HoultonSebasticook
Cary Mt. Desert
Maine CoastDownEAst
Redington-FairviewSt Andrews
MilesDean
-30 -20 -10 0 10 20 30 40
Percent Variance in Inpatient & Outpatient Hospital Allowed Payments
Hospitals best medication safety practices reduce
inpatient mortality 40% (Leapfrog, IOM)
Maine Opportunity
= +$300,00 (5%)
Total Hannaford
Opportunity $2,000,000
• Care Focused Purchasing
• Bridges to Excellence
• Leapfrog
• Tiered Quality/Efficiency Networks (Aetna, Cigna, UHC, Pacific Care, Hummana). Coming in 2007 - Primary Care & Specialists - Providers of Distinction.
Outcomes:
reduced costs by 20%
improved quality by 20%
* Pacific Care
Potential Solution Sets
CFP Overview
Care Focused Purchasing
Value Based Purchasing
• National standardized reporting for quality and price transparency
• 29 million live database
• 1st public data release (9/2007)
Initial CFP Sponsoring Employers
The POD Goal is to…
Identify and select physicians in specialties responsible for
significant portions of health care spending who deliver cost-effective care. POD selection is based on a
balance of measures of clinical performance and efficiency.
Specialties Currently Included in POD
• Cardiology
• Cardiothoracic surgery
• Gastroenterology
• General surgery
• Neurology
• Neurosurgery
• Obstetrics & gynecology
• Orthopedic surgery
• Otolaryngology
• Plastic surgery
• Urology
• Vascular surgery
POD Selection Process
Four-Step Process
Case Volume
Clinical Performance
Clinical Efficiency
Strategic Levers
Strategic LeversProgram Components
• On-site nurses every location• Dedicated Aetna Health Promotion Nurse/Resource
•$20/week Healthy Behavior Credit• Required HRA• Tobacco free• Required disease management/health promotion
• Benefit Tiering for use “Providers of Distinction”
• Primary care• 12 specialists
• Required Centers of Excellence• Transplants• Complex cancers
• Engaging Consumers• Education• Incentives• Transparency •CDHP• Advocacy
• Leverage Informatics• Data warehousing • Data Analytics (mining)
• Leverage Provider Reimbursement System• Pay for health not units/service
• Leverage Community• Employers• Physicians• Delivery systems• Guiding Stars• Maine Health / Hannaford Healthy Living Club
2008 Initiative Review/DiscussionValue Based Purchasing
Strategic LeversEvidence Based
MedicineLeverage
TechnologyGlobalization Community Benefit Design
Reducing co-pays/co-insurance for life savingservices (i.e., diabeticmedications)
Incentives to use PHR Investigate off shoring Care Management Associate Discountleverage (AssuredRemitt)
Increasing associate costshare of less essentialservices
Home monitoring Radiology/Imaging “Ashville” likeprojects
Total Value- Red Brick- Trusted 3rd party- Flat fee schedule- Incent patient
compliance
Only paying for minimallyinvasive procedures
Leverage alternativecommunicationchannels
Specialist consults Healthy Living Club Carve out all labservices to Quest
Incorporating incentivesbased on Health Index
Specialist visits Medical procedures
Healthy Hannaford Leverage PointsCompensation & Wellness Increasing scope
Compensation Wellness Benefits HBC Providers Community
Associate
Customer
$ $ $ $
Competitive Advantage
Performance Management - bonus
Nurses - education - coachingB
enefit design - incentivesM
erch
andi
sing
- ph
arm
acis
t - m
eal
plan
ning
, Gui
ding
Sta
rs, e
tc...
Tierin
g - pa
y for
perfo
rman
ce -
pref
erre
d par
tner
Business
coali
tions (
CFP), sch
ools, ch
aritab
le
contri
butions,
federa
l and st
ate re
form,
health
y living cl
ub, corporat
e giving
Preferred employer Preferred destination
40
60
80
100
120
140
160
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
in m
illion
s ($
000,
000)
Status Quo
Reduced Risk of 1%
Accerated savings overfirst 5 years
Reduced risk of 5%per year
$74
$248
$319
POTENTIA L
SAVINGS
OVER
STATUS
QUO
Projected Spend and Opportunities ( 2004 - 2013)
100+ stores
1.2 billion capital
investment
Lessons Learned
• Build a business case and translate it into “CEO” speak
• Develop a comprehensive holistic strategy
• Create cultural alignment
• Create metrics to measure success that resonate with the business leaders
• Solutions should incorporate a community based initiative
• Change the paradigm that “health” is an expense to an “investment” in human capital with a significant and measurable ROI
Benefits Roundtable Survey Benefit Benchmarking
Survey of 25 Fortune 100 Companies (Union Pacific, AT&T, Chevron) of 20,000 employees
Hannaford ascompared to all
others
Overall employee satisfaction with health benefits provided+7%
Perception of quality of care received+40%
Perception of customer service+10%
Perception of what benefits at HBC cost versus other companies +24%