Healthy , Wealthy and Wise
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Transcript of Healthy , Wealthy and Wise
Healthy, Wealthy and WiseSuccessful strategies leading to improved retention, engagement and productivity of employees
3
2013 vs. 2007 Per Capita
Measure 2013 2007 % Change
Annual Per Member Cost $3,743 $3,826 -2.2%
In Patient $1,208 $1,053 +13.0%
Ambulatory $2,536 $2,772 -9.3%
Admissions/1000 60 86 -43%
Days of Care /1,000 239 294 -23%
In Patient Surgery 37 49 -33.4%
Claimants > $50,000 28 29 -3.6%
4
Medical Risk Factors 2009-2012
BP Glucose Cholesterol BMI Triglycerides Tobacco0%
10%
20%
30%
40%
50%
60%
2009
2010
2011
2012
5
Population Risk
Low Risk Moderate Risk High Risk Very High Risk0%
10%
20%
30%
40%
50%
60%
70%
2010 2011
2012
7
Workers Compensation & Safety
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.29
1.211.15
1.05
0.89
0.790.82
0.740.8
0.94
0.81
0.66 0.660.66 0.61
0.56
0.7
0.77 0.760.74
0.86 0.89
0.79
0.68
0.6
The Jackson LaboratoryExperience Mod
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How Did We Do It?
Where did we go wrong?
What did we know for sure?
What are the manageable and unmanagible risks?
What are the costs and consequences of those risks?
Where Did We Go Wrong?Ignorance and avoidance
Unclear/undefined strategy
Lack of strong leaders
Lack of Plan and Business Model
Lack of visionaries/dreamers
Unclear/undefined accountability
Time
Funds and resources
Lack of fortitude
What Did We Know For Sure?
4%
31%
61%
38%
27%26%
12%
1%0%
25%
50%
75%
Healthy Acute Chronic Catastropic
Medical Costs
Members
Source: Aetna
The Lower the Risks…..The Lower the Costs
% Of
Population
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What Do We Know For Sure• Risks exist and result in losses
• Many risks can be eliminated
• All losses can be managed and reduced
• Best practices strategies are effective
• Waiting prolongs losses and delays results
• Employees are our most important assets. Invest in their care, at least as much as we invest in caring for our other assets
What are the Risks?
Lifestyle Driven Chronic Disease
Age Driven Impairments – Aging Workforce
Sickness & Degenerative Disease
Genetic Disorders
Environmental Risks
Unsafe Behaviors
Accidents & Injuries
Health Care Utilization
What are the Consequences of Risk
Death
Disability
Accidents
Need for Medical Care
Absenteeism
Reduced Productivity
A massive deterioration of our most important assets
All costs associated with these
Productivity Losses
Productivity assumes a present, healthy and committed workforce
“Absenteeism” and “Presenteeism” are behaviors
Incidental absences account for 80% of absence events and 33% of lost work days
Employers spend 15% of payroll on absences.
Productivity Losses
Every day 3-6% of workforce absent
Companies commonly overstaff by 10% - 20% to cover absences
Typical companies set aside 4.4% of total budget for absenteeism. Poor morale companies set aside 5.5%
Presenteeism
Presenteeism is the degree to which a worker is unimpaired and working up to potential
60% of the total cost of illnesses results from employees who continue to work despite their illnesses and impairments
Eliminating Risks
Controllable
Behavior
Resources
Process
Limited Control
Provider Quality
Macro Economics
Macro Health Care Industry
External Cultures
Population Risk Management
A. By Severity of Risk (Predictive Modeling)
B. By Disease State
C. By Medical Provider
D. By Cost
E. By Location
F. By Employee or Dependent
Risks need to be organized into categories that facilitate development of targeted strategies. Risks can be organized and stratified:
Severity Based StrategiesEngaging Employees Where They Are At
Well
No Disease
At Risk
Obesity
High Cholesterol
Acute Illness/ Discretionary Care
Doctor Visits
Emergency Visits
Chronic Illness/
Diabetes
Coronary Heart Disease
Catastrophic
Head Injury
Cancer
Prevention
Early Detection
Nurse/EAP Line
Self Care Training
Screenings
Screenings
Disease Management
Targeted Programs
Nurse/EAP Line
Nurse/EAP Line
Consumer Support
Self Care Training
Disease Management
Consumer Support
Incentives
Benefit Design
Decision Support
Case Management
Nurse/EAP Line
Consumer Support
15% Members = 85% Cost
85% Members = 15% Cost
Risk Management Strategy
A written Health and Fitness Policy is established and signed by leadership
Goals that address health risks and costs are established annually
A written action plan is in place. Timelines and accountability are established
Leadership and local management actively participate in programs and initiatives
Risk Management Strategy
Increase management capability and accountability
Develop organization culture
Engage employees and assign accountability
Acquire and manage resources
Manage, measure, improve
Health Risk Management Operations
Leadership and Management
Health and fitness issues are regularly included on operational meeting agendas
Local site management knows their facilities’ health, disability and absence costs and loss trends. They are held accountable for improvement in each of these areas.
Health and Fitness program success is an element of managers’ and supervisors’ performance evaluation
Why is Health Care So Costly in ME?
Rural older population
Low per capita Income
Poor health status with high rates of chronic disease
Significant cost shifting:
Uncompensated care for the uninsured.
Inadequate government reimbursement.
Highest % of population on Medicare and Medicaid
High incidence of Cancer
Rising demand for services
Inconsistent quality
Poor information
Inefficient costly care for the uninsured
Inefficient: Costly Care for Those Who are Uninsured
Individuals who are uninsured still receive medical care, but pay for their care out of pocket, or receive uncompensated (“charity”) care from facilities.
Because health care costs are borne out of pocket, the uninsured are less likely to receive preventive services, and delay seeking care until advanced stages of illness.
This “inefficient” way of addressing health needs and increases the cost of care.
Cost shifting: Inadequate Government Reimbursement
The Maine Hospital Association estimates that for every dollar spent rendering care to Medicare beneficiaries, hospitals receive $0.85 in reimbursement.
The Maine Hospital Association estimates that for every dollar spent rendering care to Medicaid beneficiaries, hospitals receive $0.76 in reimbursement.
These shortfalls contribute to higher insurance costs for other recipients through cost-shifting i.e. employers etc.
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Mainer’s health behaviors and lifestyles drive the high cost of care.
Maine incidence of smoking, poor nutrition, and inactivity above national average.
o 55% of adults are overweight
o 38% of teens and 76% of adults do not exercise
o Tobacco addiction is above national average
o High school substance abuse rate is higher than national average
The Maine Lifestyle (reality)
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Pre 2007 Strategy
Increase cost sharing with employees
Incent and cover prevention
Telephonic Chronic Disease Management
Complex Case Management
EAP
Aetna Networks
“Wellness”
Post 2007: What Has JAX Done To Combat These Challenges?
Joined Maine Health Management Coalition (MHMC) and became part of the solution
Reengineered Wellness Plan to JAXfit
Innovative benefit design
Tiered networks
Providers of Distinction (POD)
Value based purchasing
Partner with regional health providers
St. Joseph occupational and non occupational care on site
Enlightened Consumerism
31
Maine Health Management Coalition
The Maine Health Management Coalition (MHMC) is a non-profit organization whose over 60 members include public and private employers, hospitals, and health plans.
MHMC employers represent 93,000 Maine employees and 110,000 family members of those employees.
Participation helped us compare our health care results with coalition members.
In 2008 we found our costs were 25% higher per capita compared to MHMC average. First time we had a good Maine based comparison.
We found high costs were being driven by the high cost of the three hospitals we used (MDIH,MCMH,EMHS). JAX Per capita hospital costs were 50% higher than coalition average.
Became fully engaged with MHMC and worked to be a part of a multi stakeholder solution to state wide problem.
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Maine Health Management Coalition
Multi Stakeholder Membership
Quality, Cost, Access
Transparency & Public Reporting
Plan Sponsor Engagement
Consumer Engagement
Payment Reforms
Value-Based Purchasing
35
Providers of Distinction
St. Joseph Hospital (SJH)
St. Mary’s Hospital - knee and hip replacements
Cost for replacements paid at 100%
100% of travel, food and lodging reimbursed
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Providers of Distinction cont.
Center for Connected Health Partners Online Specialty Consultations
Harvard Medical School Faculty and Senior Attending Physicians
Expertise from Mass General, Brigham and Women’s, Dana Farber Hospitals
Web based interaction between 2nd opinion specialist, treating physician and patient
90% of interactions recommend changes in treatments and 5% new diagnosis
100% covered
Quest Diagnostics
Draw sites at JAX, Ellsworth, Bangor, CT and CA
Lab tests paid at 100%
WellMatch is an online health transparency tool accessed via computer, smartphone, or tablet
WellMatch, A Healthagen Business | Confidential and Proprietary 37
• Find a provider, by location, quality, or cost
• View prices for different providers, side by side
• Read reviews of providers from co-workers, and write new reviews
• View benefits information and total spending-to-date
38
Transparency-Empowered Health Care Consumers
Hospital A: Hernia repair (Inguinal Herniorrhaphy)
Hospital B:Hernia repair (Inguinal Herniorrhaphy)
Cost Of Service $37,511.94 Your Aetna member rate You Save $24744.95 $12,766.99 $10,266.99 Not paid $0.00 Amount paid toward meeting your deductible $500.00 Amount paid toward your remaining coinsurance $2,000.00 Your copay amount $0.00 Your Total Estimated Payment: $2,000.00
Cost Of Service $22,096.61 Your Aetna member rate You Save $12232.14 $9,864.47 $8,731.73 Not paid $0.00 Amount paid toward meeting your deductible $500.00 Amount paid toward your remaining coinsurance $632.74 Your copay amount $0.00 Your Total Estimated Payment: $632.74
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JAXfit
Engages and empowers employees to:
Improve fitness and health
Prevent problems before they occur
Better handle problems when they occur
Detect and act upon problems as early as possible
Reduce the severity of problems that may occur
Improve health care and medical outcomes
Make the best use of available resources
Improve the quality of their lives
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JAXfit cont.
Doug Coleman Fitness Center
Partnership with UMO
Onsite fitness classes
Passport to Better Health/Health Incentive Credits
Spouses invited to participate
Incentives and Rewards
Biometrics/Health Risk Assessments
Prevention
On Site Chronic Disease Management Nurses
On Site Lifestyle Coaching
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JAXfit cont.
Health Incentive Credit program
Can be used to eliminate health plan deductible
Unused credits roll over from year to year
The following opportunities to earn credits are offered to employees and spouses: (“each” equals employee and spouse)
HRA completion $300/each
Biometric screening $500/each
Lifestyle coaching $400/Each
Person health record Interaction` $100/each
Use of preventative services $200/each
Dental exams $100/each
Retirement contribution $100/each
RN disease management program$600/each
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2014 R&D Initiatives
TeleDoc or local 24/7 care
E-visits with PCP
Newtopia
Well Match
Accountable Care Organizations
Controlling Health Risks
Conclusion
Health risk management broadens health cost control beyond managing health benefit costs to managing the total cost of risk