Schaller Anderson Presents to
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Transcript of Schaller Anderson Presents to
Schaller AndersonPresents to
March 8, 2006
Today’s Objectives
• Let’s talk about our teachers and school workers and their health care
• Do you know WHO is driving your health care costs?
• How do we know this?• What can we do about it? • What are the essential components of
an ideal health care program?
Health: The Human Capitol Multiplier
Your employees can be: • The best-trained
• The most highly skilled
• The best equipped
• And work in the best supportive environment…
BUT if they are not healthy,
productivity and performance suffer
Major Causes of Lost Productivity
• Musculoskeletal problems like back pain, arthritis
• Mental health conditions like depression and anxiety and stress
• Pregnancy• Respiratory conditions like asthma and
allergies
What Happens To Us At Work? (Occupational Morbidity)
• February, 2006 study to rank all U.S. occupations assessing days of restricted activity, bed rest and missed work, medical claims, reported health status
• Of the 206 largest occupational groups in the U.S., – Social workers are ranked #1
– Floor buffers/polishers are #4
– Administrators/officials are #23
– Special education teachers are #25
– Counselors are #29
– TEACHERS are #61
These are ranked higher than police, machinists, welders, taxi drivers, nurses, plumbers and waiters out of 206 occupations
Key Workforce Strategies
1. Primary prevention of problems in the first place: health improvement, disease prevention, well care, worksite wellness policies and programs
2. Impact reduction strategies like case and disease management, Identification of highest risk members
Large Government Employer Per Capita Healthcare Spending
0
2500
5000
7500
10000
12500
15000
17500
20000
22500
25000
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Average ($2,601)
Large Government Employer Continuance Table
Claim Amount and Percent of Costs Driven by Different PercentilesIncurred Claims between Feb 1, 2005 and Jan 31, 2006
(paid through Jan 31, 2006)
PercentileTotal Costs % of Total
Average Cost Annual per member*
Top 1.0% 31.3% 81,483$ Top 5.0% 57.9% 30,103$ Top 10.0% 72.1% 18,749$ Top 20.0% 85.8% 11,156$ Top 25.0% 89.7% 9,327$ Top 50.0% 98.2% 5,109$ Bottom 50.0% 1.8% 92$ Total 100.0% 2,601$
Large Government EmployerEmployee Conditions by Department
Data Hyperlipidemia Back Pain HypertensionChronic Arthritis
Joint Pain and
Bursitis Grand Total
Employees with Condition 366 393 305 360 289 1,713 Total Department Employees 3,903 3,903 3,903 3,903 3,903 3,903
Employees with Condition 364 413 413 309 316 1,815 Total Department Employees 3,673 3,673 3,673 3,673 3,673 3,673
Employees with Condition 272 206 203 205 235 1,121 Total Department Employees 3,041 3,041 3,041 3,041 3,041 3,041
Employees with Condition 218 198 233 134 132 915 Total Department Employees 1,913 1,913 1,913 1,913 1,913 1,913
Employees with Condition 185 148 117 130 111 691 Total Department Employees 1,249 1,249 1,249 1,249 1,249 1,249
Employees with Condition 91 91 68 55 61 366 Total Department Employees 877 877 877 877 877 877
Employees with Condition 83 71 93 59 68 374 Total Department Employees 694 694 694 694 694 694 Employees with Condition 56 62 66 48 40 272 Total Department Employees 527 527 527 527 527 527
Large Government EmployerEmployee Conditions by Department
*All department names have been changed
Dept Data Hyperlipidemia Back Pain HypertensionChronic Arthritis
Joint Pain and Bursitis
Prison workers Prevalence of Employees with Condition 9.38% 10.07% 7.81% 9.22% 7.40%Total Department Employees 3,903 3,903 3,903 3,903 3,903
Budget Department Prevalence of Employees with Condition 9.91% 11.24% 11.24% 8.41% 8.60%Total Department Employees 3,673 3,673 3,673 3,673 3,673
Higher Education #1 Prevalence of Employees with Condition 8.94% 6.77% 6.68% 6.74% 7.73%Total Department Employees 3,041 3,041 3,041 3,041 3,041
Transportation workers Prevalence of Employees with Condition 11.40% 10.35% 12.18% 7.00% 6.90%Total Department Employees 1,913 1,913 1,913 1,913 1,913
Higher Education #2 Prevalence of Employees with Condition 14.81% 11.85% 9.37% 10.41% 8.89%Total Department Employees 1,249 1,249 1,249 1,249 1,249
Safety Department Prevalence of Employees with Condition 10.38% 10.38% 7.75% 6.27% 6.96%Total Department Employees 877 877 877 877 877
Health Department Prevalence of Employees with Condition 11.96% 10.23% 13.40% 8.50% 9.80%Total Department Employees 694 694 694 694 694
Medicaid Agency Prevalence of Employees with Condition 10.63% 11.76% 12.52% 9.11% 7.59%Total Department Employees 527 527 527 527 527
CategoryNumber of Employees
Percentage Employees
Hyperlipidemia 2154 21.5%
Back problems 2064 20.6%
Essential Hypertension 1992 19.9%
Other non-traumatic joint disorders 1730 17.3%
Other connective tissue disease 1616 16.2%
Other lower respiratory disease 891 8.9%
Other skin disorders 648 6.5%
Diabetes mellitus with out complications 481 4.8%
Asthma 45 4.5%
Diabetes mellitus with complications 29 2.9%
Employee Summary of Conditions
Predictive Pathways: Ranks
This is a search result from the main enrollment screen of Predictive Pathways (identifying data altered for privacy).
By clicking on any member ID, you can retrieve a profile of that member’s detailed history.
Member Profile
So What Can We Do That Matters?
• Identify the costliest members • Follow their claims• Use all available Data• Focus on key populations that drive
your costs• Worksite programs • Care management
Member Impact StoriesCase #1 - 38 Year Old Diabetic and Asthma
Before Disease Management
Disease Management Intervention
Follow-up Call 2 Months
• Non-compliant
– Not monitoring blood sugars
– Not following diet
• HbA1C 9.0 (normal less than 7)
• Sick frequently secondary to poorly controlled diabetes
• Frustrated with physician
• Education regarding importance of:
– Checking daily blood sugar
– Glucometer and how to obtain new one
– HbA1c being under 7.0
– Proper diet
• Provided names of other physicians
• Enrolled in diabetic education class
• Using glucometer regularly
• HbA1c 7.0
• Feeling better, not ill in 2 months
• Attending diabetic classes and seeing nutritionist
• New primary care physician
• Endocrinologist involved in case
Member Impact Stories (Continued)
Case #2 – Member with Congestive Heart Failure, Obesity
Before Disease Management
Disease Management Intervention
Follow-up Call 2 Months
• Non-compliant
– Had not seen cardiologist in over a year
– Poor diet including high salt foods
– No weight monitoring
– No exercise
• Education regarding condition and importance of:
– Regular cardiology appointments
– Dietary modifications
– Daily weight checks
– Importance of exercise
• Demonstrates understanding of disease process by:
– Cardiology appointments every 6 months
– Daily checks and records:
• Blood pressure
• Pulse
• Weight
– Calls cardiologist if change in status
– Using treadmill on regular basis
Member Impact Stories (Continued)
Case #3 – Follow-up with Member in Disease Management
• Member described chest pain with walking even short distances
• Disease Manager recognized possible signs of reduced blood flow to heart secondary to exercise
• Member instructed to call 911 and go to ER• Surgery ensued with 4 vessel coronary artery
bypass
Key Principles Of An Effective Health Plan
Goal: To obtain improved health outcomes, stabilize cost and improve productivity
• Identify highest risk members for future cost and enroll them in disease specific programs and care management• Educate members about their disease, its symptoms and effective tools for self-management• Continuously monitor members between physician visits to encourage self-care, identify complications, help with care coordination
Summary of the Characteristics for Medical Plan Success
• Population identification process• Evidence-based practice guidelines and assurance of
high quality care• Patient self-management education • Support the provider/patient relationship through your
policies and programs• Emphasize reduction of preventable events• Evaluate member outcomes on an ongoing basis• Focus on high cost events: concurrent review and PA of
hospital and high cost procedures• Integrate Social needs, Behavioral Health, Pharmacy
Use DATA to identify KEY ACTIONS which create better OUTCOMES