28 th Annual WELLNESS in the WORKPLACE Conference Ann Arbor, MI March - - PowerPoint PPT Presentation

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28 th Annual WELLNESS in the WORKPLACE Conference Ann Arbor, MI March - - PowerPoint PPT Presentation

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28 th Annual WELLNESS in the WORKPLACE Conference Ann Arbor, MI March 18, 2009 A.M.Colombi MD MPH Economy Efficiency Effectiveness Physical Physical Cost Outcomes Inputs Outputs Cost effectiveness Economy Efficiency Effectiveness

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28th Annual WELLNESS in the WORKPLACE Conference Ann Arbor, MI March 18, 2009 A.M.Colombi MD MPH

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Cost

Physical Outputs Physical Inputs

Outcomes

Cost‐effectiveness

Economy Efficiency Effectiveness

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Investment Physical Outputs Physical Inputs Outcomes

Cost‐effectiveness

Economy Efficiency Effectiveness

Mgmt. System

“Change Box”

Programs

  • H. Care cost
  • H. Care Use

Productivity Burden

  • f

Disease

Population

Risk

Portfolio

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Investment Physical Outputs Physical Inputs Outcomes

Cost‐effectiveness

Economy Efficiency Effectiveness

Mgmt. System

“Change Box”

Programs

  • H. Care cost
  • H. Care Use

Productivity Burden

  • f

Disease

Population

Risk

Measure sources

Mgmt Survey Implem . Scores 10 Keys™‐ HRA population based risk profile Med +Rx Claims Disability records Productivity Scores Integrated Cost

Portfolio

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Investment Physical Outputs Physical Inputs Outcomes

Cost‐effectiveness

Economy Efficiency Effectiveness

Mgmt. System

“Change Box”

Programs

  • H. Care cost
  • H. Care Use

Productivity Burden

  • f

Disease

Population

Risk

Measure sources

Metrics Mgmt Survey Implem . Scores 10 Keys™‐ HRA population based risk profile Med +Rx Claims Disability records Productivity Scores Integrated Cost 4 scores 14 scores 10 Keys Rates of Office visits, ER visits, Admissions, Net pay per patient , per episode, etc…. Cost due to medical treatment, disability, lost productivity, salary replacement, etc….

Portfolio

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Investment Physical Outputs Physical Inputs Outcomes

Cost‐effectiveness

Economy Efficiency Effectiveness

Mgmt. System

“Change Box”

Programs

  • H. Care cost
  • H. Care Use

Productivity Burden

  • f

Disease

Population

Risk

Measure sources

Metrics Mgmt Survey Implem . Scores 10 Keys™‐ HRA population based risk profile Med +Rx Claims Disability records Productivity Scores Integrated Cost Evaluation 4 scores 14 scores 10 Keys Rates of Office visits, ER visits, Admissions, Net pay per patient , per episode, etc…. Cost due to medical treatment, disability, lost productivity, salary replacement, etc….

Portfolio

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Investment Physical Outputs Physical Inputs Outcomes

Cost‐effectiveness

Economy Efficiency Effectiveness

Mgmt. System

“Change Box”

Programs

  • H. Care cost
  • H. Care Use

Productivity Burden

  • f

Disease

Population

Risk

Measure sources

Metrics Mgmt Survey Implem . Scores 10 Keys™‐ HRA population based risk profile Med +Rx Claims Disability records Productivity Scores Integrated Cost Evaluation 4 scores 14 scores 10 Keys Rates of Office visits, ER visits, Admissions, Net pay per patient , per episode, etc…. Cost due to medical treatment, disability, lost productivity, salary replacement, etc….

Portfolio

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Investment Physical Outputs Physical Inputs Outcomes

Cost‐effectiveness

Economy Efficiency Effectiveness

Mgmt. System

“Change Box”

Programs

  • H. Care cost
  • H. Care Use

Productivity Burden

  • f

Disease

Population

Risk

Measure sources

Metrics Mgmt Survey Implem . Scores 10 Keys™‐ HRA population based risk profile Med +Rx Claims Disability records Productivity Scores Integrated Cost Evaluation 4 scores 14 scores 10 Keys Rates of Office visits, ER visits, Admissions, Net pay per patient , per episode, etc…. Cost due to medical treatment, disability, lost productivity, salary replacement, etc….

Portfolio

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DA provides a clear framework for analyzing decisions that involve significant uncertainties (risk). In today's world risks can include anything from political and legal risks, to unknowns associated with market acceptance, weather, foreign exchange rates, commodity prices, and …. (why not) wellness and health outcomes.

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Creating a basic model of the business problem Determining how to best represent uncertainties Creating an exhaustive set of choices Performing quantitative analysis to determine the optimal decision

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Sorted Parameter Estimates Term Estimate Std Error t Ratio Prob>|t| % Low Risk

  • 158.2534

46.74753

  • 3.39

0.0025 Nutritional Environment

  • 52.91356

20.28908

  • 2.61

0.0157 % Aged 50+ 111.49604 45.05718 2.47 0.0211 0`½¸`Ê

Prediction Profiler

RSquare 0.65331 RSquare Adj 0.608089 Root Mean Square Error 24.65265 Mean of Response 120.7826 Observations (or Sum Wgts) 27

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RSquare 0.665526 RSquare Adj0.652662 Root Mean Square Error 14.82222 Mean of Response 54.99786 Observations (or Sum Wgts) 28 Variable Mean Std Dev Correlation Signif. Prob AFT-HPN-Episodes Per 1000 121.9436 39.12864 0.815798 <.0001 DM Epi Per 1000 ACTIVE 54.99786 25.14994 Term Estimate Std Error t Ratio Prob>|t| Intercept

  • 8.943783

9.32074

  • 0.96

0.3461 AFT-HPN-Episodes Per 1000 0.5243543 0.072902 7.19 <.0001

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Term Estimate Std Error t Ratio t Ratio Prob>|t| Physical Activity % no risk

  • 122.7227

52.38092

  • 2.34

0.0274 % Aged 50+ 77.20665 33.31348 2.32 0.0289

RSquare 0.400318 RSquare Adj0.352344 Root Mean Square Error 20.23994 Mean of Response 54.99786 Observations (or Sum Wgts) 28

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Multi‐factorial effects for any outcome , f.i.

Multiple risk factors contributing to Coronary Artery

Disease

Co‐Existing but distinct population outcomes, f.i.

Hypertension, Diabetes, Coronary Artery Disease, Workers

Compensation….

Heterogeneity of populations

Several worksites, regions

Diversity of simultaneous programs

Variance in implementation maturity and intensity

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Scalable System Change

A P S D

(Tests to adapt changes, then implementation)

System of Focus for the early adopters

(defined by Aim)

Evidence Based Wellness

A P S D A P S D

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Innovators Early Adopters Early Majority Late Majority Laggards 2.5% 13.5% 34% 34% 16%

from E. Rogers, 1995

Adopter Categories

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

K 1 B. Pressure K 2 Not Smoke K 3 Cancer Screen K 4 Flu shots K 5 Glucose test K6 Cholesterol K7 Exercise K8 Low Risk K 9 Social Contact K 10 Depression screen

Delaware (2007). “ 10 Keys to Health” : Process indicators

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Management Topic Status Problem/Opportunity Focus /priorities ID of population needs Programs coordination Plan Evaluation

(10) (5) ‐ 5 10 15 20 2005 2006 2007

Net Care Cost Inflation rate

Benchmark Delaware 44 61 78 19 35 36 46 44 47 2005 2006 2007

Delaware: Health Risk Indicators

HRA Participation No/Low Risk Know your Numbers

0% 20% 40% 60% 80% 100%

K 1 B. Pressure K 2 Not Smoke K 3 Cancer Screen K 4 Flu shots K 5 Glucose test K6 Cholesterol K7 Exercise K8 Low Risk K 9 Social Contact K 10 Depression …

Delaware: 10 Keys to Health Process indicators