Population Health Management-- Can help employers take control of - - PowerPoint PPT Presentation

Can help employers take control of rising healthcare costs? By promoting health, preventing disease, and providing a shorter path to care for employees and their families.

Philip Kurtz, CEO CareATC

Population Health Management--

“Is the ability to accurately assess the health risk of a population, develop and apply initiatives that engage the population to reduce the health risk

• f

that population.”

Population Health Management:

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Population Health Management as it applies to employers

With PCMH as the driver, workflows create a highly sophisticated and patient-centric approach to advanced care delivery, lifestyle management and nutrition.

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Population Health Management

Data Driven Healthcare

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Step 1 – Assess Health

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Data Sources for Assessing Risk

• Identifies diagnosis and procedures over time; integration of various specialty

and/or health data exchanges enhances improved health care coordination, diagnosis and treatment while reducing cost

Clinic Encounters

• Identifies historical and present prescriptions; identifies potential conflicts

between medications and can account for various symptoms; improves health outcomes and cost

RX

• Identifies risk with over 60 blood panels, blood pressure, weight, height,

circumference, and family medical history; identifies risk catches risk when patient hasn't utilized the health care system; improves diagnostics and treatment.

Personal Health Assessment

• Identifies diagnosis and treatments used by other professionals where

clinical encounters are not available; improves diagnosis and treatment

Claim Data

• Identifies compliance and obstacles to behavior changes and improves
• utcomes of treatment protocols when lifestyle changes are required for

nutrition and physical activity.

Outreach & Coaching Data

• Identifies the activity, nutrition and heart rate, blood pressure, glucose, weight,

calorie burn and overall disposition of patient on a daily/weekly basis to provide physician a better perspective of complimenting treatment protocols and lifestyle modifications.

Wellness Data

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Individual Assessment Identifies Group Risk

Identify the highest risk Clinical Perspective Financial Perspective

High Risk 10%-15% High Cost 80%

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Risk Factor Summary – Benchmark Comparison

0% 10% 20% 30% 40% 50% 60% 70% Obesity Prediabetic Diabetic Pre Hypertension Hypertension

• CDC Benchmark
• Group

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Step 2 – Stratify Risk

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Risk Stratification

Risk Analysis Action

Panic Value Patient has life threatening health issue as determined by Personal Health Assessment Requires immediate attention. Could result in ED visit or hospitalization Critical Risk Patient life is not immediately threatened but patient is likely to have a major incident in the coming 12 months Requires prompt attention by a healthcare provider. Potential for ED visit or hospitalization High Risk Patient is on a path of developing or progressing a chronic disease but has the opportunity to stop or reverse the progression Requires treatment by a healthcare provider to control disease risks Moderate Risk Patient has an indication of some risk factors that need to be monitored over a period of time to assure patient is not progressing to the next level Requires guidance by a healthcare provider to control modifiable risk factors Normal Risk Patient has little or no risk factors Patient is encouraged to continue a healthy lifestyle

1% 11% 30% 38% 20%

Panic Value Critical Risk High Risk Moderate Risk Normal Risk

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Biometric Scores Impact on Costs - Diabetes

• PHA Participants

998

• Normal A1c
• Non-Diabetic

537

• A1c Between 5.7 – 6.4
• Pre-Diabetics

369

• A1c Greater than 6.4
• Diabetic

92

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Cost of Treating Diabetes

• A1c Between 5.7 – 6.4
• Pre-Diabetics

369

• According to Center for Disease Control – up to 30% of these will become diabetics
• According to American Diabetes Association - Annual Cost of Treating a Diabetic = $13,700
• According to National Kidney Foundation – up to 30% of Diabetics Will Develop End-Stage Renal

Disease

• Annual cost of treating ESRD = $85,000 per year

(369 X 30%)X $13,700 = $1,516,590 annual cost for treating diabetics + (111 X 30%)X $85,000 = $2,830,500 annual cost for treating ESRD ___________________________________________________________

$4,347,090

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The Cost of Doing Nothing

$0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $35,000,000 0.5 1 1.5 2 2.5 Projected Cost Projected Risk

Risk Score

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Step 3 – Patient Engagement

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Initiatives to engage population

• Create rewards and incentives to motivate members of the population within

the plan design. Incentives could include: Gift cards, bonuses, reductions in premiums, additional vacation time, reduction in out of pocket cost, reduction in co-insurance or co-pays.

Incentives

• Educate members of the population on their risk factors and the long-term

impact of not doing anything, the types of treatments and programs available through your employer and the cost of these programs

Education

• Treatment within the clinic, including pharmacy, specialty referrals, and medical

procedures such as surgery and physical therapy.

Clinical

• Develop a plan for altering current lifestyles that increase an individuals risk

to one that will reduce the risk and getting the members buy-in. The lifestyle changes should encompass nutrition, activity, and stress management.

Lifestyle

• Need to have an efficient way to track members risk, medical records, health

education, physical activity, nutritional habits, biometric data such as: blood pressure, blood sugar and weight. Care team and social media communication.

Tools

• Risk assess the population to assure that the initiatives are having the desired

effect on the members of the population and on the population as a whole.

Re-assess

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Tools

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Mobile App

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Outreach/Lifestyle Coaching

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Step 4 – Manage Performance

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Managing Healthcare Expenditures

Hospitals 50% Physicians 31% Pharmacy 15% Other 4%

 Plan design and incentive programs  Disease Management  Care Coordination  Lifestyle Coaching  Removing Barriers to Care  Centers of excellence  Pharmacy Costs

2014 Healthcare Spending by Type from Centers for Medicare and Medicaid Services

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Care Planning

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Wellness- 2015 HealthyHabits Participants

Eligibilble Participants Participants Didn't participate

34% Did Not Participate 66% Participated

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Wellness- 2015 HealthyHabits Participants

Eligibilble Participants Met Goal Didn't meet Goal

44% Did not meet Goal 66% Met personal Goal

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2015 HealthyHabits Participants

Gained Weight, 29% Maintained Weight, 9%, Lost 1-4% 28%, Lost between 5-9% 11%, Lost 10% or more 23% Total Cost PEPM $20.00 Allocated back to employee $14.88 Administrative cost PEPM $5.12 Plan cost saving PEPM 42.82 Return on investment 2.14* * Does not include improved

productivity

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Employee in her 60’s Multiple comorbidities Medications for cholesterol, hypertension, diabetes, etc.

• Plan spent an average of more than $8000 a year on prescriptions
• Employee paid OOP max every year just in medication costs

PHA resulted in Care Outreach contacts Care Outreach contacts resulted in an over 40-pound weight loss 40+ Pound weight loss resulted in discontinuation of medications

• Plan saves over $8000 a year
• Employee saves $2500 a year

Controlling Pharmacy Costs

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What About the Immeasurable

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A Better Patient Experience

 Physician Led – Patients have access to a personal physician who leads a care team comprised of Nurses, Health Coaches, and Medical Assistants within a medical practice. Physicians spend more time with patients.  Whole-person Orientation – The CareTeam provides comprehensive care, including acute care, chronic disease management, preventive services, lifestyle modifications, including nutrition, activity, and stress management.  Integrated and Coordinated – Practice takes steps to ensure patients received the care and services they need from the medical neighborhood.  Focused on Quality and Safety – Practice uses the quality improvement process and evidence-based medicine to continually improvement patient

• utcomes.

 Accessible – Practice commits to enhancing patients’ access to care.

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Step 5 – Measure Results

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Mid-Size Employer with 500 Employees Coaching Participant Claims Cost Comparison

1 $173.90 $161.61 $174.42 $174.79 $194.83 $184.52 $193.69 $183.86 $175.80 $126.68 $122.44 $142.09 $261.93 $276.49 $282.23 $294.14 $298.80 $308.36 $312.45 $321.43 $322.64 $312.24 $305.50 $289.87 $0 $50 $100 $150 $200 $250 $300 $350 $400

DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV

Average Rolling 12-Month PMPM

Engaged Non-Engaged

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County Government with 1000 Employees Average Costs Before and After Clinic

$- $100.00 $200.00 $300.00 $400.00 $500.00 $600.00 $700.00 PMPM Cost Rolling 12 Mth Ave Implemented Clinic

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Municipality with 4000 Employees After Four Years of Onsite Clinic

17

Onsite Wellness Center

Comparison of 2014 Results

Adults Engaged

(n=3,980)

Adults Not Engaged

(n=1,808)

∆

Preventive Care Utilization: Well Visit Cholesterol Screening/Lipid Panel Cervical Cancer Screening Breast Cancer Screening 34% 91% 40% 45% 28% 35% 33% 37% 6 pts 56 pts 7 pts 8 pts Evidence-Based Medicine Compliance: CAD LDL Screening Diabetic HbA1c Screening 98% 78% 69% 41% 29 pts 37 pts Utilization: Admissions per 1,000 ER Events per 1,000 Premium Tier 1 Physicians 51.8 153.8 35% 78.0 160.4 33%

• 34%
• 4%

2 pts Claim Risk Score 1.668 1.955

• 16%

Average Medical Covered per Claimant $4,940 $7,024

• 30%

Adults include employees and spouses

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REMARKABLY HEALTHCARE DIFFERENT