Improving Results and Measuring ROI of Population Health Management Initiatives

March 19, 20141

Presenter

Rob Corrigan is Vice President of Product Development and Strategy of CoreSource, currently leading their strategic planning and product development teams.

Since joining CoreSource in 2007, Rob has led the design and development solutions for YourCare population management, high risk insurance pools and integrated accountable care with health care organizations.

He is a regular speaker at national conferences and has authored several articles for Business Insurance. Rob earned a bachelor’s degree in Industrial Engineering and Business Administration, and a Master’s of Business Administration from the University of Illinois at Chicago.

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About Verisk Health

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Focus on The Science of Risk

Financial Services

Property & Casualty

We drive performance in the business of healthcare. By combining clinical and analytics expertise with advanced technology and services, we help payers, employers and providers solve complex problems with measurable results.

$11.4 B Market Cap

Supply Chain

Healthcare

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LESSONS LEARNED MANAGING A TOTAL POPULATION

TODAYS DISCUSSION• Background

CoreSource YourCare

• Evolution to Quantify Value In beginning….T1 / T2 Follow the Leaders to ROI Old fashion value—one person at a time Have it your way—D.I.Y. TPM Back to Future—DxCG flux capacitor?

• Questions

PERSONAL SERVICE FROM NATIONAL TPA

TPA Experience• 35+ Years in TPA industry

• 1,100 employees

• 1.3 Million Members*• 955,000 Medical benefits• 385,000 Dental benefits• 675,000 ancillary plans

• 785 self-funded clients• 49% under 500

employees• 100 over 1,000 employees• 17 over 5,000• Health Plans & Trusts

* * Note: includes members participating in multiple benefitsSAS70 Type II auditing standardwww.sas70.com

Superior Service Results• 10.9 Million claims processed a year

• $2.9 Billion benefits paid annually

• 2.1 Million member inquiries a year

Business Unit Target Markets Products

300 – 20,000+ EmployeesSchools, Hospitals, Manufacturing,

Municipalities, Services

Universal Life, Critical Illness Disability Income, Accident Consolidated/Payroll Billing

300 – 5,000+ Employees Claims Administration Care Management Other Benefit Administration

1,000+ EmployeesEmployer groups, disease

management companies, health plans

Health Coaching Biometric Screening Fitness Center Management 24/7 Nurse line Health & Member Advocacy Telephonic enrollment

2 – 500 Employees Level Self-Funding Medical Life, Dental & Disability Insurance

Employer Medical

TRUSTMARK GROUP

Trustmark Insurance is Rated A- (Excellent) by A.M. BestMutual Insurance Company—not subject to Wall Street

YOURCARE DEVELOPMENT—A TOTAL POPULATION MANAGEMENT PRODUCT YourCare launched (2008)

Gaps in Care Monitoring:• Chronic Conditions• Preventive Screenings

Health Coaching:• Chronic Conditions • Health Risks

HealthCenter (2009) Health Fitness (2011)

On-site HRA and screeningsHealth AdvisingExpand solutionsEnhanced Health Center

2008 2009 2010 2011 2012 20130

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000YourCare Membership

Client ProgramsTrustmarkCoreSource

CoreSource and Verisk HealthSupport for effective clinical integration

• Reporting• Tracking

Outcomes• Practice Profiling

Consumer Health RiskAssessments

Consumer Health RiskAssessments

Biometric Test ResultsBiometric Test Results

Eligibility & EnrollmentEligibility & Enrollment

Pharmacy ClaimsPharmacy Claims

Medical ClaimsMedical Claims

Data Consolidation

Centers of Excellence Utilization ManagementGaps in Care Outreach

Evidence-Based Analytics

Verisk IntelligentDatabases & Norms

Data Integration

Normalization

Identify Risk Factors

Stratify & Prioritize

Member Outreach &Program Enrollment

Member Registry

Care Navigation Chronic Condition Management

Lifestyle Behavior Coaching

Discharge Planning & Follow-up

Rules & Algorithms Risk/Care Gaps Risk Models (DcGX) Participation Status

Large Case ManagementAt-Risk Prevention

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Electronic Medical RecordElectronic Medical Record

Reporting—Activity and Outcomes

Available Client Reports

Monitoring ReportsCondition Management & Prevention

Baseline

Mid-Year

Year-End

Health Advisor Enrollment Report

Coaching Progress Report

Coaching Outcomes Report

Coaching Satisfaction Report

HRA Impact Report (Verisk) HRA Aggregate Report

HRA T1/T2 Aggregate Report

Health Action Challenge Reports

- Great American Fitness Adventure

- Feel Like a Million

Screening Aggregate Report

Screening Satisfaction Report

Web Utilization Report

PARTICIPATION AND ENGAGEMENT

Care Gaps Monitoring Focus Coaching0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%YourCare Program Participation

YourCare Par-ticipant

Opt-Out / Declined

Could Not Contact

Chro

nica

lly Il

l Mem

bers

40%

60%

63%99%

Participation excludescurrent high cost members:

• Prior Year Costs > $25k• ARI > 20

or Cancer diagnosis or Case Management or Medicare eligible (65+) or COBRA participants or Enrolled < 24 months

Source: CoreSource YourCare 2013 participation, using Verisk Health Medical Intelligence Sightlines

Focus Coaching participation:– 79% < 3 months– 11% 3 to 6 months– 10% > 6 months

YOURCARE COMPLIANCE MONITORING

Cardiac Risk CAD/CHF Diabetes Respiratory Preventive0%

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

100%T1 vs T2 Gaps in Care Compliance

BaselineYear EndVH Norm

Source: CoreSource YourCare client results October 2012 through November 2013

HEALTHCENTERIntegrated member experience: single sign-on from CoreSource portal

YOURCARE IMPACTS PARTICIPATION

Compliance is better for members usingPrimary physician or medical home (+16%)HealthCenter (+55%)

YourCare participants more likely to usePreventive Screenings (+15%)Annual Health Exam (+5%)Hospital Review and Case Management (+12%)

But has not influenced participation inHealth risk assessments (HRA)Health coaching

YourCare Solutions

INCENTIVE SOLUTIONS INCREASEPARTICIPATION AND RESULTS

0%

10%

20%

30%

40%

50%

60%

70%

80%

53%50%

41%

56%

30%

73%

39%

27%31%

54%

18%

70%

Reward Solutions EMPOWERED Coaching

*Source: Health Fitness clients (47) with over 400,000 Eligible Participants, 2012

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FOLLOW THE MARKETRETURN ON INVESTMENT (ROI)

Natural experiment:• YourCare Clients—participants & opt-outs• Benchmark—other CoreSource groups not using TPM

DMAA ROI methodology• Member exclusion criteria• Hospital usage trends (T1 vs T2)• Quantify savings with average cost per service• ROI based on YourCare fees

YOURCARE ROI = $4.7 TO $1

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

CompliantMembers

Gaps in Care Medical Acuity Hospital Inpatient Emergency RoomVisits

Total Paid ClaimCosts

Your

Care

Hig

her(

Low

er) t

han

Benc

hmar

k

YourCare vs Non-YourCare (Benchmark) GroupsPrior YearCurrent Year

Source: CoreSource book-of-business analyzed using Verisk Health, April 2010Note: Outcomes compare the actual change for CoreSource groups using YourCare relative to other CoreSource groups NOT using any disease management program. Results are adjusted for differences in the risk and demographic mix of members across groups.

LESSONS LEARNED—BETTER COMPLIANCE LIMITS

ADDITIONAL CHRONIC ILLNESSES

People following the evidence-based guidelines for managing their chronic illness have fewer “gaps in care”….

. . . which limits developing other chronic conditions that escalate a person’s medical risk or acuity

Source: CoreSource Book-of-Business, January 2012 analyzed using Verisk Health Medical Intelligence SightlinesNote: Results includes all groups whether they use YourCare or not.

…RESULTING IN LOWER HOSPITAL UTILIZATION BETTER CONTROL OF HEALTH PLAN COSTS…compliant people have fewer

hospital admissions or emergency room visits for illness-related care...

. . . leading to lower health care costs & trends because their

chronic illness is under control

Source: CoreSource Clients experience, January 2012 analyzed using Verisk Health Medical Intelligence Sightlines.

DEFINING SUCCESS—ONE MEMBER AT A TIME Clients reaction—ROI is great, but what about my members? Compliance with evidence-based medicine guidelines is key:

• Define Compliance—using Care Gap Index (CGI)• Compliance trends by member

Impact on co-morbidities—no escalation of medical risk (RI) Defined Success controlling costs when:

• Low cost member remain low cost (below average)• Moderate cost members cost decline (as compared to prior year)• Higher cost members experience significant drop in costs (+25%)• Exclude High cost members (over $25,000 in prior year) to limit

regression to the mean affect

YOURCARE IMPROVES MEMBER COMPLIANCE

YourCare Participation Impacton Chronic Care Compliance

80%

65%

95%

47%40%

55%

81%

66%

87%

58%

33%

53%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

YourCareParticipants

Did NotParticipate

BenchmarkGroups

YourCareParticipants

Did NotParticipate

BenchmarkGroups

% o

f Mem

bers

with

Chr

onic

Illn

ess Prior Year

Current Year

Low Risk / Gaps in Care Monitoring Higher Risk / Focus RN Coaching

Source: CoreSource book-of-business analyzed using Verisk Health Medical Intelligence, April 2010

COMPLIANCE IMPACTS CLIENT’S RISK

Care Gaps Risk Index DxCG (M18) DxCG (M26) CoMorbidity0.75

0.8

0.85

0.9

0.95

1

1.05

1.1

1.15

1.2

1.25T1 vs T2 Risk Scores

BaselineYear End

Source: CoreSource YourCare client results October 2012 through November 2013

QUANTIFY SAVINGS BY MEMBER RISK LEVEL

YourCare Benchmark YourCare Benchmark YourCare Benchmark YourCare Benchmark$0

$1,000

$2,000

$3,000

$4,000

$5,000

YourCare vs Benchmark Group’s Change in Member’s Av-erage Annual Allowed Plan Costs by Medical Risk Level

Current Prior Year Current Prior Year

BaseYear

CurrentPeriod

Low Risk Members Average Risk (Median) At-Risk Members High Risk Members

Source: CoreSource YourCare Adult Members on Plan 2+ years, January 2012 analyzed using Verisk Health Medical Intelligence Sightlines

CLIENT PROGRAMS USING VERISK HEALTH

Clients using other:• Population Management products• Community-based health improvement initiatives

Health System clients• Pilot integrated care management on Employee plan• Proprietary population management product

Quarterly monitoring using Health Care Clients benchmark:• Overall cost and utilization trends• Chronic condition trends• Quality & utilization comparison trends

COMPLIANCE TRENDS AND BENCHMARKSBY CONDITION

Chronic Conditions by Physician Involvement in Managing Condition

# of Members w/Condition

Clients Members

CS BOB Average

VH NormCS BOB Average

VH NormChange in

ComplianceDec-12

Chronic Care Management ConditionsAsthma 997 86.2% 84.4% 83.2% 1.8% 3.0% (0.6%) 86.9%Chronic Obstructive Pulmonary Dx (COPD) 148 73.8% 74.0% 73.2% (0.2%) 0.6% (0.8%) 74.5%Congestive Heart Failure (CHF) 89 74.8% 74.2% 73.6% 0.5% 1.2% 0.1% 74.6%Coronary Artery Dx (CAD) 638 77.0% 76.3% 76.6% 0.7% 0.5% 0.7% 76.4%Diabetes 1,310 74.3% 76.9% 79.1% (2.6%) (4.8%) (0.6%) 74.9%Hypertension 3,043 73.9% 66.1% 69.4% 7.7% 4.4% 1.3% 72.6%

Medication Management ConditionsAtrial Fibrillation 154 45.8% 47.0% 62.1% (1.1%) (16.3%) (8.0%) 53.8%High Cholesterol 3,097 52.0% 60.5% 67.8% (8.5%) (15.8%) 4.6% 47.4%

Physician Monitored ConditionsArthritis 161 64.0% 68.8% 71.9% (4.8%) (7.9%) (5.7%) 69.7%Back/Neck Pain 2,068 92.8% 95.1% 95.4% (2.3%) (2.6%) (1.2%) 94.0%Depression 574 91.3% 92.4% 92.6% (1.1%) (1.3%) (1.1%) 92.4%End-Stage Renal Dx (ESRD) 126 65.0% 69.1% 69.0% (4.1%) (3.9%) (1.1%) 66.1%Inflammatory Bowel Dx (IBD) 117 87.5% 71.4% 71.6% 16.2% 15.9% 2.5% 85.0%Migraine 223 95.2% 90.5% 89.9% 4.6% 5.2% 1.4% 93.8%Pain Management 5,777 93.3% 93.5% 93.6% (0.2%) (0.3%) 2.6% 90.7%

Chronic Care Management based on compliance with physician office visits, medication and testing to monitor statusPhysician Management based on regular physician office visits and testing to monitor statusMedication Management based on medication compliance and regular physician visits to monitor status

Compliance with Evidence-Based Care Client Better (Worse) Compliance Trend

COMPLIANCE TRENDS AND BENCHMARKSBY MEMBER BEHAVIOR

Member Behaviors Contributing to Gaps in Care

Clients Members

CS BOB Average

VH NormCS BOB Average

VH NormChange in

ComplianceDec-12

Managing Chronic ConditionLong Office Visit with Doctor 9.2% 12.8% 11.2% 3.6% 2.0% (0.5%) 8.7%Medication Compliance 38.4% 40.3% 35.8% 1.9% (2.6%) 2.5% 40.9%Testing to Monitor Condition 49.4% 34.2% 29.0% (15.2%) (20.4%) (0.6%) 48.8%

Complications of Chronic IllnessAdmitted to Hospital 5.0% 4.4% 6.4% (0.6%) 1.4% (0.1%) 4.9%CoMorbid Chronic Condition 20.4% 19.2% 16.8% (1.2%) (3.6%) (0.3%) 20.2%Emergency Room Visit 11.0% 9.1% 11.7% (1.9%) 0.7% 0.2% 11.2%Hospital Re-Admission 6.7% 5.2% 6.2% (1.6%) (0.6%) (0.3%) 6.4%Illness-related Complication 4.0% 4.0% 4.3% 0.0% 0.3% (0.2%) 3.7%

Partnering with Primary PhysicianCondition Monitoring 55.5% 52.3% 48.8% (3.1%) (6.6%) (6.0%) 49.5%Follow-Up After Discharge 48.7% 48.5% 50.2% (0.2%) 1.5% (0.2%) 48.5%Follow-Up after ER Visit 24.5% 23.9% 26.1% (0.6%) 1.6% 1.2% 25.7%

Proactive Preventive HealthAnnual Physician Office Visit 19.5% 23.7% 28.4% 4.2% 8.9% 2.7% 22.2%Cancer Screening 49.1% 52.8% 58.3% 3.6% 9.2% (0.7%) 48.4%

Members with Gaps in Care Client Better (Worse) Compliance Trend

COMMUNITY-BASED DIABETIC HEALTH PROMOTION—CLIENT ASSESSMENT Participants are higher risk than other diabetics—

leading to more admissions, emergency room and physician visits

Yet, health care usage is under control:• Inpatient hospital patient days increased less• Emergency room visits declined

Benefit plan costs declined for participants:• Few high cost participants account for 24% of total costs• Other participants actual and risk-adjusted costs declined

ALLOWED CHARGES PER PERSON(EXCLUDING ALL HIGH COST MEMBERS)

Prior Year Current Year Prior Year Current Year$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

LPiHO ParticipantsAll Other Diabetics

Actual Medical Allowed Charges DxCG Normalized Charges

Impact of high-cost members::24% of LPiHO Members had annualcosts over $50,000 in prior/current yearas compared with 5% for other diabetics

Source: CoreSource Client’s Health Plan Experience from May 2010 through April 2012 analyzed using Verisk Health

RISK ADJUSTED COSTS AND TRENDS COMPARISON

Current Risk Adjusted Costs (Model #18)

Prior Year Projected Costs (Model #26)

Prior Year Projected Costs (Model #56)

0%

10%

20%

30%

40%

50%

60%

70%Actual vs Projected Member Costs

using DxCG Projected Costs

Compliant MembersStable NonCompliantDeclining Compliance

% o

f M

em

be

rs A

ctu

al <

Pro

jec

ted

Co

sts

Source: CoreSource Clients Health Plan Experience, 2011 to 2013 using Verisk Health Medical Intelligence Sightlines

CONCLUSIONS FROM LESSONS LEARNED

Participation leads to more participation Changing behavior better compliance

fewer hospital services lower total plan costs Tracking behavior changes is

easy….quantifying related cost savings can be tricky

Mid-market employers need member specific outcomes and savings—DxCG may be key

Verisk Health partners with us to improve process

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