managing the biggest risk all employers face: employee health … · 2019-08-09 · 2 american...

1

Managing the Biggest Risk All Employers Face:

Employee Health StatusPresented by:

Joe San FilippoChief Health Care Strategist

Nationwide Better Health

Managing Employee Health Risk

• Putting things in historical perspective• Understanding health risk• Introducing real solutions• Embracing healthcare consumerism• Offering real solutions, not band aids

The Evolution of Health Care

• Industrial Age – 19th and early 20th Century• Information Age – late 20th Century• Knowledge Age – 21st Century• Moving from knowledge to wisdom

Industrial Age 1850-1950

• Shift from Agrarian to Industrial economy• Pollution and poor public health• Politics dominate the West

– Civil Wars, World Wars, Cold War – Socialism, Communism and Democracy– Labor laws emerge – Taft-Hartley Act– Entitlement mentality established

• Health Insurance became prevalent

The Information Age 1950-2000

• Economics Rule; Communism fails• Communications advance technology• Disease-based health care system relies on

intervention, not prevention• Rapid growth in healthcare technology fueled by

broad 3rd party financing• Obesity rates soar• Demographics begin to change

Managing Risk of Death

• Heart disease is by far the leading cause of death

• The American Heart Association’s 2010 Goal: Reduce death by heart disease and stroke by 25%

Result: 25.8 % reduction by 2007- saved 160,000 lives in 2006- will save 240,000 lives in 2008

2

American Heart Association2010 Impact Goals

0%1.9%3.2%Obesity rate of growth

-2%30%39%40%Physical Inactivity

-16%58%64.9%77.3%High Blood pressure uncontrolled

-25.8%146.7144.4194.6Heart Disease Deaths per 100,000

Change to date

2010 Target

Current Status

Baseline 1999

Indicator

Employee co-payment

Employee Contribution

Paid by employer

$777$791

$4,20214%13%

73%

2002

$5,770

$1,738

$1,859

$6,817

18%

17%

65%

2008 (proj.)

$10,414AVERAGE U.S. HEALTH-CARECOVERAGE PER EMPLOYEE

The Changing Climate of Health Care:Key Trends and Implications

Source: Hewitt Associates, 2007

Health Insurance to Surpass Wages by 2020if Trends Continue

$-

$10

$20

$30

$40

$50

$60

$70

$80

$90

$100

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Cos

ts (i

n Th

ousa

nds)

Years

Wages Family Premium

Many Employers’ Productivity Costs Exceed Health Care Spending

56%

Annual Payroll ($000)

$2,167,446,623

$1,673,389,262

Firms with 2,500+ employeesFirms with 1-2,499 employees

44%56%

Strategies must be developed to mitigate bothStrategies must be developed to mitigate both

Sources: US Census Bureau; Watson Wyatt’s 2002 Staying @ Work Survey; “Highlights from Health Tablesand Chartbook”

$240B

$235B

Health Insurance

Costs(14.1% Direct)

Disability & Absence

Costs(14.3% direct and Indirect)

H&P Spend approx. $475B

Increasing each year

Increasing each year

“Health care costs are expected to soar from today’s 16% of GDP toward 20% by around 2020.”(Fortune)

Where will we get the money to pay for healthcare?

Source: GAO’s August 2007 analysis, 2008 ACS Healthcare Solutions

United States Government Accountability OfficeTestimonyBefore the Committee on the Budget,U.S. Senate

LONG-TERM FISCALOUTLOOK

Action Is Needed to Avoid the Possibility of a Serious Economic Disruption in the FutureStatement of David M. WalkerComptroller General of the United States

GAOFor Release on DeliverExpected at 10:00 a.m. ESTTuesday, January 29, 2009

-20

-15

-10

-5

0

5

2000 2005 20152010 2020 2025 2030 2035 2040

Federal Surpluses and Deficits Under GAO’s Alternative SimulationPercent of GDP

Effect of Health Care on the National Retirement Risk Index

44%35%

44% 48%

61%

50%

61%68%

All Early Boomers1948-1954

Late Boomers1955-1964

Gneration Xers1965-1974

Original NRRINRRI Including Health Care Expenses

0%

80%

60%

40%

20%

Source: Center for Retirement Research at Boston College publication: February 2008, Number 8-3 – Health Care Costs Drive Up the National Retirement Risk Index

3

• Medicare’s unfunded liability is $41 TRILLION- Market capitalization of every publicly tradedcompany is only $18 T.

• If Medicare costs exceed 4.5% inflation by 1% it will consume 12% of the entire GDP by 2020- If 2% excess growth; 20% of GDP

• Conclusion: Medicare and Medicaid entitlement programs are not sustainable

• Watch for means tests, privatization, and a robust retiree medical health insurance market.

Who will pay for baby boomer healthcare?

Source: Douglas Holtz-Eakin, former head of CBO and Chief Economist, President’s Council of Economic Advisors under George W. Bush; Currently Director of Economic Policy for John McCain

Source: Douglas Holtz-Eakin, former head of CBO and Chief Economist, President’s Council of Economic Advisors under George W. Bush; Currently Director of Economic Policy for John McCain

Strategies for managing health risk

• Insurance for catastrophic events- Reinsurance- Risk pools- Safety net

• Chronic care costs becoming uninsurable- Delay or prevent chronic illness- Incentives to improve health status- Healthcare consumerism- Realign incentives for quality care

Health Care Spending

Health Fork

$

t* One Time

Policy Change

OldSpendingPath

NewSpendingPath

Time

Source: National Center for Policy Analysis - John Goodman

Medical Tourism

$3,311N/A$25,000$10,000$7,000$4,500 - $8,500$62,000Spinal Fusion

$24,100$12,000$11,000$11,100$10,000$6,200 - $8,500$40,000Knee Replacement

$12,700$6,000$4,000$6,000$4,500$2.300 - $6,000$20,000Hysterectomy

$11,400$14,000$12,000$9,200$12,000$5,800 - $7,100$43,000Hip Replacement

$19,600$13,800$9,000$11,200$13,000$4,998 - $7,500$57,000Angioplasty

$29,5000$18,000$15,000$12,500$10,000$9,000$160,000Heart ValveReplacement

$34,150$22,000$24,000$16,500$11,000$6,651 - $9,300$130,000Heart Bypass

KoreaMexicoCosta Rica

SingaporeThailandIndiaUnited States

Source: Medical Tourism Assn., 2007 Survey

Dealing with the Cost of Healthcare

Employers Respond:

• Manage chronic conditions and keep under control

• Reduce risk forthose who havenot yet developeda condition

• Keep employees at work and productive

• Invest in Human Capital

Payer Challenges:

• Help employers migrate to Consumer Driven Health Plans

• Introduce Population Health management

• Reach and engage employees

• Provide integrated solutions for both health AND productivity

Issue:

• Health care costs outpacing wages and inflation

• 70% of absence and disability cost attributed to chronic illness

• Global competition requires increased productivity

Water Level

Health Promotion/

Lifestyle Management

Disease Management

Population at risk

who have filed a claim

Health Maintenance

Population with no known risk factors

Risk Line

Total PopulationTotal PopulationTotal PopulationPopulation with risk

but not sick

Water Level

Understanding Health Risks

Total Population Health Management

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Behavior Impacts Unhealthy Lifestyles

Obesity• Nearly 75 percent of adults will be overweight by

2015*Disease• Up to 70% of all major diseases result from

lifestyle choices and habits and are preventable• In 50% of patients with diabetes, depression is

a co-morbid condition

Source: Johns Hopkins Bloomberg School of Public Health

Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10%–14%


No Data <10% 10%–14%


No Data <10% 10%–14%


No Data <10% 10%–14% 15%–19%


No Data <10% 10%–14% 15%–19%

5


No Data <10% 10%–14% 15%–19% ≥20


No Data <10% 10%–14% 15%–19% ≥20


No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity* Trends Among U.S. AdultsBRFSS, 2003

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

0

1000

2000

3000

4000

5000

6000

7000

8000

25 35 45

BMI (kg/m2)

Ave

rage

Exp

endi

ture

s

Reference:Wang F, McDonald T, Bender J, Reffitt B, Miller A, Edington D.Association of Healthcare Costs with Per Unit Body Mass IndexIncrease. Journal of Occupational and Environmental Medicine.2006; 48.668-674

*p<.001

Medical Costs (Slope=$120/BMI point)*Drug Costs (Slope = $93/BMI point)*

6

Employers’ Respond: Incentives to lower risk

• Encouraging and rewarding healthy behaviors• Matching funds for health

savings/reimbursement accounts• More generous plan eligibility and plan design

for desired behavior• Expanding access to behavioral health services

to address obstacles to lifestyle change

Incentives to encourage “enlightened self interest” in personal health decisions and lifestyle (Consumerism)

Employers Respond: Value Based Benefit Design

• Encourage preventive care• Remove obstacles to compliance• Provide access to maintenance drugs• Proactively address behavioral health issues• Reward healthy behavior

Consumerism –The return of market economics

• Create opportunities for new incentives• Increase engagement in Health Promotion and

Disease Management• Improve Rx compliance• Better health outcomes• Lower risk scores mean lower health cost and

higher productivity

Benefits of CDHPs:

High Performance PatientsFollow Treatment Guidelines More Closely

CDHP Members are more likely to very carefully follow treatment regimens for chronic conditions:

CDHPs Combined With Value Based Benefits Yield Better Outcomes

NOT Always Just About Reduction in Utilization

Observed Increase in Preventive and Wellness Care:Immunizations 12%Well baby care 40%Preventive visits 5% to 12%Cervical cancer screenings 14%

Observed Increase in Certain Rx Utilization:Use of insulin +22%Use of cardio medication +2%Use of asthma medication +6% to 21%

Source: Aetna, CIGNA, UHC, Aon

CDHP Engages and Informs Consumer

• Participate in Wellness Programs……………. 20%• Get an annual checkup…………………………30%• Inquire about drug costs………………………200%• Inquire about lower cost treatments…………..50%• Choose less extensive, expense treatment…300%• Engage in health improvement activities……..25%

McKinsey surveyed 2,500 adult consumers and concluded consumers (under CDHP programs) are more likely to:

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The Generations of Consumerism

1st GenerationDiscretionarySpending

2nd GenerationBehaviorChanges

3rd GenerationHealth andPerformance

4th GenerationPersonalizedHealth

Traditional

Consumers

Employers

Health Plans

Pharmacy

Government

Providers

Consumerism is a progression of many different interdependent components and stakeholders

Source: PWC Health Research Institute – Take Care of Yourself, 2007 NDC Annual Conference Materials

Overview of Consumer Driven Health

Prem

ium

s In

$ B

illon

s

Mar

ket S

hare

%

CDHP Industry growth estimates vary from 15 – 50 million members

Source: Forrester Research, 2007 NDC Annual Conference Materials

Forrester Research predicts CDHPs to account for $400 Billion in premiums and 25% market share by 2010!

$0

$100

$200

$300

$400

$500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100%

5%

10%

15%

20%

25%

30%

Premiums Market Share

Managing Healthcare Risk

• Identify the risks via HRAs, biometric screening, medical claims, pharmacy claims and disability data

• Stratify risk into programs that define their risk(s), manage their gaps in care, monitor treatment compliance, and measure clinicalvalues

• Reach and Engage members in behavior change programs• Integrate all services – administration, management and reporting

Health PromotionMaternity

Management

Health Promotion

Disability Management

MaternityManagement


DiseaseManagement


DiseaseManagement

MedicalManagement

HEALTHY AT RISK CHRONIC ACUTE & CATASTROPHIC

Absence Management

Integrated Health Services

Managing Health Risk:Moving from intervention to prevention

– Personal health records to track health status– Health advocates, coaches, counselors (advocacy)– Access to data regarding quality and cost

(transparency)– Shared decision-making

Health AssessmentsBiometric Screenings Health Promotion ProgramsDisease Management

Enhanced Two-Level HRA StratificationFor Lifestyle Health Management

HRA

3-4 Risk Factors

Our model incorporates

factors required for the right

intensity level of coaching

Risk stratification categories are based primarily on intensity of lifestyle, health coaching required to facilitate risk reduction in medium/high risk individuals, and to keep “apparently healthy” individuals healthy.

0-2 Risk Factors

5-6 Risk Factors

Population Stratification

1st Level of Stratification

Individual Stratification

2nd Level of Stratification

Lower Risklower-intensity

intervention required

Moderate Riskmoderate-intensity


Higher Riskhigher-intensity


Lifestyle Management - Risk StratificationCase Scenario 1








NBH

UofM

HRAFindings:

Mr. Jones, Age 46Name:

Univ. of Michigan Risk Status: = Lower RiskNBH Risk Status: = Higher Risk

Conclusion:


Overweight (BMI = 27.4)Smokes 20 cigarettes/daySedentaryFamily history of premature CHDPrehypertension

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Lifestyle Management - Risk StratificationCase Scenario 2









Overweight (BMI = 25.6)Fasting glucose = 265 mg/dl (i.e., poorly controlled diabetes)

Hypertension, no medication(BP = 143/89 mmHg)

Family history of premature CHD

Hyperlipidemia, not on medication(TC = 214 mg/dl; LDL = 152 mg/dl; HDL = 37 mg/dl)

Meets criteria for diagnosis of metabolic syndrome (i.e., glucose, BP, and HDL)

Framingham 10-yr CHD Risk Score = 20% (i.e., double average risk and equivalent to the risk for a person with CHD)

Univ. of Michigan Risk Status: = Lower RiskNBH Risk Status: = Higher Risk

Conclusion:

HRAFindings:

Mrs. Smith, Age 54Name:

UofM

NBH

Managing health risk improves productivity

Chronic IllnessAffects more than 1/3 of working-age Americans

Accounts for 75% of the nation’s annual health care costs

Accounts for 26% of STD episodes

Drives unscheduled absences

Source: NBGH 2006 Conference and Presentation (Kaiser Family Permanente, September 2005, Gartner, October 2005; CDC 2004 and 2005; Health, United States, 2005)

3Risks

1 Risk

2 Risks

Days Lost per Year

15

10

5

0

Source: Wayne, Burton, MD. IHPM North American Summit Meeting 2000

Health care Expenses are divided into two types:

Direct Costs

Indirect Costs

Conditions that lead to employees not being present at work (e.g. absenteeism, STD, workers’ comp)

Workers physically present at work, not fully engaged due to health problems or work/life issues (i.e. presenteeism)

Top 10 Conditions and their health care costs:

1. Hypertension $392 PEPY2. Heart Disease $368 PEPY3. Depression / Mental Illness $348 PEPY4. Arthritis $327 PEPY5. Allergy $271 PEPY6. Diabetes $257 PEPY7. Migraines / Headaches $214 PEPY8. Any Cancer $144 PEPY9. Respiratory $134 PEPY10. Asthma $100 PEPY

Condition Cost (per employee)

Condition Costs Beyond health claims Biometric Screening

• Performed on-site, complements HRA• Creates immediate awareness of health risks• Enables people to “know their numbers”• Identifies pre-diabetes and pre-hypertension• Encourages engagement with a health coach• Provides employer with de-identified total

population health risk assessment

Disease Management Programs

• Addresses need to manage chronic illness• Establishes advocacy for the patient• Empowers members• Assesses readiness for change and gaps in care• Proven ability to reduce risk• Results in “compression of morbidity”• Should not be limited to disease-specific issues

Avoiding Costsper member/per year

98%

Outcomes: Disease Management

0%

50%

100%

CardiacDisease $12,077

Following Physician’s Medication Regimen

Asthma $1,340

Diabetes $12,672

50%

Typical Compliance

Program Compliance

Source: 2005 Nationwide Better Health Outcomes and Cost avoidance model

9

10%

20%

30%

40%

50%

60%

70%

Diabetes Cardiac AsthmaCHF

52%

63%

40%

53%

16%

32%

45%

54%

48%

64%

29%

52%

% o

f Mem

bers

Pre-Program

Post-Program

A – Controlled HbA1cB – Controlled Blood PressureC – Controlled Blood Pressure

D – Desirable LDL LevelsE – Compliant with Daily WeightsF – Compliant with Peak Flow

A B C D E F

Source: NBH 2005 Disease Management Outcomes.

Disease Management Outcomes What Gets in the way of progress?

• Behavioral health is an obstacle• Leading cause of workplace absence and

disability• 36 million lost work days annually• Depression is the leading cause of lost

Disability Adjusted Life Years (DALYs) – 11%• Alcohol use disorders is 3rd leading cause

of DALYs – 5%• Drug use, self-inflicted injury and violence

account for an additional 5%Sources: McKinsey Report to Ohio Business Roundtable – Nov 2007World Health Organization report on Global burden of disease

• In the United States, more than 70% of people diagnosed with depression are employed and depression amounts to “400 million” lost work days a year(Source: Keith Dixon, Ph.D., President Cigna Behavioral Health)

• The economic cost (for depression) is a staggering $51.5 Billion a year in lost productivity(PWMH partnership for workplace mental health)

• In the U.S., depressed employees use, on average $4,000/year of medical services versus less than $1,000/year for non depressed employees(Source: Keith Dixon)

Trends:Depression in the Workplace Today’s Model

Telephonic/OnlineConsulting

EAPNurse LineCoaching

HRA

Online or Paper-BasedBiometric ScreeningRetrospective Claims

AnalysisData Analytics

EngineROS Analytics

Automate IncentivesPredictive Modeling

Cost Trending

Incentive Programs

HSA/HRA CreditReduced Deductible

Non-Monetary AwardsMonetary Awards Work/Life Services

Resources/ReferralsChildcareEldercare

On-Site ????

AbsenceManagement

Disability Mgmt.Workers CompReturn-to-Work

DiseaseManagement

Case Management?? Chronically Ill

ComprehensivePopulation Health

Program

Healthcare ContentWeb Portal

Plan InformationDiet/Nutrition Content

WellnessInterventions

On-Site FitnessOn-Site Medical

Smoking CessationObesity

With all the tools available, how easy is it for the member to navigate?

Source: 2007 NDC Annual Conference Materials

Putting it All Together

Consumer Driven Health Plans and Prescription

Drug Design

Provider Cost and

Quality Information

Disease Management

and Wellness Programs

CDHC

Educationand

Decision-MakingTools

Benefitsstructure

Incentives Informationand tools

Consumerism

An integrated approach to reducing frequency and severity of disabilitiesSource: Hewitt & Associates, An Employer’s Guide To CDHC 2006, 2007 NDC Annual Conference Materials

Source: The McKinsey Quarterly, July 2007, 2007 NDC Annual Conference Materials

The Knowledge Age Begins: 2000 and beyond

• Open sourcing of information• Instant access to digital data worldwide• Global Medical economy now enabled• Knowledge means power• Age of “-Omics” has arrived• Consumerism embraces knowledge• Cultural diversity aids in evolution of healthcare

10

Putting Knowledge to good use

• Health Care crossing the digital divide at last• Use of data to reward quality• Evidence based medicine (finally)• Technology advances:

– Genomics, Proteomics, Glycomics– Molecular imaging– Nano-medicine– Microelectromechanical systems (MEMS)

• Medical Homes and patient-centric care

Moving from Knowledge to Wisdom

• Electronic medical records• Personalized medicine• Integration of care• Apply technology to public health • Consumerism matures to enlightened self-

interest• Shared decision making• Realign incentives for providers, patients and

payers

Personalized Medicine

• Merging East and West• Physical, emotional and spiritual health linked• Shift from intervention to prevention• Predict and prevent technology• Continuous bio-monitoring• Gene slicing and DNA repair• Implants and drug delivery systems• Health Advocate Avatars

Strategy for managing health risk

• Embrace healthcare consumerism• Provide tools to assess and manage health risk

– Health Risk Assessments– Biometric Screening– Health Coaching– Disease Management

• Increase productivity while lowering healthcare costs

Assessing the Political Landscape

• Democrats:– Universal Access– More options to join government sponsored plans– Pay for all this by rescinding “tax breaks”

• Republicans:– Change the practice of medicine by realigning

incentives– Move from provider orientation to patient-centric care

emphasizing prevention and risk-reduction– Increase healthcare consumerism and market

competition

What the Candidates are Telling Us

• Coverage for all Americans is the top priority(mandatory vs. affordable)

• All consumers should have government plan options

• New coverage will be paid by rescinding tax cuts and reducing costs

• Providers will adopt IT and pay-for-performance(best practices)

Source: 2008 ACS Healthcare Solutions

Democrats favor universal access in directed markets

11

What the Candidates are Telling Us

• Stop focusing on payment and start focusing on patients

• Help consumers make informed choices• Encourage private companies offer alternative

coverage• Tax deductions transferred to individuals• Establish National health insurance policy to

encourage competition across State lines


Republicans favor free-market competition

What the Candidates aren’t Telling Us

• Consumers do not have resources to buy more coverage

• Enforcing purchase requirements is not politically palatable

• Governments do not have resources to subsidize more coverage

• Economy, infrastructure, education and defense require major investments


Neither incentives nor mandates guaranteepurchase of health insurance


• Clinical transformation and performance improvement are the keys to reform

• Health consumerism has the potential move from a “sick care system” to prevention and health

• Payers and purchasers must eliminate misaligned incentives

• Progress will come from pursuit of realistic shared, and measurable objectives


The good news: practical and proven solutions are available


Americans can be counted on to do the right thing…after they have exhausted all the other possibilities

WINSTON CHURCHILL

APPENDIX AU.S. v. Canadian Healthcare

Systems

Free Market Medicine v. Socialized Medicine

• Comparing U.S. and Canadian healthcare

• Debunking myths

12

The Myth of High Quality : Canada v. US

• Canadian life expectancy is two years longer than ours, implying that the health care systems of the two countries have something to do with that result. Yet doctors don't control our overeating, overdrinking, etc

• The percent of middle-aged Canadian women who have never had a mammogram is double the US rate

• The percent of Canadian women who have never had a pap smear is triple the US rate

• More than 8 in 10 Canadian males have never had a PSA test, compared with less than half of US males

• More than 9 in 10 Canadians have never had a colonoscopy, compared with 7 in 10 in the US

Obesity Rates

31%

17%

3%

33%

19%

3%

0%

10%

20%

30%

40%

U.S. Canada Japan

Men Women

U.S vs. Canada (BMI > 30)

Source: David Cutler, Ed Glaeser, Jesse Shapiro, Harvard University

Infant Mortality and Low Birth Weight

7.6

5.7

0

5

10

U.S. Canada *

* Rate of teenage mothers 3 times higher in Canada

Percent of Babies less than 2500 grams

Source: June and David O’Neill, Baruch College

Canadian v. US Healthcare quality

• These differences in screening may explain why US cancer patients do better than their Canadian counterparts. For example:– The mortality rate for prostate cancer is 18% higher in

Canada– The mortality rate for breast cancer is 25% higher in

Canada– The mortality rate for colorectal cancer among

Canadian men and women is about 13% higher than in the US

Canadian v. US Health Care

• Among senior citizens, the fraction of Canadians with asthma, hypertension, and diabetes who are not getting care is twice the rate in the US

• The fraction of Canadian seniors with coronary heart disease who are not being treated is nearly three times the US rate

APPENDIX BMedical Homes

13

Introduction to Medical Homes

• “creating access to the right health care,at the right time, in the right place”

A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.

Source: Access Health Columbus presentation

What is a Medical Home?

a regular provider or

place of care

care or advice available on weekends or

evenings

provider or place of care

can be reached by phone

office visitswell

organized & running on

time

What is a

Medical

Home?

Source: Commonwealth Fund 2006 Health Care Quality Survey

Medical Home Principles

Medical Home

Principles

Each patient has an ongoing relationship with a personal

physician trained to provide first-contact, continuous, and

comprehensive care

A personal physician leads a team of individuals at the practice level who collectively take responsibility for the

ongoing care of patients

Care is coordinated and/or integrated across all elements of the complex

health care system and the patient’s community

The personal physician is responsible for providing for all the patient’s

health care needs or taking responsibility for appropriately

arranging care with other qualified professionals

Source: Joint Principles of the Patient Centered Medical Home, February 2007; developed by American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association

Patients with a medical Home Report Better Coordination Between Their Regular Provider and

Specialist

Percent of adults ages 18-64 who have seen a specialist in past two years

Regular provider helped decide

who to see

Regular provider communicated with specialist about medical

history

After seeing specialist, regular provider seemed

up to date

Regular provider helped you understand

information from specialist care

73 77 8073

58 5865

51

0

25

50

75

100

Medical Home Regular source of care, not a medical home


The Majority of Adults with a Medical Home Always Get the Care They Need

Percent of adults ages 18-64 reporting always getting care they need when they need it


55

74

52

38

0

25

50

75

100

Total Medical home Regular source of care, not a medical

home

No regular source ofcare/ER

**

* Compared with medical home, differences remain statistically significant after adjusting for income or insurance.

Racial and Ethnic Differences in Getting Needed Medical Care Are Eliminated When Adults Have Medical Homes

74 74 76 74

52 53 52 5038 44

31 34

0

25

50

75

100

Total White African American Hispanic

Medical homeRegular source of care, not a medical homeNo regular source of care/ER

Percent of adults ages 18-64 reporting always getting care they need when they need it


14

Patients with Medical Homes—Whether Insured or Uninsured—Are Most Likely

to Receive Preventive Care Reminders

Percent of adults ages 18-64 receiving a reminder to schedule a preventive visit by doctor’s office


65 6753

47

30

17

0

25

50

75

100

Insured all year Any time uninsured

Medical HomeRegular source of care, not a medical homeNo regular source of care/ER

**

* Compared with medical home, differences are statistically significant.

Adults with a Medical Home Have Higher Rates of Counseling on Diet and Exercise Even When

Uninsured

Percent of obese or overweight adults ages 18-64 who were counseled on diet and exercise by doctor


8065

73 69

39 34

0

25

50

75

100

Insured all year Any time uninsured

Medical HomeRegular source of care, not a medical homeNo regular source of care/ER

* *

* Compared with medical home, differences are statistically significant.

APPENDIX CDemographic Changes


• U.S. POPULATION: New demands• Rapid cultural, racial, and ethnic diversification

(globalization)


Source: US Bureau of he Census, 2008 ACS Healthcare Solutions


Source: US Bureau of he Census, 2008 ACS Healthcare Solutions

200225250275300325350375400

1970 1980 1990 2000 2010 2020 2030 2040 2050

Immigrants & descendants since 1970Grow th from descendants of 1970 residents

POPULATION GROWTHProjected U.S. population growth if immigration and fertility do not change:

Total population in millions

Immigrants & descendants since 1970Growth from descendants of 1970 residents


• In 2002, 23% of all births in the United States were to immigrant mothers (legal or illegal), compared to 15% in 1990, 9% in 1980 and 6% in 1970

• Even at the peak of the last great wave of immigration in 1910, the share of births to immigrant mothers did not reach the level of today. And after 1910 immigration was reduced, whereas current immigration continues at record levels, thus births to immigrants will continue to increase.

Source: Center for Immigration Studies, 2008 ACS Healthcare Solutions

Births to Immigrants at All-Tim HighNearly ¼ of Mothers are Foreign-Born

15

Summary Forecast and Observations

• From “one-size-fits all” toward personalized molecular medicine

• From “hands on” medicine toward more virtual care

• From public directives toward private sector initiatives

• From paternalistic insurance toward individual responsibility


Health Care undergoing dramatic shifts in balance (not total transformation)


• Slower than desired by reformers, faster than expected by others

• Providers as the rate-limiting factor• Payers as the necessary catalyst for

meaningful progress


Health Care will develop unevenly over next few years


• Scenarios for improvement greater than prospects for decline

• Old problems solved will exceed new problems created

• Eliminating waste is a manageable path to survival and growth

• Digital transformation of health care creates the light at the end of the tunnel


Health Care becoming different, diverse, and generally better


• At best, candidates’ plans set the stage for subsequent discussion

• Only legislatures can change the laws guiding health care

• Legislative outcomes do not reflect campaign promises

• Issue pre-emption by opponents is common(Medicare D)


Presidential candidates’ health plans do not get implemented as proposed


• Supply of practitioners is insufficient to meet increased demand

• Many practitioners do not accept many health plans

• Future supply of practitioners is not tied to changes in coverage

• Cultural, racial, and ethnic barriers are a growing problem


Insurance Coverage does not guarantee access to health professionals


• Choices must be made when resources are limited

• Today’s real political challenge is making necessary trade-offs

• Progress requires a consensus on priorities for health care

• Change will be slow, difficult, and uneven over next decade


Lower costs, higher quality, and universal access are mutually exclusive

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“30% of all direct health care outlays today are the result of poor-quality care, consisting primarily of over use, misuse,

and waste”

By:Midwest Business Group on HealthIn collaboration withJuran Institute, Inc.The Severyn Group, Inc.

Reducing the Cost of Poor-Quality Health CareThrough Responsible Purchasing Leadership


Reducing Waste in US Health Care Systems

Reducing Waste in US Health Care SystemsRoger W. Bush, MD

JAMA. 2007;297:871-874.

An epidemic of waste blights the US health care delivery system. Despite a huge dedication of resources to health care in the United States, the medical system does not deliver safe, effective, efficient, patient-centered, timely, and equitable care as recommended by the Institute of Medicine.1

Specifically, the US health care system is not safe: 50 000 to 100 000 or more lives are lost each year because of medical error,2 and 42% of respondents to a public survey reported experience with poorly coordinated, inefficient, or unsafe care.3

The system is not effective: 45% of recommended care is not provided, without regard to presence or type of insurance payment,4 and Medicare and Medicaid, which pay for about half of the compensated care in this country, do not significantly reward higher-quality care outcomes or clinicians.

47 Million Uninsured

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18

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5

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15

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Illegal Alien Income > $50,000 Under Age 35 Eligible for Medicaid but have

not applied

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managing the biggest risk all employers face: employee health … · 2019-08-09 · 2 american...

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