september 10th, 2019 presented by | brianna jacque and ... · today’s presentation –what it is...
TRANSCRIPT
Population Health Management From An Analytical Perspective
September 10th, 2019 Presented by | Brianna Jacque and Craig Herbst
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TODAY’S PRESENTATION – WHAT IT IS AND IS NOT
What it is not
• A disparaging review of Population Health strategies as a means to control costs. Far from it. These strategies, when implemented well, really help reduce trend and improve people’s health.
What it is
• A balanced analytical view of:
• Best practices
• Potential obstacles
• ROI calculation & reasonable limitations
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TODAY’S AGENDA
1. What is it? 2. Potential pitfalls –Math & human behavior
3. Best practices 4. ROI thoughts
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THE “ACADEMIC” DEFINITION
Academic Definition: Population Health Management is the aggregation of patient data across multiple health information technology resources, the analysis of that data into a single, actionable patient record, and the actions through which care providers can improve both clinical and financial outcomes.
• Flowery language – sounds good
• Not real specific
• Unclear how to achieve
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THE PRACTICAL GOALS
1. Get members to maximize cost & quality when seeking care in the immediate term.
2. Ensure chronic conditions are managed as to not lead to unnecessary utilization & cost.
3. Engage members to maintain and/or improve a healthy lifestyle as measured by drivers of medical spend.
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POPULATION HEALTH MANAGEMENT ON A PROSPECTIVE ROI TIMELINE
Now – 0-2 Months
•Case Management
•Cost/Quality Steerage
•2nd Opinions
•Readmission Avoidance
Intermediate Term –2 Months to 2 Years
•Chronic Condition Care Compliance
•Medication Adherence
Long Term – 2 Years+
•Biometric wellness programs
•Lifestyle management programs
Cost/Quality Programs
Benefits are realized in more immediate term.
Advocacy
Transparency
Critical Event Management
Health Cost Estimator
Telemedicine & NurseLine
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TODAY’S AGENDA
1. What is it? 2. Potential pitfalls –Math & human Behavior
3. Best practices 4. ROI thoughts
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POTENTIAL PROGRAM ROI PITFALLS – AN ANALYTICAL PERSPECTIVE
Top 5 ROI Deluders and
Derailers
Employee Turnover
Participation –Selection Bias
Fully Insured vs. Self Funded
Measurement Methodology
Total Investment –Program + Payroll
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EMPLOYEE TURNOVER
• Will they be around for you to recoup your investment?
• The cost of implementing a population health strategy is immediate. However, the savings will likely come further down the road.
• In companies/industries with high turnover, an ROI may be tougher to get given a large number of employees may no be with the company.
• Be sure to investigate turnover by tenure.
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WHO’S PARTICIPATING?
• Nationally, the top 5% of claimants account for about 50% of medical spend.• To have any meaningful impact, the highest risk individuals have to actively participate
to “move the needle” – 80/20 rule.• Measuring how many of the highest risk are engaging is one of the most important
statistics in determining success.
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MEASURING SUCCESS
• Focus on the true drivers of cost over time using evidenced-based medicine.
• Track non-compliant individuals & non-participants and compare.
• Break out repeat participants vs. new participants.
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FULLY INSURED HEALTH PLANS
27.9%31.2%
39.5%
49.7%
56.9%62.3%
69.9%74.9%
78.5%
87.5%91.2% 93.2% 95.3% 96.4% 97.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
5 10 25 50 75 100 150 200 250 500 750 1,000 1,500 2,000 2,500
SOA Credibility By Group Size (in Members)
• Beware of the actuarial credibility problem • Credibility – The amount of a group’s own claims experience that is used in
developing their fully insured rates.• The remaining percentage used is the carrier’s overall book of business.
• The risk is for smaller fully-insured groups because any progress they make, in terms of claims prevention, may not be fully reflected in their renewals thus diluting their ROI.
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ACCOUNTING FOR TOTAL COST
• Many companies only include the program costs and not total costs.
• In calculating the total investment, don’t forget to include paycheck incentives.
• This often is the largest part of any investment.
Participants 1,000
Program Cost Per Person $150
Monthly Incentive $50
Cost % of Total Cost
Program Costs $150,000 20%
Incentive Costs $600,000 80%
Total Costs $750,000 100%
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TODAY’S AGENDA
1. What is it? 2. Potential pitfalls –Math & human Behavior
3. Best practices 4. ROI thoughts
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DEFINE YOUR OBJECTIVE
What are you trying to accomplish with your health management strategy?
1. A program designed to be an employee benefit
2. A cost management initiative
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IF YOUR OBJECTIVE IS AN EMPLOYEE BENEFIT
PHYSICA L HEALTH
• Daily Habit Tracking• Biometrics/HRA• Health Coaching• Condition Management• Webinars• Device Integration• Wellness Challenges
EMPLOY E E ENG AGE M EN T
• Training & Development• Continuing Education• Employee Recognition• Mentorships• Annual Company Survey
SOCIAL & EMO TION AL HEALTH
• Volunteering• Donate Blood/Platelets• Community Fitness Event
(5K, Intramurals, etc.) • Financial Wellness• Stress Management
Training
ENG AGED BENEF IT S
• Primary/Preventative Care• Dental Visit• Meet with Enrollment Rep• EAP Resources• Receive 401k Match
• Don’t expect an ROI as there will likely be none (big selection bias likely)
• Focus on programming that is:• Fun• Flexible• Engaging
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IF YOUR OBJECTIVE IS A COST REDUCTION INITIATIVE
Key Tenets of a Successful Program:
1. Include meaningful incentives/penalties that focus on results and/or
improvement
2. Combine multiple data sources to improve risk identification – biometrics,
claims, utilization review, etc.
3. Measure & track cost drivers – biometrics, care compliance, migration, etc.
4. Track repeat and non-participants year-over-year
5. Give appropriate tools for members to engage
6. Remove barriers – Communication is key
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TODAY’S AGENDA
1. What is it? 2. Potential pitfalls –Math & human behavior
3. Best practices 4. ROI thoughts
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TANGIBLE ROI VISIBILITY BY PROGRAM
Case management, telemedicine &
cost/quality tools
Mandatory disease management
Biometric wellness
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ROI COMPARISON & CONTRAST
Timeline Programs Calculating ROI Examples Complicating Variables
Short-Term0-2 Months
• Cost/Quality Tools• Case Management• 2nd Opinion Services• Telemedicine
Difficulty: Less Difficult
Return = Dollar value of utilization steered (ER, elective surgeries steered or eliminated, etc.)
Investment = Cost of programs plus any incentives
• Not too many, potentially attributing savings to the programs that people would have done on their own
Intermediate-Term2 Months – 2 Years
• Disease Management Difficulty: More Difficult
Return = Dollar value of reduction in E.R. & inpatient stays related to non-compliance of care
Investment = Cost of programs plus any incentives
• Not too many, potentially attributing savings to the programs that people would have done on their own
• Prior health history• Demographics• Random luck in a given year
Long-Term2+ Years
• Biometric Wellness• Employee
Engagement Tools
Difficulty: Most Difficult
Return = While a bit tough to calculate in the short-term, it’s a bet that health maintenance & improvement over time will yield trend reductions
Investment = Cost of programs plus any incentives
• Regulatory Environment – Can you incent?
• Longer-term bet• Turnover• Health plan financing
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TAKEAWAYS FOR TODAY
1. Be honest on what you want your program to accomplish
2. Measure what counts
3. Be aware of the deluders & derailers
4. Your investment in population health management is likely greater than you may realize
Craig HerbstCottingham & Butler Employee Benefits
563-587-6461 – direct
Brianna JacqueCottingham & Butler Employee Benefits
563-587-5035 – direct
QUESTIONS?