CIA Annual MeetingCIA Annual MeetingSession 3203Session 3203

Measuring Wellness: The Issues?Measuring Wellness: The Issues?

Tom BroganPresident

June 28th, 2005

Ever evolving environmentEver evolving environment

• Labour shortages

• Changes to retirement law

• Two-tier health care

Court decision

Public opinion

Journalistic bias

Health & WellnessHealth & Wellness

Health is a state of complete physical,

mental, and social well-being and not

merely the absence of disease and infirmity.

World Health Organization Constitution, 1948

Wellness PerceptionWellness Perception

Survival

Freedomfrom

disease

Ability to perform daily

activities

Qualityof

Life

Shift aw

ay in

view

ing h

ealth

From

QUANTIT

Y to Q

UALITY

Measures:• Infant mortality• Life expectancy

Wellness PerceptionWellness Perception

Survival

Freedomfrom

disease

Ability to perform daily

activities

Qualityof

Life

Shift aw

ay in

view

ing h

ealth

From

QUANTIT

Y to Q

UALITY

Measures:• Prevalence Rates• Incidence rates• Clinical outcomes

Wellness PerceptionWellness Perception

Survival

Freedomfrom

disease

Ability to perform daily

activities

Qualityof

Life

Shift aw

ay in

view

ing h

ealth

From

QUANTIT

Y to Q

UALITY

Measures:• Productivity Loss• Absenteeism• Disability

Wellness PerceptionWellness Perception

Survival

Freedomfrom

disease

Ability to perform daily

activities

Qualityof

Life

Shift aw

ay in

view

ing h

ealth

From

QUANTIT

Y to Q

UALITY

Subjective Measures obtained through questionnaires

Measuring Quality of LifeMeasuring Quality of Life

• Quality of life measurements through structured questionnaires

• Various instruments developed:

World Health Organization: WHOQOL

EuroQol

SF-36, etc.

Measuring Wellness:Measuring Wellness:Conditions do applyConditions do apply

• Current state of health

The ill - need treatment

The healthy - need prevention

Top10%

=56%of

Cost

Cost ConcentrationCost Concentration

0%

20%

40%

60%

80%

100%

5% 10%

15%

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Private Drug Plans 2004 ODB 2004/05

Cost per ClaimantPDP: $3,866ODB: $8,446

From most expensive to less expensive claimants

Source: BROGAN INC. Private Drug Plans Database

Defining Wellness:Defining Wellness:Conditions do applyConditions do apply

• Current state of health

The ill - need treatment

The healthy - need prevention

• Age

• Economic status

• Location

Is health care providing wellness?Is health care providing wellness?

• Drugs

Can improve wellness

Reduce morbidity, mortality

Provide economic benefits

Not the sole answer (perhaps not the most

important solution)

$0

$10

$20

$30

$40

92/93

93/94

94/95

95/96

96/97

97/98

98/99

99/00

# Deaths

0

500

1,000

1,500

Drug Cost

Drug Costs Deaths

Reduced Mortality, HIVAIDSReduced Mortality, HIVAIDS

Source: BROGAN INC. Ontario Drug Plan

Reduction in Hospital UtilizationReduction in Hospital Utilizationfor Asthma 1990-2000for Asthma 1990-2000

-61%

-24%

-48%

-70%

-60%

-50%

-40%

-30%

-20%

-10%

0%

Hospitalizations Days of Stay Avg. Length ofStay

% R

isk

Red

uct

ion

Source: Innovation Crossroads – The health and economic value of new medicines, GSK

Age Standardized Mortality Rate Age Standardized Mortality Rate per 100,000 Men, Canada, 1969-1997per 100,000 Men, Canada, 1969-1997

0

100

200

300

400

500

600

7001

96

9

19

71

19

73

19

75

19

77

19

79

19

81

19

83

19

85

19

87

19

89

19

91

19

93

19

95

19

97

Cardiovascular Disease

Ischemic Heart DiseaseAcute MI

Source: The Changing Face of Heart Disease and Stroke in Canada, 2000

Reduced Risk with 1% ReductionReduced Risk with 1% Reductionin Blood Glucose Levelsin Blood Glucose Levels

25%

16%

24% 21%

33%

12%

0%

5%

10%

15%

20%

25%

30%

35%

Anydiabetes-

relatedMicro-

vascularMyocardialinfarction

CataractExtraction

Retinopathy12 Years

Micro-albuminuria

12 years

% R

isk

Red

uct

ion

Source: Innovation Crossroads – The health and economic value of new medicines, GSK

Age-standardized breast cancer incidence and Age-standardized breast cancer incidence and mortality rates, Canada, 1985 to 1999mortality rates, Canada, 1985 to 1999

2735

0

20

40

60

80

100

12019

85

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Incidence Mortality

Source: Statistic Canada, Health Reports Vol. 15, No. 2

Wellness…Wellness…Why should we care?Why should we care?

• Cost to clients, employers, society

Lost work time

Premature mortality, morbidity

Burden of IllnessBurden of IllnessSelected Medical ConditionsSelected Medical Conditions

$0B $5B $10B $15B $20B

Cardiovascular Diseases

Musculoskeletal Diseases

Cancer

Injuries

Respiratory Diseases

Mental Disorders

Digeestive Diseases

Direct Costs

Indirect Costs

Source: Health Canada, 1998

Wellness…Wellness…Why should we care?Why should we care?

• Cost to clients, employers, society

Lost work time

Premature mortality, morbidity

• Business opportunity

• Social obligation

• Urgent need

Cannot count on government

Measuring Wellness…Measuring Wellness…It’s all a matter of perspectiveIt’s all a matter of perspective

• Employee

• Employer

• Insurer/Third Party Administrator

• Public sector health care system

• Recipient/Beneficiary: Age

Current health status

Socio-economic status, etc.

GivenFrom

InsurerPerspective

How can you influence health?How can you influence health?

• Biological factors

• Lifestyle choices

• Environmental conditions

• Health care system

Prevention

TreatmentDeterminants of Health, Page 9, Romanow Report

Health care componentsHealth care components ~ all as important ~ ~ all as important ~

Each condition requires different actions:

• Life-style choices:

Healthy living, smoking, obesity, etc.

• Physicians/Testing:

Compliance, early detection (ex. PSA)

• Drug therapy:

Ex. Diabetes, RA, High-Cholesterol etc.

• Hospitals:

Injuries, surgeries, etc.

Role of InsurersRole of Insurers

• Break cost containment philosophy, silo

thinking: move to economic value

• Health & Wellness = more costs:

Tests, drugs, treatments, monitoring, etc.

More aggressive treatment

• Results hard to measure, benefits hard to

quantify

Role of InsurersRole of Insurers

• Promote aggressive treatment

• Incentives for healthy living

• Incentives for prevention and early action

• Incentives for compliance

• More member education

Wellness…Wellness…answering the basic questionsanswering the basic questions

• Wellness - operational definition required

• Philosophical issues

Investment or cost

Degree of intervention

• Wellness has economic benefits

• Innovative programs required - courage and

persistency demanded