sacramento county no. 0451271 license no. 0451271 innovative solutions. enduring principles. ......

License No. 0451271 License No. 0451271 Innovative Solutions. Enduring Principles.

Sacramento County Keenan’s Strategies for Designing Effective

Total Population Health Management Programs

Presented on: April 26, 2017

License No. 0451271 Innovative Solutions. Enduring Principles.2

Higher Risks = Higher Cost

Risk Factors Related to Increased Health Care Cost

At High Risk For ...Average Annual Higher HC Cost

% Higher HC Cost

Depression $2,184 48.0%

High Blood Glucose $1,653 31.8%

High Blood Pressure $1,378 31.6%

Obesity $1,091 27.4%

Tobacco Use $587 16.3%

Physical Inactivity $606 15.3%

High Stress $413 8.6%

Source: Goetzel et al., 2012


Workers with chronic conditions and/or 3+ health risk factors (e.g., obesity, smoking,

physical inactivity, high BP, high cholesterol, etc.) tend to have significantly higher rates of

health-related lost productivity through absenteeism (missed work days) and

presenteeism (unproductive work days) (Mitchell & Bates, 2011)

Annual Lost Productivity By Chronic Conditions and Risk Level

GroupAverage % of

Workforce

Mean Annual Health-Related Absentee Days Per Ee

(Absenteeism)

Mean Annual Health-Related Unproductive Days Per Ee

(Presenteeism)

Condition Level

No conditions 45% 1.4 3.7

1 condition 29% 1.9 7.9

2+ conditions 27% 3.0 20.1

Risk Level

Low (0-2 risks) 68% 1.6 5.1

Medium (3-4 risks) 21% 2.4 12.9

High (5+ risks) 10% 3.6 28.9

Source: Mitchell & Bates, 2011

Chronic Conditions & Increased Risk Factors = Unproductive Employees


Much of What Causes Chronic Conditions Is Avoidable

Eight modifiable risk factors are associated with 15 chronic conditions that account for

80% of total medical costs for chronic illnesses. (World Economic Forum, 2010)

Accounting for 80% of total costs for chronic illnesses

1. Diabetes

2. Coronary Artery Disease

3. Hypertension

4. Back Pain

5. Obesity

6. Cancer

7. Asthma

8. Arthritis

9. Allergies

10. Sinusitis

11. Depression

12. Congestive Heart Failure

13. Lung Disease (COPD)

14. Kidney Disease

15. High Cholesterol

Chronic Conditions

Poor Diet

Excessive

Alcohol

Consumption

Insufficient

Sleep

Poor Standard

of Care

Poor Stress

Management

Lack of Health

Screening

Smoking

Physical

Inactivity

Modifiable

Risk Factors


How does obesity affect Workers’ Compensation (WC) Cost?

Duke University - 2007 Landmark Study

• Obese workers filed 2xs the number of WC claims as their

counterparts

• Medical costs 7xs higher

• Missed 13xs more days of work

• Body parts most prone to injury for obese individuals included lower

extremities, wrists or hands, and the back. Most common injuries were

slips and falls, and lifting.

Costs to U.S. businesses

related to obesity exceed

$13 billion annually

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjG26Lh8f3PAhUNy2MKHYc7BqkQjRwIBw&url=http://www.johnstonefitness.com/2012/01/11/fat-loss-101-the-scale-is-not-nearly-as-important-as-you-may-think/&psig=AFQjCNGLD00rD4bHZ1UuoTk3ijsmQ9_pJA&ust=1477757457754593

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjG26Lh8f3PAhUNy2MKHYc7BqkQjRwIBw&url=http://www.johnstonefitness.com/2012/01/11/fat-loss-101-the-scale-is-not-nearly-as-important-as-you-may-think/&psig=AFQjCNGLD00rD4bHZ1UuoTk3ijsmQ9_pJA&ust=1477757457754593


ROI for Health Management Programs

1. Source: Aldana, SG, Financial impact of health promotion programs: a comprehensive review of the literature, American Journal of Health Promotion, 2001, volume 15:5: pages 296-320.2. Source: Aldana, SG, Financial impact of health promotion programs: a comprehensive review of the literature, American Journal of Health Promotion, 2001, volume 15:5: pages 296-320.3. Source: Chapman, LS, Meta-evaluation of worksite health promotion economic return studies, Art of Health Promotion, 2003, 6:6, pages 1-16.4. Source: Chapman, LS, Meta-evaluation of worksite health promotion economic return studies: 2005 Update Art of Health Promotion, 2005, p. 1-16.


• Only a small proportion of employers utilize all the health management

program components required for successful programs. (Goetzel & Ozminkowski, 2008;

bswift, 2013; Goetzel et al., 2014 )

• Many well-intentioned health management programs are “poorly designed,

executed in a haphazard fashion, do not follow evidence-based best

practices, are not evidence-based, are inadequately resourced, are not

culturally supported, and are therefore not effective.” (Goetzel et al., 2014)

• “Comprehensive” health management programs are effective, while those

characterized as “random acts of wellness” (such as simply administering a

health risk assessment and/or offering a wellness website are generally

ineffective. (Goetzel et al., 2014)

Why Are Some Health Management Programs Missing the Mark?


• “Off-the-shelf” programs provided through health care carriers or third-

party vendors also fail if they lack leadership support and are not

integrated into the culture of an organization. (Goetzel et al., 2014)

• A recent study showed that to attain a wellness program participation rate

of at least 50%, companies that lack organizational commitment to

establishing a culture of health and that don’t have strong communications

and branding will need to provide an incentive that’s 300% higher in cash

value than companies having those two critical attributes. (Loeppke et al., 2013)


The Population Health Continuum

Source: Based on Kaiser Family calculations using data from the USDHHS Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2010


What Is Total Population Health Management (TPHM)?

Definition:

An integrated, coordinated set of individual, organizational,

and cultural initiatives that focus on the health needs of a

defined population at all points along the health continuum

Goal:

To maintain, improve, and manage the health and well-being

of individuals through cost-effective and tailored health

solutions


Population Health Management

Data Sharing and Coordination

Pharmacy Management

Health Assessment

Wellness Program

High-Risk Case Management

The Integrated Population Health Management Model

Workers Compensation

Program

Biometric Screening

Vision Program

Condition Management

Employee Assistance Program

Dental Program


Best Practices for

Population Health Management

I. Secure Organizational Commitment and Support

II. Assess and Stratify the Population Based on Risk for Chronic

Conditions and Associated Costs

III. Develop a Comprehensive, Integrated Multi-Year Strategic Plan

with Risk-Targeted Interventions

IV. Engage Members Through Effective Incentive and Promotional

Strategies

V. Engage Providers to Co-Manage Member Health and Fill Gaps in

Care

VI. Evaluate PHM Program Outcomes

VII. Modify the Program Based on Evaluation and Re-Assessment

Sources: Goetzel & Ozminkowski, 2008; Baicker et al., 2010; Berry et al., 2010; The Advisory Board Company, 2010; O’Donnell & Bensky, 2011; Gallup-Healthways, 2011; Aldana et al., 2012; Chapman, 2012; Gavin, 2012; Terry et al., 2013; Loepke et al., 2013; bswift, 2013; World Economic Forum, 2013; Mulhausen, 2014; HERO, 2014; Goetzel et al., 2014


Strategies for Effective Health Management Programs

• Consider the full continuum of health management to achieve and maintain optimal health and productivity across the entire workforce.

• Keep healthy people well, and help those whose health has been impaired

move to an optimal level of wellness.

• Apply best-practice population health management strategies that have proven effective in engaging employees and their dependents, while responding to the unique characteristics and needs of the organization.

• Obtain organizational and leadership support to ensure sustainability and credibility.

• Coordinate and integrate internal and external wellness resources, for a more consistent and effective program.


Strategies for Effective Health Management Programs

• Provide a program that achieves a return on investment (ROI) for the organization through improved health and productivity.

• Use targeted, multi-media communications to employees that provide continuity and consistency across the wellness program components.

• Create a culture of wellness that supports employee health, well-being, and quality of life.

• Evaluate program effectiveness to further refine the program and improve outcomes.


Challenges in Conducting Population Health Management

• Worksite Culture and Environment

• Resistance to Change

• Privacy and Confidentiality

• Data Sharing: Coordination, Protection, and BAAs

• Rules, Regulations, and Legal Issues

• Cost

• Measuring Effectiveness (ROI)


Common Health Management Program Components

• Health Screenings

- Biometric screenings (blood pressure, body fat, blood lipids, glucose)

- Preventive health screenings (physicals, mammogram, colonoscopy, immunizations)

• Health Assessment

• E-Health Website (education, self-management tools)

• Health Coaching (onsite, online, telephonic)

• Wellness Challenges and Campaigns (online, onsite)

• Onsite Facilities (fitness classes, onsite gym)

• Other (flu shots, massage therapy, etc.)

• Integration with Other Health Management Programs

- Condition management

- Workers Compensation

- Employee Assistance Program

- Health and Safety

• Incentives


Low to No Cost Health Management Program Components

• Wellness Committee and Champions

• Internal Resources/Campaigns

• Carrier/Vendor Resources

• Community Based Resources (American Heart Association, American Diabetes Association, etc.)

• Healthy Policies (Healthy Meeting, Vending Machine, Walking Meeting, Ergonomic)

• Walking Groups/Trails


Use of Carrier vs. Third Party Wellness Program Resources

• Limitations in PHM services and customization available from health care carriers, but pricing could be lower than with third-party vendors

• Health care carriers may provide “seed funding” for PHM initiatives

• “Seed funding” often comes with “strings attached”

• Very limited or no access to medical, pharmacy, or participant data

• PHM data analytics and reporting are limited

Third Party Wellness Program Resources

• Flexibility in contracting for customized, best-fit PHM services

• One comprehensive program for all employees (simplified message)

• Full access (through broker) to health and participation data

• Able to obtain custom PHM data analytics and reporting

• Are often more costly

Carrier Wellness Program Resources


Incentive Options

Prizes

• Immediate gratification

• Participant-perceived value: low to moderate

• Tends to drive enrollment and completion in programs, not as effective in behavior change

• Some prizes may be taxable

Gift Cards/Checks

• Immediate to long-term gratification

• Participant-perceived value—varies on dollar amount

• Tends to drive enrollment and completion in programs, not as effective in behavior change

•Taxable to the employee

Premium Differential, Deductibles/ Co-Pays

• Long-term gratification

• Participant-perceived value: high

• Non-taxable

• Can drive long-term engagement, as it ties s participation directly to the health plan


Participation & Outcome-Based Combination (Example)

Required Activities to Earn Wellness Participant Rate Timeframe

Complete an onsite Biometric Screening January – August

Complete an online Health Assessment January – August

Complete 100 Wellness Points January – August

Wellness Points Options (Sample of Outcome Based)

Qualifying Wellness Activity Points Earned Max Points

Health Coaching (Lifestyle and Condition Management) 20 pts per completed goal 100

HealthTrails™ Online Challenge 20 pts per 100 miles 40

Colorful Choices™ Online Challenge 20 pts per 100 produce points 40

Preventive Care Exam (Medical, Dental, Vision) 10 pts per exam 20

Body Mass Index (BMI) of < 30 (Example of a Benchmark for an Outcome Based Program) 20 pts per biometric value 20

Blood pressure of < 120 AND < 80 mmHg

(Example of a Benchmark for an Outcome Based Program)20 pts per biometric value 20

Glucose of 60-99 (Example of a Benchmark for an Outcome Based Program) 20 pts per biometric value 20

Total Cholesterol of < 199 OR TC:HDL Ratio of < 4.0

(Example of a Benchmark for an Outcome Based Program)20 pts per biometric value 20

Premium Adjustments Or Account Based Rewards

January through Dec for Following YearIndexable

(Sliding Scale Based On Points Earned)

Participation and Outcomes-Based Wellness Incentives Example


3-Phase Health Management Program Model

Phase I – 2017 (Current) Phase 2 – 2018 Phase 3 – 2019

Features • Limited-scope wellness program• Program branding• Utilization of carrier resources

• Launch of expanded health management program• Focus on building awareness of the extensive program

offerings and the premium-based incentive design• Participation in 2018 = wellness rate for medical

premium in 2019• Tobacco use surcharge

• Addition of health coaching to the wellness component

• Intensive communications campaign to highlight health coaching services and the premium-based incentive design

• Participation in 2019 = wellness rate for medical premium in 2020

Components • Biometric screening (Sutter Health)• Wellness platform (Sutter Health)o Health assessments

• Wellness challenges (HES)• Onsite wellness workshops (Carriers)• Condition management (Carriers)• Healthy policies• Wellness committee and champions

• Biometric screening (Sutter Health)• Wellness platform (Sutter Health)o Health assessmentso Wellness challenges

• Onsite wellness workshops (Carriers)• Condition management (Carriers)• Healthy policies• Wellness committee and champions

• Biometric screening (Sutter Health)• Wellness platform (Sutter Health)o Health assessmentso Wellness challengeso Health coaching

• Onsite wellness workshops (Carriers)• Condition management (Carriers)• Healthy policies• Wellness committee and champions

Incentives Incentives Focused on Participation:

• Raffles for gift cards and prizes for participating in the various wellness activities

Sample Incentives Focused on Participation & TobaccoFree:

• Receive a wellness medical premium rate ($50/mo lower than the non-wellness rate) in 2019 for meeting wellness program requirements during 2018 for:1) Completing an onsite biometric screening2) Completing an online health assessment3) Earning 100 Wellness Points

• $50/mo Tobacco Use Surcharge5

Sample Incentives Focused on Participation, Risk Reduction, & Tobacco Free:

• Receive a wellness medical premium rate ($50/mo lower than the non-wellness rate) in 2020 for meeting wellness program requirements during 2019 for:1) Completing an onsite biometric screening2) Completing an online health assessment3) Earning 280 Wellness Points

• $50/mo Tobacco Use Surcharge5

Program Cost Examples

• Biometric screening: $35/pp x 500 Ees1= $17,500• Online wellness platform: $7.53 x 500 Ees1 = $3,765• Consultant and Incentive Costs =?

• Biometric screening: $35/pp x 4,000 Ees2 = $140,000• Online wellness platform: $7.53 x 4,000 Ees2 = $29,400• Consultant and Incentive Costs =?

• Biometric screening: $35/pp x 6,000 Ees3= $210,000• Online wellness platform: $7.53 x 6,000 Ees3= $45,180

• Health coaching: $150,000 (preliminary estimate)4

• Consultant and Incentive Costs =?

ExampleRevenue Offsets1

None –Carrier generosity • Sample Tobacco Surcharge (8% tob users): $50 x 800 Ees x 12 mos = $480,000

• Sample Tobacco Surcharge (7% tob users): $50 x 700 Ees x 12 mos = $420,000

• Sample Non-Wellness Monthly Medical Premium Surcharge: $50 x 6,000 x 12mos = $3,600,000

1 Based on 5% participation 2 Based on 40% participation 3 Based on 60% participation 4 Based on 10% participation 5 Waived if tobacco user completes a tobacco cessation program


Employer: City of FairfieldBenefits Plan: Fully Insured Eligible Population: 700 EesYear Full Program Was Established: 2013

Best-Practice Program Components (I,III,IV,VI,VII):

Strong leadership commitment and involvement

Onsite biometric screening (yearly) by Kaiser

Online personal health assessment (yearly) via Kaiser, Western Health Advantage, Sutter Health

Carrier claims analysis to identify high-cost, high-prevalence conditions

Multi-year, comprehensive strategic plan, with program integration

Behavior change activity tied to creative incentive structure

Use of EAP resources for wellness seminars

Online wellness resources/activities through the Kaiser HEP and WHA platforms, and through Health Enhancement Systems (HES) for wellness challenges

Onsite activities: wellness challenges, health education classes, social outings

Program evaluation

PHM Case Study


Incentive Design:• Activity-based participatory design • $300/yr lower premium contribution for:

a) Completing a biometric screening b) Personal health assessmentc) Completing 2 City of Fairfield approved wellness activities

• Opportunity drawings for participating in wellness challenges (chance for non-benefitted Ees to earn rewards)

Results: • Participants with a BMI >25 decreased from 72% (2012) to 69% (2014)• Participants with a cholesterol score >200 decreased from 36% (2012) to 34% (2014) • Female participants receiving recommended mammograms increased from 77% (2012) to 91%

(2014)• Received American Heart Association’s Fit Friendly Company Gold Award in 2014 & 2015

PHM Case Study


Questions ?

sacramento county no. 0451271 license no. 0451271 innovative solutions. enduring principles. ......

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