Schaller AndersonPresents to

March 8, 2006

Today’s Objectives

• Let’s talk about our teachers and school workers and their health care

• Do you know WHO is driving your health care costs?

• How do we know this?• What can we do about it? • What are the essential components of

an ideal health care program?

Health: The Human Capitol Multiplier

Your employees can be: • The best-trained

• The most highly skilled

• The best equipped

• And work in the best supportive environment…

BUT if they are not healthy,

productivity and performance suffer

Major Causes of Lost Productivity

• Musculoskeletal problems like back pain, arthritis

• Mental health conditions like depression and anxiety and stress

• Pregnancy• Respiratory conditions like asthma and

allergies

What Happens To Us At Work? (Occupational Morbidity)

• February, 2006 study to rank all U.S. occupations assessing days of restricted activity, bed rest and missed work, medical claims, reported health status

• Of the 206 largest occupational groups in the U.S., – Social workers are ranked #1

– Floor buffers/polishers are #4

– Administrators/officials are #23

– Special education teachers are #25

– Counselors are #29

– TEACHERS are #61

These are ranked higher than police, machinists, welders, taxi drivers, nurses, plumbers and waiters out of 206 occupations

Key Workforce Strategies

1. Primary prevention of problems in the first place: health improvement, disease prevention, well care, worksite wellness policies and programs

2. Impact reduction strategies like case and disease management, Identification of highest risk members

Large Government Employer Per Capita Healthcare Spending

0

2500

5000

7500

10000

12500

15000

17500

20000

22500

25000

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Average ($2,601)

Large Government Employer Continuance Table

Claim Amount and Percent of Costs Driven by Different PercentilesIncurred Claims between Feb 1, 2005 and Jan 31, 2006

(paid through Jan 31, 2006)

PercentileTotal Costs % of Total

Average Cost Annual per member*

Top 1.0% 31.3% 81,483$ Top 5.0% 57.9% 30,103$ Top 10.0% 72.1% 18,749$ Top 20.0% 85.8% 11,156$ Top 25.0% 89.7% 9,327$ Top 50.0% 98.2% 5,109$ Bottom 50.0% 1.8% 92$ Total 100.0% 2,601$

Large Government EmployerEmployee Conditions by Department

Data Hyperlipidemia Back Pain HypertensionChronic Arthritis

Joint Pain and

Bursitis Grand Total

Employees with Condition 366 393 305 360 289 1,713 Total Department Employees 3,903 3,903 3,903 3,903 3,903 3,903

Employees with Condition 364 413 413 309 316 1,815 Total Department Employees 3,673 3,673 3,673 3,673 3,673 3,673

Employees with Condition 272 206 203 205 235 1,121 Total Department Employees 3,041 3,041 3,041 3,041 3,041 3,041

Employees with Condition 218 198 233 134 132 915 Total Department Employees 1,913 1,913 1,913 1,913 1,913 1,913

Employees with Condition 185 148 117 130 111 691 Total Department Employees 1,249 1,249 1,249 1,249 1,249 1,249

Employees with Condition 91 91 68 55 61 366 Total Department Employees 877 877 877 877 877 877

Employees with Condition 83 71 93 59 68 374 Total Department Employees 694 694 694 694 694 694 Employees with Condition 56 62 66 48 40 272 Total Department Employees 527 527 527 527 527 527

Large Government EmployerEmployee Conditions by Department

*All department names have been changed

Dept Data Hyperlipidemia Back Pain HypertensionChronic Arthritis

Joint Pain and Bursitis

Prison workers Prevalence of Employees with Condition 9.38% 10.07% 7.81% 9.22% 7.40%Total Department Employees 3,903 3,903 3,903 3,903 3,903

Budget Department Prevalence of Employees with Condition 9.91% 11.24% 11.24% 8.41% 8.60%Total Department Employees 3,673 3,673 3,673 3,673 3,673

Higher Education #1 Prevalence of Employees with Condition 8.94% 6.77% 6.68% 6.74% 7.73%Total Department Employees 3,041 3,041 3,041 3,041 3,041

Transportation workers Prevalence of Employees with Condition 11.40% 10.35% 12.18% 7.00% 6.90%Total Department Employees 1,913 1,913 1,913 1,913 1,913

Higher Education #2 Prevalence of Employees with Condition 14.81% 11.85% 9.37% 10.41% 8.89%Total Department Employees 1,249 1,249 1,249 1,249 1,249

Safety Department Prevalence of Employees with Condition 10.38% 10.38% 7.75% 6.27% 6.96%Total Department Employees 877 877 877 877 877

Health Department Prevalence of Employees with Condition 11.96% 10.23% 13.40% 8.50% 9.80%Total Department Employees 694 694 694 694 694

Medicaid Agency Prevalence of Employees with Condition 10.63% 11.76% 12.52% 9.11% 7.59%Total Department Employees 527 527 527 527 527

CategoryNumber of Employees

Percentage Employees

Hyperlipidemia 2154 21.5%

Back problems 2064 20.6%

Essential Hypertension 1992 19.9%

Other non-traumatic joint disorders 1730 17.3%

Other connective tissue disease 1616 16.2%

Other lower respiratory disease 891 8.9%

Other skin disorders 648 6.5%

Diabetes mellitus with out complications 481 4.8%

Asthma 45 4.5%

Diabetes mellitus with complications 29 2.9%

Employee Summary of Conditions

Predictive Pathways: Ranks

This is a search result from the main enrollment screen of Predictive Pathways (identifying data altered for privacy).

By clicking on any member ID, you can retrieve a profile of that member’s detailed history.

Member Profile

So What Can We Do That Matters?

• Identify the costliest members • Follow their claims• Use all available Data• Focus on key populations that drive

your costs• Worksite programs • Care management

Member Impact StoriesCase #1 - 38 Year Old Diabetic and Asthma

Before Disease Management

Disease Management Intervention

Follow-up Call 2 Months

• Non-compliant

– Not monitoring blood sugars

– Not following diet

• HbA1C 9.0 (normal less than 7)

• Sick frequently secondary to poorly controlled diabetes

• Frustrated with physician

• Education regarding importance of:

– Checking daily blood sugar

– Glucometer and how to obtain new one

– HbA1c being under 7.0

– Proper diet

• Provided names of other physicians

• Enrolled in diabetic education class

• Using glucometer regularly

• HbA1c 7.0

• Feeling better, not ill in 2 months

• Attending diabetic classes and seeing nutritionist

• New primary care physician

• Endocrinologist involved in case

Member Impact Stories (Continued)

Case #2 – Member with Congestive Heart Failure, Obesity

Before Disease Management

Disease Management Intervention

Follow-up Call 2 Months

• Non-compliant

– Had not seen cardiologist in over a year

– Poor diet including high salt foods

– No weight monitoring

– No exercise

• Education regarding condition and importance of:

– Regular cardiology appointments

– Dietary modifications

– Daily weight checks

– Importance of exercise

• Demonstrates understanding of disease process by:

– Cardiology appointments every 6 months

– Daily checks and records:

• Blood pressure

• Pulse

• Weight

– Calls cardiologist if change in status

– Using treadmill on regular basis

Member Impact Stories (Continued)

Case #3 – Follow-up with Member in Disease Management

• Member described chest pain with walking even short distances

• Disease Manager recognized possible signs of reduced blood flow to heart secondary to exercise

• Member instructed to call 911 and go to ER• Surgery ensued with 4 vessel coronary artery

bypass

Key Principles Of An Effective Health Plan

Goal: To obtain improved health outcomes, stabilize cost and improve productivity

• Identify highest risk members for future cost and enroll them in disease specific programs and care management• Educate members about their disease, its symptoms and effective tools for self-management• Continuously monitor members between physician visits to encourage self-care, identify complications, help with care coordination

Summary of the Characteristics for Medical Plan Success

• Population identification process• Evidence-based practice guidelines and assurance of

high quality care• Patient self-management education • Support the provider/patient relationship through your

policies and programs• Emphasize reduction of preventable events• Evaluate member outcomes on an ongoing basis• Focus on high cost events: concurrent review and PA of

hospital and high cost procedures• Integrate Social needs, Behavioral Health, Pharmacy

Use DATA to identify KEY ACTIONS which create better OUTCOMES