Sustainable Onsite Healthcare Solutions Participate… Change... Save August 25, 2016 1
Medical Trend Increase: Reality Check BCBS of NC Trend 11.3% 2
Real Healthcare Cost Increases At 11.3% trend, healthcare costs will DOUBLE in 6.4 years If your costs are $7,500 per employee now, in just over six years it will be $15,000 This is completely UNSUSTAINABLE! It will be very difficult to continue to pass much of the cost to employees 3
Healthcare Economics Number of People With Chronic Conditions (in millions) Source: Projection of Chronic Illness Prevalence and Cost Inflation 2000 4
Cost of Chronic Conditions Average Per Capita Health Care Spending $15,000 $14,768 $13,000 $10,414 $11,000 $9,000 $7,761 $7,000 $5,074 $5,000 $2,844 $3,000 $1,081 $1,000 0 1 2 3 4 5+ Number of Chronic Conditions Source: Projection of Chronic Illness Prevalence and Cost Inflation 2010 5
What do we know? Early detection reduces treatment costs Detecting a serious condition in the first half of the disease development process reduces the cost of treatment by 63% and increases the likelihood of full recovery by 300%. New England Journal of Medicine
What do we know? Risk management Reduces Specialty Care Improved health, greater self-efficacy skills and better access to front-end components of the delivery system would facilitate increased utilization of preventive and primary care and depend less on downstream utilization of specialty care and emergency care. Healthcare Reform Magazine Population Risk Management & Workplace Health Centers April 29, 2014
What do we know? 80% Non-compliant The primary intermediate barrier to effective and efficient chronic care is under-utilization of high value services. 80% of patients with a chronic disease receive only half the care that evidence-based protocols suggest they should receive. Colorado Business Group on Health Donna Marshall, Executive Director September 14, 2015
Healthcare Economics Our current healthcare system does not provide an economic incentive for providers or members to control costs. With no supply & demand controls, healthcare expenses will continue to rise. 9
Healthcare Economics • Demand only increases – Elective procedures did go down with economic downturn • Supply always matches demand – Demand increases are consistent and predictable – Very little over capacity – Very little supply shortages • Supply increases can cause increased demand • End user is not end purchaser • When we really need care, there is no price that we would not pay • No stake holder outside of employers are financially incented to keep costs down 10
Current Healthcare System Annals of Family Medicine: Each physician would have to spend 21.7 hours per day to provide all recommended acute, chronic and preventive care for a panel of 2,500 patients. Washington Post 2012 Traffic safety is no more a core competency for auto body shops than wellness, prevention, and care coordination are for most community hospitals. Journal of Healthcare Management, 2014
Current Healthcare System “The U.S. health care system is structured around diagnosis and treatment rather than wellness and prevention. We have a ‘sick’ care system rather than a ‘health’ care system.” – American Hospital Association, Health for Life – www.aha.org Not trained to prevent Not staffed to prevent Not located to prevent Not paid to prevent
What can we actually do about it? Create Health Accountability Reduce Demand Healthcare Improve Affordability and Accessibility to Healthcare 13
Remove Bar Barrie riers rs to We Must Car Care 14 14
Measure of health Risks
Convenience drives participation
Incentives drive change 17
A road Map for Change 18 18
Prescribe a Balanced Approach Ac Account countabili ability ty Resources 19 19
Personal Resources Annual Health Risk Assessment Preventive & primary care Diagnosis/treatment of minor conditions Prescriptions Blood and laboratory analyses Chronic condition management Care coordination 20-30 minute appointments – no waiting Convenient and free
Typical Scope of Services Acute Visits: Minor Illness/ Sick Visits Employee Risk Factors Wellness Coaching Allergy Symptoms Bronchitis / cough Wellness Exams Earache / ear infection Compliance Monitoring Flu-like symptoms Mononucleosis Chronic Visits: High Blood Pressure Motion sickness prevention Sinus infection / congestion High Cholesterol Pink eye & styes Diabetes Management Sore throat / strep throat Weight Management Upper respiratory infection Smoking Cessation Nutrition and Exercise Counseling Urinary tract/bladder infection Acute Visits: Minor Injury (off job) Care Coordination Visits: Blisters Help to establish a PCP Bug bites & stings Referrals to a PCP Referrals to a specialist Minor burns Minor cuts & lacerations Referrals to a dietician Minor wounds & abrasions Splinter removal
How Health Management Saves Measured in Claims Emergency Room Money Specialist Care Hospital Days Drug Costs Lower cost primary care Soft Savings Work time Productivity 22 22
Achieving High-Performance Plans with Onsite Health Centers Organizations Strongly Agree in rating health centers: Improve employee access to convenient health care services 95% 94% Decrease time away from work Deliver and promote screening and preventive health services 90% 83% Enhance worker productivity 77% Improve integration of health and productivity efforts Improve quality and consistency of care 73% 73% Improve support of chronic condition care 70% Manage and revers lifestyle health risks 62% Reduce medical costs / reduce increase in medical trend Benefits of 54% Onsite Clinics Provide concierge medical service as a perk
Case Study • Local Government has been with Synergy Healthcare for three full years • 1,900 employees & 800 spouses on the health plan • Large enough employer with enough “life years” of experience to be fairly credible 24
3 Steps… Participate Change Save 25
Step 1 Participate 26
Participation Incentive Program 1. Employees and Spouses must participate in the health risk assessment. 2. Based on their number of medical high risks, they must visit the onsite clinic or their personal physician based on the following schedule: # of High Risks Required Visit Compliance Periods 0 None 1 1 of the first 2 compliance periods (added 2015) 2-3 2 of the 3 compliance periods 4+ All 3 compliance periods All wellness participants with 1 high risk must visit the clinic at least one time to go over their HRA results. • Don’t just give them the information, incent them to speak multiple times to a medical professional about their results. • HRA alone may bring 5-10% of members to make changes. • HRA and compliance visits will bring 20-30% to make significant changes. 27
Step 1 Results Participants in both the 2013 & 2014 HRA Risk Factor Baseline Follow-Up Change Obese - BMI > 30 41.5% 44.4% 7.0% Hypertensive >=140/90 13.8% 17.8% 28.8% Anti-Hypertensive Meds 30.6% 31.7% 3.9% Total Cholesterol > 200 35.8% 33.2% -7.2% 22.1% 23.8% 7.7% LDL > 130 HDL < 40 17.6% 22.2% 26.6% 20.4% 19.5% -4.2% Triglyceride > 150 Lipid-lowering Meds 23.2% 23.1% -0.4% BMI 29.7 30.0 1.2% 191.5 193.5 1.0% Weight 28
Step 1 Results…Risk Change • Members that had to go to the clinic saw improvements • Members that didn’t have to go to clinic had a high number get worse Participants in both the 2013 & 2014 HRA 0-1 Change 2-3 Risks Change 4+ Change Risk Risks Increased Risk 306 38.8% 103 28.6% 7 9.6% Jumped Risk Tier 192 24.4% 47 13.1% Improved Risk 57 7.2% 142 39.4% 47 64.4% Stepped Down Risk 99 27.5% 39 53.4% Tier No Change 425 53.9% 115 31.9% 19 26.0% 539 68.4% 214 59.4% 34 46.6% No Risk Tier Change 788 360 73 Total Don’t Get Worse! 29
Step 2 Change 30
Health Improvement Incentive Program In addition to the incentive for Health Risk Assessment participation and compliance, there will be another wellness incentive, based on the results of the HRA. To qualify for the incentive, employees must do one of the following: 1 or fewer high risk factors on the HRA Improve one of your high risks from last years HRA Make an improvement after HRA and verified by the clinic Improvements Screening Test High Risk % Decrease Required Blood Pressure-Systolic 140 or higher 10% Blood Pressure-Diastolic 90 or higher 5% Blood Glucose 100 or higher 5% Triglycerides 200 or higher 10% Total Cholesterol 240 or higher 10% HDL Cholesterol 40 or less (Males) Increase 5% 30 or less (Females) LDL Cholesterol 160 or higher 10% Body Mass Index 30 or above Reduce 1 BMI point 31
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