Sacramento County Keenan’s Strategies for Designing Effective Total Population Health Management Programs Presented on: April 26, 2017 Innovative Solutions. Enduring Principles. License No. 0451271 License No. 0451271
Higher Risks = Higher Cost Risk Factors Related to Increased Health Care Cost Average Annual % Higher At High Risk For ... Higher HC Cost 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 2 Innovative Solutions. Enduring Principles. License No. 0451271
Chronic Conditions & Increased Risk Factors = Unproductive Employees 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 Mean Annual Health-Related Mean Annual Health-Related Average % of Group Absentee Days Per Ee Unproductive Days Per Ee Workforce (Absenteeism) (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 3 Innovative Solutions. Enduring Principles. License No. 0451271
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) Modifiable Risk Factors Chronic Conditions Poor Diet 1. Diabetes 2. Coronary Artery Disease Physical 3. Hypertension Inactivity 4. Back Pain Accounting for Smoking 5. Obesity 80% of total 6. Cancer Lack of Health 7. Asthma costs for Screening 8. Arthritis chronic Poor Stress 9. Allergies Management illnesses 10. Sinusitis 11. Depression Poor Standard of Care 12. Congestive Heart Failure 13. Lung Disease (COPD) Insufficient Sleep 14. Kidney Disease 15. High Cholesterol Excessive Alcohol Consumption 4 Innovative Solutions. Enduring Principles. License No. 0451271
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 5 Innovative Solutions. Enduring Principles. License No. 0451271
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. 6 Innovative Solutions. Enduring Principles. License No. 0451271
Why Are Some Health Management Programs Missing the Mark? • 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) 7 Innovative Solutions. Enduring Principles. License No. 0451271
• “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) 8 Innovative Solutions. Enduring Principles. License No. 0451271
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 9 Innovative Solutions. Enduring Principles. License No. 0451271
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 10 Innovative Solutions. Enduring Principles. License No. 0451271
The Integrated Population Health Management Model Biometric Dental Program Screening Health Vision Program Assessment Population Health Pharmacy Management Wellness Management Program Data Sharing and Coordination High-Risk Case Condition Management Management Workers Employee Compensation Assistance Program Program 11 Innovative Solutions. Enduring Principles. License No. 0451271
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 12 Innovative Solutions. Enduring Principles. License No. 0451271
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. 13 Innovative Solutions. Enduring Principles. License No. 0451271
Strategies for Effective Health Management Programs • 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. • Provide a program that achieves a return on investment (ROI) for the organization through improved health and productivity. 14 Innovative Solutions. Enduring Principles. License No. 0451271
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) 15 Innovative Solutions. Enduring Principles. License No. 0451271
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