Download REDUCE HEALTH PLAN COSTS WHILE PROVIDING GREAT

REDUCE HEALTH PLAN
COSTS WHILE PROVIDING
GREAT SERVICE TO YOUR
EMPLOYEES
About Windstream











Formed in 2006 through spin-off and merger
11 acquisitions
Transformation from rural ILEC to enterprise telecom company
12,500 employees
84% enroll in medical
22 local unions covering 15% of the workforce
Employees in 46 states with work locations ranging from virtual employees to tech truck meetings
in parking lots to call centers with 800 employees
Rural/smaller city presence
Average age of employees is 45
30% of employees are female
HDHP full replacement for non -union employees
1
Windstream’s Selection of Quantum for 2012
 State of the art disease and chronic condition management program
 “Intercept” model used to intervene in process at earliest possible time for optimal outcomes
 Medical home (first touch site) to coordinate fragmented services from numerous specialty
vendors
 Advocate for participants in dealing with health care system
2
Windstream Health and Wellness Strategy
We want each member of the Windstream family to be healthy and able to fulfill
their highest potential at work and at home while keeping healthcare costs as
low as possible.
Guiding Principles:
 Health Status Management—Help plan participants identify health risks; provide and strongly
encourage use of resources needed to reduce health risks
 Design Plans and Programs with Intent—Offer competitive plan designs along with innovative
programs that improve health, add value to participants and manage cost. Ensure vendors are
accountable for results
 Promote Health Care Consumerism —Engage employees to be health care consumers and
provide resources to help participants improve their health and navigate the health system
 Cost Management—Goal of no increase in employer cost on PPPY basis year over year
 Competitive Employee Premiums —Offer affordable and competitive contributions to diverse
workforce
 Provide positive customer service experiences to plan participants
3
Windstream Benefits in 2016
ALL WINDSTREAM MEMBERS AND THEIR
PROVIDERS
Single ID card and phone number | www.windstreamhealth.com | Mobile App
Member/provider services (medical and Rx):
•
Benefits
•
Eligibility
•
Provider selection and cost/quality
•
Advocacy
Clinical/care coordination services:
Pre-notification
•
•
•
Concurrent/utilization review
•
Pre-admission/post-discharge
•
•
Episodic care coordination
Case management
Chronic condition
management
4
Windstream And Quantum Health Today
INTEGRATION WITH OTHER VENDORS
CHAMPION FOR MEMBERS
QUANTUM HEALTH AS A BUSINESS
PARTNER
5
HOW THE MODEL WORKS
HELP ME FIND A GET-IT-DONE
WARRIOR WHO WILL STAY BY MY SIDE
THROUGH MY ENTIRE JOURNEY
VALUABLE INSIGHTS
Our expertise is understanding
consumer behavior in the
healthcare space.
7
/ QUANTUM HEALTH / CONFIDENTIAL AND PROPRIETARY
GROUNDED IN CONSUMER
BEHAVIOR RESEARCH
+ Expertly guide self-funded employers and their health plan members
through the complex healthcare process
+ Study 1: Pioneered consumer behavior process mapping in
healthcare tracking 3,200 patients and 290 providers for 2 years
+ Study 2: NarrativeLogic Study
+ 16-year track record reflects deliberate, tested approach
+ Our model is proven to deliver results
+ Enhances the member healthcare experience
+ Reduces employer healthcare spend by 7–9 percent, without
reducing benefits
+ Recognized as a market leader by several prestigious
industry and workplace awards
8
/ QUANTUM HEALTH / CONFIDENTIAL AND PROPRIETARY
•
•
•
•
•
16+ years of experience
80+ clients
500,000+ members
90% client retention rate
NPS of 72
THE CONSUMER QUANDARY
SANCTUARY
THE AVERAGE PATIENT
WILL SEE 5-7 DIFFERENT
PROVIDERS
FACED WITH AVERAGE OF
41 DECISIONS
9
/ QUANTUM HEALTH / CONFIDENTIAL AND PROPRIETARY
EXPERTISE
WARRIOR
STICK WITH THEM
FRIENDSHIP
WINDSTREAM MEMBER JOURNEY
Member Diagnosis: Breast Cancer
Receive a call from a
member while in the
waiting room at a
provider’s office with an
eligibility question.
Nurse Care
Coordinator discusses
chemotherapy with the
member’s provider to
understand the full
scope of member’s
treatment plan
Contacts in eleven months: 14
Member expresses
she is overwhelmed
with chemotherapy.
Nurse Care
Coordinator discusses
support; emotionally
and clinically.
2015
Nurse Care
Coordinator outreaches
the same day to
discuss the member’s
recent breast cancer
diagnosis. They
discuss caregiver
support and benefits.
10
During a post-discharge
call the member and
Nurse Care Coordinator
discuss nutritional
needs and set goals
associated with these
needs.
2016
Member begins
chemotherapy and
discusses side-effects with
the Nurse Care
Coordinator. Her diagnosis
changed since the last
discussion and member
was very concerned.
Nurse Care
Coordinator assists in
coordinating an innetwork precertification
for a mastectomy.
Member calls her Nurse
Care Coordinator to
discuss benefits and the
cost of her oral
chemotherapy
medication.
RESULTS
83%
11
98%
WINDSTREAM ENGAGEMENT
ALL HOUSEHOLDS
CONTACT WITH A CARE COORDINATOR
IN THE LAST 12 MONTHS:
83%
12
MEMBERS WITH CLAIMS >=
$50,000
CONTACT WITH A CARE COORDINATOR
IN THE LAST 12 MONTHS:
98%
7.0
18.5
AVERAGE NUMBER OF
CONTACTS PER MEMBER
AVERAGE NUMBER OF
CONTACTS PER MEMBER
WINDSTREAM ENGAGEMENT
HIGH RISK MEMBERS:
MODERATE RISK MEMBERS:
CONTACT WITH A CARE COORDINATOR
IN THE LAST 12 MONTHS:
CONTACT WITH A CARE COORDINATOR IN THE
LAST 12 MONTHS:
87%
15.6
AVERAGE NUMBER OF
CONTACTS PER MEMBER
69%
6.2
AVERAGE NUMBER OF
CONTACTS PER MEMBER
76% OF HIGH RISK MEMBERS WITH ACUTE/COMPLEX CONDITIONS WERE IDENTIFIED
THROUGH REAL-TIME INTERCEPT
13
WINDSTREAM UTILIZATION
MEMBERS WITH A
PREVENTIVE SERVICES
MEMBERS WITH A PRIMARY CARE
VISIT
IN THE LAST 12 MONTHS
IN THE LAST 12 MONTHS
76%
PRIOR TO QUANTUM HEALTH
57% OF MEMBERS WITH A
PREVENTIVE SERVICE
81%
PRIOR TO QUANTUM HEALTH
64% OF MEMBERS WITH A
PRIMARY CARE PHYSICIAN
13% DECLINE IN EMERGENCY ROOM VISITS IN THE LAST 12 MONTHS
14
REAL-TIME INTERCEPT
HIGH RISK MEMBERS WITH CHRONIC
CONDITIONS
REAL-TIME INTERCEPT: 41%
15
HIGH RISK MEMBERS WITH ACUTE/COMPLEX
CONDITIONS
REAL-TIME INTERCEPT: 76%
WINDSTREAM FINANCIAL RESULTS
2012- 2015
4.1%
CAGR
VS.
INDUSTRY 6.6%
16
$1,130
Per member avoided
cost
• Real-Time Intercept
• Clinical Model
• Direct Provider
Communication
• Efficient utilization
of healthcare
services
KEY FACTORS THAT DRIVE
RESULTS
+ In the Natural Flow
+ Stick with the Consumer
+ Authority to Act
+ Based 100% on Consumer Research
+ Mapping Study ensures Real Time Intercept at Disconnect Points
+ Narrative Logic Study informs how Consumer Experiences the Journey
+ Independent – There Just for the Consumer
17
Data Aggregation and Measuring Results
Data Aggregation and Measuring Results
 Identify meaningful data to be reported by each vendor
 Continue to encourage Quantum to improve ability to report on true results
‒ Risk reduction
‒ Gap closures
‒ Direct connection between intervention and quality improvement and/or cost management
 Worked with Healthyroads to improve meaningful Cohort reporting
 Aon’s Health Intelligence On Demand tool aggregated all relevant (and available) data
‒ Medical/Rx
‒ Biometrics
‒ Wellness program participation
‒ Tobacco use
‒ Chronic condition counseling participation
‒ Absence data
‒ Attitudinal Segmentation
19
Care Coordination
Engagement by Cost Cohort
Windstream ¹
Population Distribution
Contact Frequency and Type
Members
% of
Membership
% of Total Cost
% with Contact
Contacts Per
Member
% Contacts
With Provider
All Members
25,356
100.0%
100.0%
55.9%
4.4
43.8%
Members with Claims < $10,000
23,369
92.2%
30.0%
52.5%
3.4
38.8%
Members with Claims >= $10,000
1,987
7.8%
70.0%
95.0%
10.9
53.7%
Members with Claims >= $25,000
801
3.2%
52.8%
96.3%
14.9
56.3%
Members with Claims >= $50,000
363
1.4%
38.6%
97.8%
18.5
60.7%
Members with Claims >= $100,000
134
0.5%
23.7%
99.3%
23.0
65.8%
Quantum Health Book of Business
Population Distribution
Contact Frequency and Type
Members
% of
Membership
% of Total Cost
% with Contact
Contacts Per
Member
% Contacts
With Provider
All Members
267,278
100.0%
100.0%
60.9%
4.4
48.7%
Members with Claims < $10,000
244,432
91.5%
29.2%
57.7%
3.4
43.7%
Members with Claims >= $10,000
22,846
8.5%
70.8%
95.2%
11.0
58.6%
Members with Claims >= $25,000
8,830
3.3%
52.3%
96.8%
15.3
61.0%
Members with Claims >= $50,000
3,753
1.4%
37.3%
98.2%
20.2
63.0%
Members with Claims >= $100,000
1,367
0.5%
23.3%
99.2%
27.0
66.8%
¹ Includes members enrolled with QH during the reporting period and their total medical and pharmacy claims.
20
Windstream Portal
21
Windstream/Healthyroads Portal
22
WinWell with Healthyroads
 Over 98% participation for two consecutive years with both Health Risk Assessment and
biometric screenings for covered employees and spouses
 Used Cohort analysis to measure High Risk Migration based on SELF -REPORTED HEALTH
RISK ASSESSMENT
Lifestyle High Risk Migration (HRM)
Sedentary
Screening only T1
28.1
T2
22.8
Online T1
21.6
T2
16.2
Coaching (≤3) T1
25.9
T2
21.1
Coaching (4+) T1
26.4
T2
19.8
HRM
Stress
HRM
25.2
-5.3
29.8
25.5
4.6
33.1
4.3
28.1
0.4
39.1
8.3
44.3
-1.2
42.3
17.9
3,789
-3
-2.7
9.5
4,226
-4.8
-2.5
15.2
-2.8
44.9
3.9
Sum HRM
HRM
12
47.1
24.2
-6.6
52.6
Tobacco
20.6
40.3
24.8
-4.8
HRM
52.2
21.2
-5.4
Diet
11.9
673
-2.6
-3.3
14.1
-2.6
10.9
3,725
-8.5
-3.2
12,413
In an analysis of Windstream members (EE+SP) between January 2014 and February 2016 (i.e. 26 month time period):
(1) The cohort group that completed 4+ coaching sessions exhibited the greatest high risk migration based on self-reported
Health Risk Assessment (-8.5%).
23
WinWell with Healthyroads
 Over 98% participation for two consecutive years with both Health Risk Assessment and
biometric screenings for covered employees and spouses
 Used Cohort analysis to measure High Risk Migration based on ACTUAL BIOMETRICS
Biometric High Risk Migration (HRM)
Obese
Screening only T1
43.4
T2
43.6
Online T1
37.3
T2
38.6
Coaching (≤3) T1
46.3
T2
46.7
Coaching (4+) T1
52.1
T2
51.9
HRM
BP
HRM
20.1
0.2
21.3
15.4
1.2
17.1
2.3
19
-0.3
8.4
2
8.3
-0.6
9.8
7.2
3,792
1
-0.1
4.6
4,318
3.3
0.3
6
-1.7
10.7
0.1
Sum HRM
HRM
4.3
10
18.9
-0.2
11.1
Glucose
7.3
9
15.1
0.4
HRM
11.4
13.1
1.30
Cholesterol
6.6
862
1.3
0.6
8.4
-0.9
7.6
2,958
-1.8
-0.8
11,930
In an analysis of Windstream members (EE+SP) between January 2014 and February 2016 (i.e. 26 month time period):
(2) The cohort group that completed 4+ coaching sessions was the ONLY cohort group that exhibited improved biometric HRM (-1.8%).
24
Data Aggregation Allows for Data-Driven Decisions
 Continuously Enrolled for 24 months
 80% of Participants are at-risk for weight
 Morbidly obese Participants are 60% more costly than normal weight Participants (56% more
costly when HCC are removed)
Participant Weight Risk – 2014
Medical/Drug Paid PPPY– 2014
Morbidly
Obese
≥ 40 BMI
9%
Obese
≥ 30 – <40 BMI
36%
$7,000 $6,601
Underweight <18.5
BMI
1%
$6,232
$6,000
$5,000
$4,000
$3,919
$3,816
$3,230
$3,000
At-Risk: 80%
$2,514
$2,000
$1,000
Overweight
25 - <30 BMI
Normal
18.5 - <25 BMI
35%
17%
$,0
Unknown
3%
25
Data Aggregation Allows for Data-Driven Decisions
Metabolic Syndrome* Risks
30%
$6,000
28%
25%
22%
10%
$4,818
$2,900
15%
$3,582
20%
23%
$5,000
$4,370
26%
$4,000
$3,000
$2,000
$1,000
5%
$,0
0%
0 risks
1 risk
2 risks
3+ risks
 Participants with 1 or more risks for Metabolic Syndrome have healthcare costs 24% to 66% higher based on
the number of risks
 Metabolic Syndrome significantly increases a Participant’s risk of developing diabetes, heart disease or stroke
 Addressing key risk factors will decrease the number of Participants with 3+ risks for metabolic syndrome
* 3 of 5 key risk factors: waist circumference, blood sugar, blood pressure, triglycerides, HDL
26
Data Aggregation Allows for Data-Driven Decisions
Biometric Risks by Condition—Diabetes
Diabetics are more likely to be at risk for key biometric and lifestyle risks
100%
90%
80%
70%
60%
93%
82%
80%
76%
69%
63%
68%
79%
58%
51%
57%
50%
40%
33%
30%
20%
32%
14%
10%
10%
0%
Blood Pressure
Blood Sugar
Diabetics
Cholesterol
Triglycerides
Non-Diabetics
All
Weight
27
Data Aggregation Allows for Data-Driven Decisions
Weight Risk by Absence Category
45%
42%
38%
40%
35%
35% 36%
35%
35%
30%
30%
25%
25%
20%
18%
17%
13%
15%
14%
14%
9%
8%
10%
5%
15%
3%
1%
3%
2%
3%
2%
3%
1%
0%
Low Absence
Underweight
Moderate Absence
Normal
Overweight
High Absence
Obese
Morbidly Obese
Overall
Unknown
28
Data Aggregation Allows for Data-Driven Decisions
Case Management (CM) and Chronic Condition Management (CCM) Engagement
 Over 90% of Participants engaged with case or condition management are at-risk for weight
 Average length of stay is lower for Participants being actively managed in case or condition
management
 Among Participants engaged in condition management there is higher compliance with condition
specific medications
Utilization by Engagement
Admits/
1000
Days/
1000
Average
Length
of Stay
CM Engaged
647
2,529
3.91
CCM Engaged
412
1,564
3.8
Identified but Not
Engaged
42
184
4.35
All Participants
40
178
4.45
Cholesterol Lowering Drug
Compliance
100%
80%
60%
40%
20%
0%
75%
61%
78%
63%
66%
65%
29
Windstream’s Segmentation
High Engagement
24%
5%
Get Through
the Day
Reward
Improvement
and Habit
Leading
The
Way
I Need a
Plan
Require
Action and
Improvement
 “I Need a Plan” is the largest segment,
has the second highest risk score
17%
Guide
Action and
Improvement
High
Challenge
9%
Low
Challenge
In It For Fun
15%
 Among health assessment and or
screening Participants who were
identified for coaching, the “I Need a
Plan” segment had the highest
engagement (95%)
15%
Simplify
Awareness and
Action
Value
Independence
Not Right
Now
Low Engagement
Segment
# of
Lives
% of Total
Lives
PHCC
HCC
DxCG
Medical/ Drug
Risk Score Paid/ Participant
I Need a Plan
2,175
24%
43
27
1.38
$4,039
In It for Fun
1,542
17%
26
11
1.29
$3,668
Value Independence
1,357
15%
19
10
1.11
$3,044
Not Right Now
1,360
15%
30
14
1.30
$4,256
Leading the Way
847
9%
18
5
1.35
$4,524
Get Through the Day
485
5%
15
3
1.54
$4,221
Unknown
1,267
14%
36
18
1.44
$5,163
Total
9,032
100%
187
88
1.33
$4,071
30
Where are we now?
 Quantum continuous improvement in the areas of vendor integration and data analytics to support
ROI
 Wellness program design may not be working as hoped – working on a new wellbeing strategy
with less focus on incentives and greater focus on behavior change and culture
 Obesity is a significant issue and Lifestyle Coaching is not producing the results we want to see
‒ Implemented weight loss programs in 2016 (significant engagement with no financial
incentives)
 Continue to evaluate programs to impact those at high risk, specifically diabetics
 Enhance education on consumerism to support full replacement HDHP
31
Q&A