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Transcript
Are you ready for
the future of wellness?
Gaston
Regional
Chamber
Healthcare
Summit
Leading
edge
wellness
strategies
for your
organization
1
00.25.910.1 (4/08)
Wellness matters
70 – 90 percent of health care costs are due to unhealthy choices and
preventable risks 1
In 2008, employers are projected to spend 46% more for health care costs
than in 2003, an average of $9,312 per employee 2
Chronic diseases cost businesses more than $1 trillion in lost productivity 3
U.S. companies lose nearly $63 billion in lost work and productivity each
year due to employee injuries and illnesses 4
1
2
3
4
Health Care Statistics, Prevent Disease.com, 2006
2008 Towers Perrin Health Care Cost Survey
“An Unhealthy America: The Economic Burden of Chronic Disease,” The Milken Institute, October 2007
Journal of Occupational and Environmental Medicine, July 2007
Wellness works
Wellness programs may save organizations $900/person/year in direct medical costs 1
Most employers can expect a $3 to $1 return on investment for preventive services
and health promotion 2
Employers can save $1.65 in health care expenses for every dollar spent on a
comprehensive health care program 3
Wellness programs save money through:
 Lower health care costs
 Greater productivity
 Reduced absenteeism 4
1
2
3
4
Wellness Councils of America (WELCOA) Absolute Advantage: ROI Bullseye; Building a First ClassWorkforce by David R. Anderson, 2003
Healthcare Cost Trends for 2008, PricewaterhouseCoopers, 2008
Journal of Occupational and Environmental Medicine, February 2008
Purdue University, February 2007
The plan sponsor’s journey to wellness…
embracing change and developing a supportive culture
Gather information to
understand needs and
develop strategies
Solutions that drive
meaningful change and
make your vision a reality
Celebrate your successes
and refine your strategies
for the future
The plan sponsor’s journey to wellness…
Five steps to creating an effective wellness strategy
Gather and analyze
information
Define goals
and objectives
Design wellness
strategy
Develop
implementation plan
Evaluate outcomes and
refine strategy















Assess your workplace culture, environment, business and benefit strategies
Review claim information to understand utilization and health risks
Understand your employees, preferences, health status and behaviors
Identify the behaviors you want to change
Determine how wellness programs will contribute to your benefit strategy
Define how you will measure and determine success
Review current plan designs; align with defined goals and objectives
Choose wellness programs and incentives that will meet your needs
Identify other workplace changes, cafeteria food, smoke-free environment
Ensure leadership commitment and support
Create a detailed implementation plan and timeline
Develop a comprehensive communications plan
Measure outcomes against goals and objectives
Gather feedback about how well your strategy is working
Celebrate successes and refine your strategy
Supporting members with wellness solutions
that span the continuum of care
Health/low risk
At risk for
disease/injury
Stay well (mind and body)
Managing
a chronic
disease
Identify and manage health risks
to prevent disease and disability
Manage/mitigate disease
impact
Reduce absenteeism and
on-the-job productivity loss
Identify and manage those
most at risk for disability
Major health
events
Provide structured programs
to support return to health and
productivity
Manage medical care
Manage disability
Access to Quality Care
SM
Aetna Health Connections
The suite of programs & services that enables wellness solutions
Staying
Healthy
Changing
Lifestyles
Managing
Conditions
Major
Health Events
Case Management
Integrated Solutions
Disease Management
Lifestyle Coaching *
Advocacy Programs *
Worksite Clinic Services *
Personal Health Record
MedQuery
Health Fairs and On-site Screenings *
Informed Health Line
Simple Steps To A Healthier Life® Health Assessment
Discount Programs, Natural Products and Services
Well Visits & Screenings
Communications Campaigns and Toolkits
Tools and Informational Resources
Aetna Healthy ActionsSM Incentives Capabilities
* Availability may vary by location, product, group size
A plan sponsor’s multi-year wellness strategy
(Illustrative only)
Increase in productivity
More health assessments
Lower absenteeism
Incentives
Fitness and weight
management programs
Incentives
Simple Steps To A
Healthier Life®
Simple Steps To A
Healthier Life®
Disease Management
Disease Management
YEAR 1
YEAR 2
Reduction in medical costs
Lifestyle coaching or
wellness counseling
Integrated Health
Solution
Increase in physical activity
Reduction in medical costs
Incentives
Simple Steps To A
Healthier Life®
Disease
Management
YEAR 3
The Aetna Experience
Overall trends in Aetna employee population
Engagement
(chronically ill)
Going down
Going up
Medical
Trend
2007 trend is 3.3%A
compared to 5.9%
as of 11/06 and
15.9% as of 11/05
Engaged and
Engageable
population increased
from 64.3% in 2005
to 72.7% in 2006
Results of Healthy Lifestyles
Illness
Simple Steps
Program
Burden
(chronically ill)
Participation
Participation in
Healthy Living
Programs climbed
111% from 2005 to
2007
Participation
increased from
10,939 in 2006 to
17.085 employees
in 2007, a 56%
increase
Retrospective Risk
Score shows
chronically ill
population became
less sick over last
2-1/2 years
Please note: Trend is the result of plan design, medical management and wellness interventions. Today we are
talking about wellness interventions, but all interventions should be used to get the trend in line.
Illness burden measures the breadth and intensity of diseases in a population.
A
Dec 2007 12 month rolling trend
Aetna Confidential
may not be copied or reproduced without prior written approval
We’re creating a future where…
Your employees and their families are fully engaged in their
health and take responsibility for health care decisions
The benefits experience they receive is personalized to meet
their needs, based on experienced clinical knowledge and analysis
All benefits seamlessly work together to enhance your bottom
line and the well-being of your employees
10
We’re creating a future where…
Your employees and their families are fully engaged in their
health and take responsibility for health care decisions
The benefits experience they receive is personalized to meet
their needs, based on experienced clinical knowledge and analysis
All benefits seamlessly work together to enhance your bottom
line and the well-being of your employees
Seamless Linking HRA to PHR to Wellness Programs
11
The journey to optimal health starts with
the health assessment…
Know your:
Numbers
Health status
Modifiable risks
Wellness resources
Staying Healthy
Simple Steps to a
Healthier Life
Lifestyle Changes
Preventive Screenings
Improve Nutrition
Well Visits
Increase Physical Activity
Managing Conditions
Major Health Events
Medical Adherence
Care Plan
Care Management
Managed Disability
… and continues with the right programs and services
Aetna Personal Health Record goes
well beyond a static claim history
Our industry-leading PHR is really like a personal health assistant

All patient information in one place

A dynamic system for interactivity based
on our patented CareEngine® technology

Integrated patient and health care
information to support higher quality, costeffective care

A unique decision aid for health care
providers, providing up-to-the-minute
information on the patient
We’re creating a future where…
Your employees and their families are fully engaged in their
health and take responsibility for health care decisions
The benefits experience they receive is personalized to meet
their needs, based on experienced clinical knowledge and analysis
Value Based Benefits - Rx/DM incentive: Copay relief for
medication adherence for specific drug classes
All benefits seamlessly work together to enhance your bottom
line and the well-being of your employees
Seamless Linking HRA to PHR to Wellness Programs
14
EvidenceBased
Care
Effective application of evidence-based
care is key to improving outcomes
Improving care for
members at all
stages of health
Evidence-based care relies on
research evidence to enhance
patient care
Evidence-based
strategies are built
into our:

Strategies for collaborating with
members and physicians to improve
health

Clinical coverage decisions

Strategies to identify care improvement
opportunities

Overall medical care management
approach
Aetna Pharmacy Management
Medication adherence
22% of U.S. patients take less of the medication than is prescribed
American Heart Association: Statistics you need to know.
http://www.americanheart.org/presenter.jhtml?identifier=107
Accessed November 21, 2007.
Aetna Pharmacy Management
Why adherence matters
“Of all medication-related hospital admissions
in the United States, 33 to 69 percent are due
to poor medication adherence, with a resultant
cost of approximately $100 billion a year.”
Results of failure to adhere to prescribed medications:
 Increased hospitalization
 Poor health outcomes
 Increased costs
 Decreased quality of life
 Patient death
Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein
MC, Avorn J. Long-term persistence in use of statin
therapy in elderly patients. JAMA 2002;288:455-461
The Logical Next Step
Several sources of data:
1.
Surveys of self-reported
underuse and pill-splitting
2.
Comparisons of people
with less and more
generous drug insurance
3.
Longitudinal studies of the
introduction of payment
caps
Reducing or eliminating costsharing (at least for some
conditions or for some levels
of risk) may increase
adherence to efficacious
medications
In fact, the cost of paying for increased drug costs may be (more
than) offset by the cost-savings from averted clinical events
Aetna Pharmacy Management
Overcoming barriers to adherence
Health plan pays member copay
 Reduces member out-of pocket costs
 Emphasizes the importance of continuing therapy
Education and outreach
 Explains the need for medication therapy
 Breaks down complex therapies into manageable parts
 Offers strategies for coping with side effects
Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein
MC, Avorn J. Long-term persistence in use of statin
therapy in elderly patients. JAMA 2002;288:455-461
Aetna Pharmacy Management
Average health care expenditures per
year ($)
Investment in medication adherence
can lead to dramatic reductions in
overall cost of care
$10,000
$55
$8,000
Rx $
$165
$285
$404
Medical $
$6,000
$763
$4,000
$8,812
$6,959
$6,237
$5,887
$2,000
$3,808
$0
1-19%
20-39%
40-59%
60-79%
80-100%
Diabetes Medication Level of Adherence (% days supply/year)
Outcome is significantly higher than outcome for 80100% adherence group (P<0.05). Differences were
tested for medical cost and hospitalization risk.
Sokol M et al. Impact of Medication Adherence on Hospitalization
Risk and Healthcare Cost. Medical Care.
Volume 43, Number 6, June 2005
Sensitivity Analysis: Time
Horizon
Health Affairs 2007; 26: 186
Benefit Design Research Study
Aetna / Harvard Proposal
• Aetna to participate with Harvard in a
study to formally test the hypothesis that
by removing financial barriers (co-pay, coinsurance and deductibles) for certain
conditions we would:
– Increase medication adherence
– Improve clinical quality
– Decrease medical costs
We’re creating a future where…
Your employees and their families are fully engaged in their
health and take responsibility for health care decisions
Work Site Clinics: Brings wellness to the worksite
The benefits experience they receive is personalized to meet
their needs, based on experienced clinical knowledge and analysis
Value Based Benefits - Rx/DM incentive: Copay relief for
medication adherence for specific drug classes
All benefits seamlessly work together to enhance your bottom
line and the well-being of your employees
Seamless Linking HRA to PHR to Wellness Programs
23
What is engagement?
Engagement is an
individual’s ownership of
and active participation in
his or her journey to optimal
health and wellness
JOIN US
Engagement matters
1
2
3
4
•
Up to 50% of health care costs are due to unhealthy
choices and preventable risks1
•
In 2008, employers are projected to spend 46% more for
health care costs than in 2003, an average of $9,312 per
employee2
•
Chronic diseases cost businesses more than $1 trillion in
lost productivity3
•
U.S. companies lose nearly $63 billion in lost work and
productivity each year due to employee injuries and
illnesses4
NAHU’s Healthy Access Briefing Report: Constraining Medical Costs, 2006, https://www.nahu.org/legislative/healthyaccess/Report-ConstrainingMedicalCosts.pdf
2008 Towers Perrin Health Care Cost Survey
“An Unhealthy America: The Economic Burden of Chronic Disease,” The Milken Institute, October 2007
Journal of Occupational and Environmental Medicine, July 2007
Your organization may already be paying
Lost productivity and a lack of focus on wellness can cost your organization
We know…
Increased productivity has been noted as a
key reason plan sponsors adopt an onsite health center*
Onsite programs using face-to-face coaching and motivational
higher
engagement levels than telephonic only delivery
interviewing techniques result in
of programs
Worksite health services create and support an effective wellness
create and maintain a
culture of wellness
strategy by helping to
* Watson Wyatt “Realizing the Potential of Onsite Health Centers” 2008 Study
©2007
Aetna Inc.
Our worksite health solution:
Aetna Health Connections Direct2you
•
•
Expands and extends our Aetna Health
Connections overall health and wellness
solutions portfolio
Initial offering includes onsite delivery of:
– Selected Aetna Health
Connections programs
already delivered
telephonically
– Biometric screenings
.
Our future vision of
Direct2you solutions:
 Part-time clinical
staff
 Community-based
centers
 Remote outreach
and engagement
Aetna Health Connections
Direct2you
The program includes face-to-face delivery of any
combination of these programs:
Available
beginning
1/1/2009
 Disease Management
 Wellness Counseling
 Behavioral Health (BH) Assessment and
Counseling
 Employee Assistance Program (EAP)
Assessment and Counseling
 Biometric Screenings available through
Summit Health or Quest Diagnostics
We’re creating a future where…
Your employees and their families are fully engaged in their
health and take responsibility for health care decisions
Work Site Clinics: Brings wellness to the worksite
The benefits experience they receive is personalized to meet
their needs, based on experienced clinical knowledge and analysis
Value Based Benefits - Rx/DM incentive: Copay relief for
medication adherence for specific drug classes
All benefits seamlessly work together to enhance your bottom
line and the well-being of your employees
Seamless Linking HRA to PHR to Wellness Programs
29