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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