Download At Risk - flagg management inc

Wellness-Driven Outcomes
Driving Participation &
Rewarding Outcomes
Healthways-Core Commitment
To support evidence-based programs across all
product lines that improve health and provide
meaningful clinical and financial outcomes.
Acquired MyHealthIQ Diagnostics June 2005
Whole Population Solution
Care Support
Health Support
Outcome
Risk
Disease
No or Low Claims
Intense and Frequent Claims
Low
Healthy
High
Family
History
Lifestyle
Issues
Acute
Persistent
Chronic
Terminal
Catastrophic
Palliative
Catastrophic Care
Complex Case Management
Disease Management
Decision Support
Screening and Secondary Prevention
Education and Information Sharing
Health Promotion, Wellness and Primary Prevention
Evidenced Based Patient/Physician Interventions  Behavior Change Rx
Scalable
Analytics and Knowledge Engines  Specificity
Common Systems and Database Platforms  Integration
Copyright © 2006 American Healthways, Inc.
Wellness Models: HRA Driven Model
Health Risk Assessment
Worksite Health
Fair/Finger Stick
Medical
Screening/Venipuncture
Self-Directed Content:
No Intervention
Self-Directed
Interventions No
Incentives
Coaching
HRA Only Scoring
Lab and Biometric
Scoring
Outcomes Incentives
HRA
Data Collection
Worksite
Health Fair
Content/Web
Tools
Interventions
Self-Directed
Interventions
Coaching
HRA Scoring
Scoring/
Incentives &
Outcomes
Wellness Models: Portal/ASP Model
Wellness Models: Medical Exam Model
Objective Data Improves Participation
From a random sample of 12,000 participants that completed
the MHIQ HRA and Worksite Medical Exam:




74% could not self report their cholesterol, blood pressure
or body fat.
42% more participants tested “positive” for Nicotine than
self-reported they smoked.
33% self-reported “good or excellent” self-perception of
health but unknowingly had 3+ clinical risk factors
28% self-reported “good eating habits” but had dangerous
blood fat levels
Biomedical Stratification & Support
Participation: Avg. 80%
HRA, Exam/Labs, Score, $$$ Incentives
(Support Self-Directed Participants)
MHIQ
LOW
Low/No
Risk
HIGH
Early Signs
At Risk
Symptoms
Cost Avoidance
Pro-Change
Readiness Preparation
Lifestyle Interventions
Evidence-Based Outcomes
Event
Chronic
Cost Reduction
Disease Management
(Nurse Coaching)
Capture Employee’s View
Health Risk Assessment-HRA
•
Univ. of Mich. HMRC Research Criteria
•
CDC Prevention Assessments:
-CHD, Diabetes, Cancer
•
Full Medical History & Current Conditions
•
Lifestyle and Mental Health Assessment
•
Readiness For Change
•
Health Plan Access and Satisfaction
•
Highly Valid-Not Scored or Incentivised
•
Used to Correlate Lifestyle & Lab Results
Compare and Contrast to Medical Data
Worksite Medical Exam
•
Serum Cotenine-Tobacco
•
Full Lipids-Heart Disease
•
Glucose-Diabetes
•
Triglycerides-Heart Disease
•
GGT-Alcohol Abuse
•
Body Fat/BMI-Obesity, Heart Disease
•
Blood Pressure-Hypertension, Heart Disease
•
20 Chem. Panel: Vital Organ Test
Make The Correlation…Continually!
Hypertension
Obesity
Worksite Medical Exam
•
Serum Cotenine-Tobacco
•
Full Lipids-Heart Disease
•
Glucose-Diabetes
•
Triglycerides-Heart Disease
•
GGT-Alcohol Abuse
•
Body Fat/BMI-Obesity, Heart Disease
•
Blood Pressure-Hypertension, Heart Disease
Not Enough
Exercise
Personal Health Score & Incentives
Features of Employee’s IQ Report
Health IQ Score: Quantifies modifiable risk
factors that impact health care claims
100 is best score: no risk factors
71 recommended minimum score to qualify for
incentives in Y2
•Baseline Score
•Summary of Lab Results
•Scores weighted:
“Impact on Claims”
•Rank by Severity: Red Alert
prompts action
• Modifiable
Risk Factors
• Clear/Visual Prompts
Base Year
Score
57
Incentives That Work
Year 1: Apply and Reward Financial
Incentives
Year 2: Mandate Spouse Participation for $$$
Year 3: Reward Health Improvement




Maintain Low-Risk Health Score
Improve Health Score by at least 5pts
Have MD Certify Compliance
Reward Intervention Enrollment
Messaging: “We are Targeting Risk Factors That
Diminish Health
Clearly articulate your objectives.
“We need your help to improve the health
of our organization.”
Share the Facts…the Costs
Smokers average $3,400 per year in excess
medical claims
The risk of death from Cardiovascular Disease
increases 30% if you smoke
Source: CDC
It’s silent…how would you know?
High Blood Pressure is the leading cause of
disability and death from stroke, heart attack
and kidney failure
Untreated Hypertension results in 33% more
sick days
Source: CDC
It’s silent…we want you to know!
Cholesterol is a leading indicator of heart
disease. A 10% reduction can lower risk of
Cardiovascular Disease (CVD) by 30%
Source: CDC
Obesity…it will kill you. That’s why we care.
Medical costs from obesity are higher than
adding 20 years to your life. Obese patients
spend 77% more on medications
Source: CDC
Bad Food, No Exercise=Diabetes!
Do you have it…because 1 in 3 adults have a
lifetime risk of diabetes: Medical claims for those
with diabetes are 6x higher…than the “have-nots”
Source: CDC
Communicate, Communicate, Communicate….
When, Where,
How and Why?
Confidential!
Confidential!
Confidential!
What Does MyHealthIQ Do That Others Don’t
Over 90% of the Health IQ participants improved 3
or more clinical metrics after one year of
participation
Over 50% of Health IQ participants improved 6 or
more clinical metrics after one year of participation
Objective Data & Report Card Motivates Change
Y1 Employees With Scores Under 71pts
Test Result after 12 months (Y2)
No other Intervention than HIQ
•
12% Y2 Negative Nicotine (Positive Y1)
•
58% Improved Diastolic BP
•
48% Reduced Glucose
•
59% Reduced LDL
•
62% Lowered Total Cholesterol
•
44% Reduced Body Fat
Source: Healthways Informatics Research. December, 2005 data from statistically significant
sample of company database. Results may vary with different groups and incentives.
Medical Wellness…Objective…Supporting

Objective Data (Lab and Physical Exam) Drives Risk Assessment

Premium Reduction Incentives Activate Consumer to Engage

Population Participation Rates >80% Year 1

Customized Self-Directed Behavior Change Tools and Support

Outcomes Driven Wellness that Works



Improved Health
Lower Costs
Improved Productivity
Copyright © 2006 American Healthways, Inc.
Prove It’s Working
Measured Health Improvement
From Year-to-Year Medical Results
56%
49%
Reduced
“At Risk”
Population
Baseline
Year 1
Copyright © 2006 American Healthways, Inc.
Represent Significance…Satisfy the Skeptics.
Population:
Improvement in
Risk Scores:
Baseline to Year 1
Statistically Significant
Improvement
Any Improvement
At Risk
Total
О
О
О
О
О
О
О
О
О
О
О
О
О
О
О
О
О
О
О
О
О
О
Factors
Total Cholesterol
HDL Cholesterol
LDL Cholesterol
Total Cholesterol/HDL Ratio
BMI
Systolic Blood Pressure
Diastolic Blood Pressure
Triglycerides
Glucose
Nicotine
Body Fat Percentage
Copyright © 2006 American Healthways, Inc.
Tobacco Cessation Outcomes
Of the members who had Baseline Scores
(“at risk”),
41% tested positive for nicotine
12%
Positive
Negative
From this group of members, 12%
tested negative by year 1.
This outcome is at least twice that of results experienced
from typical tobacco cessation programs.
Copyright © 2006 American Healthways, Inc.
Weight Management Outcomes
Of the members who had Baseline Scores
(“at risk”), 92% had an unfavorable body fat percentage,
based on their age and gender
Not At Risk
46%
At Risk
From this group of members,
46% improved this measurement by year 1.
Copyright © 2006 American Healthways, Inc.
What do we know from History…RELAPSE!
Have a Support Plan…Educate
Employees about Behavior Cycles
Interventions
Blood Pressure Compliance
Lipid Management Compliance
Mild Anxiety and Depression
Self-Directed
Desired
Behavior
Change
Exercise and Physical Activity
Stress Management
Nutrition and Body Composition
Tobacco Cessation
Platform
Copyright © 2006 American Healthways, Inc.
Give them Objective Data, Tool Kits and
Expectations
Give them a Chance…Give them a Choice.
•We make your
employees Healthier
•Healthy employees are
more productive
•Healthy employees cost
less to insure.
Product Snapshot
Personal Program Portal
24/7 access to health content, tools, reports, lab results and
online support
Account
Admin
Online Q & A
Archive of
Assessments
Confidential
Report
Access
Personal
Health Content
“Push”
Medline
Health
Search
Current Test
Status
Health Support: In “Action” Phase
Score, Educate, Support, Measure
Health Support-Tools
Score, Educate, Support, Measure
Risk Specific Messaging and Support
Score, Educate, Support, Measure
Medline/NIH Health Search Resource
Score, Educate, Support, Measure
“Readiness” Messaging for Ambivalent
• Over 16,000 Possible Personalized
Pro Change Report Iterations
Telephonic Support
AMHC's Care Enhancement Center:
 Outbound Alert High-Extreme Cases
 Guide To Resources, Support, Monitor
 Self-Actuate: Unlimited Inbound Support
Primary Care Referrals
6 of 10 participants tested do not have
primary care physician
74% surveyed, reviewed their HIQ report with
a physician
Mail Support
All participants are provided 24/7 access to their
reports,health content, tools, lab results and online support
on the web, plus…
–Printed Reports Are Confidentially
Mailed to Participants’ Homes
–Quarterly Targeted Mailings can
be Distributed to all Participants
–Outbound Counselors Call
High/Extreme Cases
–All Reports Refer to Healthwise
Self-Care Guide (included)
Individual Reporting
Score, Educate, Support, Measure
Stakeholders Support
99% of all MHIQ participants allow their PHI to be shared
with other providers in their plan
2
Analytics/Consultants
3
1
Health Plans
Mental Health-EAP
AMHC
Informatics
5
4
Smoking, Weight
Loss, CoachingContractors
Health History, Labs,
Symptoms-DM
Methods of Measuring ROI
HSS Published Guidelines for Financially Incentivized
Bonafide Wellness Programs April 2003.
• Companies measure ROI Differently:
• Against “Cost of Doing Nothing” with annual double digit
premium inflation-Engage Employees-Reduce Trend
•Net Cost after shifting higher premiums to non-participants
•Reduction of Average Medical Claims
•Reduction of STD, Workers Comp, Absenteeism,
Presenteeism-Estimated at 3x Cost of Programs.
Financial Outcomes: Claims Reduction
In 12 months from initiating the program and scoring
lab and biometrics Y1 to Y2:




83% Participation Rate
52% reduction of participants with Extreme Risk
Status
47% reduction of participants with High Risk
Status
Year-over-year reduction in average medical
claims of $1,440.
Source: MHIQ Customer, March, 2005 data from statistically significant sample of company database.
Results may vary.
Financial Outcome: Lowering Renewals
In 12 months from initiating the program and
among users from Y1 to Y2:



85% Participation Rate
MHIQ Incentive Structure made the program
cost neutral
6% reduction in claims in Y2 vs. a 9%
increase forecasted based on trend
Source: Culver Academy, June 2005 data from a statistically significant sample of company’s database.
Results may vary.
Discussion
Thank you for your consideration
For More Information
Contact: Darren Hodgdon, SVP
615.565.5909
[email protected]