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Ron Loeppke - Leveraging the Tools of Technology with the Power of Prevention

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Cleveland HeartLab 2013 Symposium

Cleveland HeartLab 2013 Symposium

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  • Globally, more people have access to a mobile device than have access to drinking water, electricity or a toothbrush.80% of the world’s population has access to safe drinking water (BBC News, 2011) 81% of the world’s population has access to electricity (WEO, 2011)“Right now there are more mobile phones than toothbrushes”. Just under just under 6 billion mobile devices being used worldwide. (Institution of Engineering and Technology, 2011; Dr. Mike Short)
  • • Wireless solutions are well suited to address some of the biggest challenges in health care today.• 77% of Americans over 65 have 2 or more chronic conditions (Dept. of Health & Human Services)• By 2020, at least 160 million Americans will be monitored and treated remotely for at least one chronic condition (Johns Hopkins University)• Both consumers and physicians are rapidly embracing wireless health (PricewaterhouseCoopers, 2010)• 56% of consumers like the idea of remote care• 88% of physicians wanted patients to track/monitor health at home
  • This HPBS study showed the broader presenteeism and absenteeism costs of poor health to employers were $2.30 for every $1.00 spent on medical/pharmacy costs, and did not even include the additional costs of the following:Workers’ Compensation CostsShort-term Disability Long-term Disability Overtime Turnover Temporary Staffing Administrative Costs Replacement Training Off-Site Travel for Care Customer Dissatisfaction Variable Product Quality
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    • 1. Leveraging the Tools of Technology with the Power of Prevention Ron Loeppke, MD, MPH, FACOEM, FACPM U.S. Preventive Medicine
    • 2. Content Attestation and Disclosure I am an employee and shareholder of U.S. Preventive Medicine and the content in my presentation, is unbiased, and to the extent possible, evidence-based.
    • 3. Overview  Articulate how to leverage the Power of Prevention with the Tools of Technology  Delineate the Converging Trends that are advancing the value of population health management for Employers, ACOs/PCMHs , Physicians and Consumers  Review the solid Business Case for why employers are investing in Prevention and Population Health Management  Analyze published outcome studies and ROIs from comprehensive Prevention and Population Health Management initiatives.
    • 4. Converging Trends Driving the Demand for Prevention  Epidemiological Trends  Political Trends  Cultural Trends  Financial Trends
    • 5. Converging Trends Driving the Demand for Prevention Epidemiological Trends: • The Growing Economic Burden of Illness and Health Risks in Society
    • 6. Healthcare Costs: Which Matters More Age or Health Risk? Annual Medical Costs $11,965 $11,909 $10,785 $7,991 $12,000 $5,114 $8,927 $5,710 $9,000 $7,989 $6,625 $4,620 $6,000 $3,353 $2,565 $5,756 $3,000 $3,734 $1,776 0 $2,193 $4,613 $2,740 $0 19-34 35-44 45-54 55-64 Age Range Edington. AJHP. 15(5):341-349, 2001 65-74 75+ High Med Risk Low
    • 7. As Health Risks go so go Health Costs Dr. Dee Edington Zero Trends
    • 8. Converging Trends Driving the Demand for Prevention Epidemiological Trends: • The Growing Burden of Illness and Burden of Health Risks in Society • The Positive Potential of the Compression of Morbidity
    • 9. Compression of Morbidity Live Healthier Longer and Die more Suddenly at Lower Cost Health “Sudden Death in Overtime” “Acceptable QOL” “Disability” Age The compression of morbidity relates to postponing the age of onset of morbidity, disability and cumulative health costs--even though life expectancy is increased--largely by reducing health risks Hubert, Bloch, Oehlert and Fries. Lifestyle Habits and Compression of Morbidity. J Gerontol A Biol Sci Med. June, 2002; 57 (6) M347-51
    • 10. Converging Trends Driving the Demand for Prevention Epidemiological Trends: • The Growing Burden of Illness and Burden of Health Risks in Society • Compression of Morbidity Political Trends: • Bipartisan Support for Prevention • Aligning Incentives among Consumers, Providers, Employers • ACOs/P4P/PCMH… and ultimately the Consumer Centered Health Home 2/4/2011 10
    • 11. Focusing on the “Health” in Health Reform Legislation  National Prevention Strategy and Council  Employer-Based Wellness Program Incentives for Employees  Grants for Small Businesses to Provide Workplace Wellness  ACOs and PCMHs  Medicare Coverage of Annual Wellness Visit  Medicare Better Health Rewards Program
    • 12. Converging Trends Driving the Demand for Prevention Epidemiological Trends: • The Growing Burden of Illness and Burden of Health Risks in Society • Compression of Morbidity Political Trends: • Aligning Incentives among Consumers, Providers, Employers • ACOs/P4P/PCMH…Consumer Centered Health Home Cultural Trends: • Wellness is the new Green: Ultimate Personal Sustainability • Social Networking/Game Theory Innovations in Healthcare
    • 13. Gamification in Healthcare  Since 2004 One Game has been played 50 Billion hours (5.93 Million Years)  183 M people are “Gamers” (> 13 hours per week)  97% of Youth play regularly  25% of > 50 y/o play regularly  Future Nobel Prizes in Medicine Copyright 2010 U.S. Preventive Medicine
    • 14. Gamers Succeed Where Scientists Fail: Molecular Structure of Retrovirus Enzyme Solved, Doors Open to New AIDS Drug  Science Daily (Sep. 19, 2011) — Gamers have solved the structure of a retrovirus enzyme whose configuration had stumped scientists for more than a decade.  The gamers achieved their discovery by playing Foldit, an online game that allows players to collaborate and compete in predicting the structure of protein molecules.  They did it in only three weeks..  The Center for Game Science, in the Department of Computer Science and Engineering at the University of Washington, is where gamers, students, scientists and scholars apply gaming principles and play games (like Foldit) to innovate breakthroughs in fields as diverse as biology, education and nanotechnology.
    • 15. Converging Trends Driving the Demand for Prevention Epidemiological Trends: • The Growing Burden of Illness and Burden of Health Risks in Society • Compression of Morbidity Political Trends: • Aligning Incentives among Consumers, Providers, Employers • ACOs/P4P/PCMH…Consumer Centered Health Home Cultural Trends: • Wellness is the new Green: The Ultimate Personal Sustainability Index • Social Networking/Game Theory Innovations in Wellness • Mobile/Wireless Tech, EMRs, etc. Transforming the Healthcare Industry
    • 16. How the Digital Revolution will create better healthcare Dr. Topol is a Cardiologist at Scripps and Editor–in-Chief of Medscape
    • 17. Mobile Technology: The World’s most ubiquitous platform Globally, more people have access to cell phones than drinking water, electricity or a toothbrush. *Source: IMS Report: The World Market for Internet Connected Devices, 2012. 17
    • 18. TRANSFORMING HEALTHCARE By 2020, ~160 million Americans monitored and treated remotely for at least one chronic condition Johns Hopkins University. Chronic Conditions: Making the Case for Ongoing Care. Retrieved 10/20/12, from http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf 18
    • 19. Prescription Apps - Wireless Engagement  Poised to transform healthcare as we know it  Always with you, always on  Perpetual Connectivity/Communication – Information into Knowledge – Reminders/Notifications – Knowledge into Action – Clinical and Social support – Action into Results Mobile Health App 19
    • 20. Mobile Health Manager App: In Development Pedometers Mobile Fitness Apps Glucose Meters Blood Pressure Devices Tracking Devices Activity Armbands Sleep Managers Mobile Weight Loss Apps Scales Labs 20
    • 21. Mobile Health Manager Kits Diabetes CHF COPD/Asthma Wellness & Prevention
    • 22. Mobile Health Manager for Diabetes: In Development
    • 23. Mobile Diabetes Manager: Physician Summary Report  Glucose – – – – – Target Range % on Target Highest/Lowest reading Avg Glucose overall Avg pre/post meal glucose  Weight – Current + Goal  Nutrition – Avg calories + carbs / day  Medication – Current List – # missed doses – % adherence  Diabetes Health Checklist Items  Exercise – Avg weekly minutes – % Goal – Most frequent activity 23
    • 24. Converging Trends Driving the Demand for Prevention Epidemiological Trends: • The Growing Burden of Illness and Burden of Health Risks in Society • Compression of Morbidity Political Trends: • Aligning Incentives among Consumers, Providers, Employers • ACOs/P4P/PCMH…Consumer Centered Health Home Cultural Trends: • Wellness is the new Green: The Ultimate Personal Sustainability • Social Networking/Game Theory Innovations in Wellness • Mobile/Wireless Tech, e-PHRs, etc. Transforming the Healthcare Industry Financial Trends • The Problem: The Cost Crisis is largely due to the Health Crisis
    • 25. Patients with chronic diseases account for 75% of U.S. healthcare costs Of the $2 trillion spent on U.S. health care Of every dollar spent… …75 cents went towards treating patients with one or more chronic diseases In public programs, treatment of chronic diseases constitute an even higher portion of spending: More than 96 cents in …and 83 cents in Medicaid Medicare… “The United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases.” -- Centers for Disease Control and Prevention 10/29/2013 Proprietary and Confidential U.S. Preventive Medicine 25
    • 26. Converging Trends Driving the Demand for Prevention Epidemiological Trends: • The Growing Burden of Illness and Burden of Health Risks in Society • Compression of Morbidity Political Trends: • Aligning Incentives among Consumers, Providers, Employers • ACOs/P4P/PCMH…Consumer Centered Health Home Cultural Trends: • Wellness is the new Green: The Ultimate Personal Sustainability • Social Networking/Game Theory Innovations in Wellness • Mobile/Wireless Tech, e-PHRs, etc. Transforming the Healthcare Industry Financial Trends • The Problem: The Cost Crisis is due in large part to the Health Crisis • The Bigger Problem: Total Cost Impact of Poor Health to Employers
    • 27. The Bigger Problem: The Full Cost of Poor Health Personal Health Costs Medical Care Pharmaceutical costs Productivity Costs Absenteeism Short-term Disability Long-term Disability Iceberg of Full Costs from Poor Health Presenteeism Overtime Turnover Temporary Staffing Administrative Costs Replacement Training Off-Site Travel for Care Customer Dissatisfaction Variable Product Quality Sources: Loeppke, R., et al., "Health and Productivity as a Business Strategy: A Multi-Employer Study", JOEM.2009; 51(4):411-428. and Edington DW, Burton WN. Health and Productivity. In McCunney RJ, Editor. A Practical Approach to Occupational and Environmental Medicine. 3rd edition. Philadelphia, PA. Lippincott, Williams and Wilkens; 2003: 40-152
    • 28. Evidence Based Preventive Medicine is a Key Solution Centers for Disease Control and Prevention has found that:  80% of Heart Disease and Type II Diabetes as well as  40% of Cancer are Preventable – if people just: » stopped smoking, » ate healthy and » exercised
    • 29. Health is not a Spectator Sport
    • 30. Whole Population Health Management Wellness/Health Promotion Early Detection Early Intervention/Care Mgt Total Population Low Risk Medium Risk High Risk LS Risk DM Risk Population of One
    • 31. The Fundamental Formula for Success BH + BHC = LC Better Health + Better Health Care = Lower Cost When Financial Risk is linked to Clinical Risk Outcomes will Drive Incomes Population Health Management is the Key
    • 32. Health System Primary Care Innovation/Value Based Care Model: Empowering the Dr-Pt Relationship Health Inventory & Biometric Screenings Health Coaching/ Concierge Meet with Primary Care Physician “Triple Aim” and Physician/Clinician Satisfaction Population Health Management IT Integrator Platform Advanced Medical Home Model and Team Based Care (incl. EHR) Care Coordination for Chronic Conditions Pharmacy Utilization & Compliance
    • 33. Physician Review 34
    • 34. Physician Review
    • 35. Consumer and Provider Prevention Score Consumer Prevention Score Based on an individual’s assessment and actions towards a healthy lifestyle 685 Provider Prevention Score Bob Smith Sue Jones 750 722 Steve Wonder 844 Based on Dr. Welby’s aggregate score of patients managed
    • 36. Aligned Incentives with Physician and Employee/Consumer  Example of Points for Physicians and Patients to receive $ incentive: Evidence Based Medicine Quality Criteria Quality Points Preventive screenings (e.g. USPTF age/gender specific recommended mammograms, colon cancer screenings) 2 Disease-specific treatment and monitoring – eg. Diabetics receiving HbA1C at least every 6 months 3 Diabetics – Maintain participation in Disease Management or Lifestyle Management program per criteria 5 Physician Reviewing HRA with Patient 2  Performance Savings Bonus split in thirds (Drs/Pts/Employer)  Added $1.00 of Abs/Pres Savings for every $1.00 Med/Rx Savings  Quality Points Value for Physicians and Patients  1 Quality Point = $19.39 Loeppke R, Nicholson S, et al. “The impact of an integrated population health enhancement and disease management program on employee health risk, health conditions and productivity”. Population Health Management. 2008: 11(6); 287-296.
    • 37. Technology in a Workplace Wellness Program
    • 38. Overall Health Risk Reduction with 2 Year TPP Participation Net Movement of Health Risk Levels in Cohort Baseline vs Year 2 on Prevention Plan N = 7,804 71% 60% 5531 4666 29% 23% 2291 1775 11% 847 Low Moderate 6% 498 High Loeppke, R; Edington, D; Bender, J; Reynolds, A. “The Association of Technology in a Workplace Wellness Program with Health Risk Factor Reduction” Journal of Occupational and Environmental Medicine: 3/2013
    • 39. Health Risk Reductions with 2 Year TPP Participation (Total N = 7,804) # People and % of the # People and % of the Baseline High Risk Baseline High Risk Group Group remaining High Reducing Risk out of Risk after High Risk after Year 2 Year 2 Individual Risks # People and % of overall population (7804) with High Risk in Baseline Year Blood Pressure 923 (12%) (M=142/90) 179 (19%) (M=143/90) 744 (81%) (M=123/77) HDL 328 (4%) (M=31) 134 (41%) (M=30) 194 (59%) (M=41) Cholesterol 836 (11%) (M=263) 353 (42%) (M=265) 483 (58%) (M=208) Fasting Blood Glucose 1616 (21%) (M=116) 926 (57%) (M=123) 690 (43%) (M=92) Body Mass Index (BMI) 3338 (43%) (M=33) 2937 (82%) (M=34) 401 (12%) (M=26) Loeppke, R; Edington, D; Bender, J; Reynolds, A. “The Association of Technology in a Workplace Wellness Program with Health Risk Factor Reduction” Journal of Occupational and Environmental Medicine: 3/2013
    • 40. Diabetes Care Management: Inpatient Days per 1000 Diabetic Members per Year N = 299 1361 1400 1200 1000 800 600 400 458 301 261 200 0 Proprietary and Confidential U.S. Preventive Medicine
    • 41. Diabetes Care Management: Total Costs Per Diabetic Per Month across 3 Years in Program N = 299 $1,400.00 $1,200.00 $1,000.00 $800.00 $1,262.15 $849.17 $691.85 $667.20 $600.00 $400.00 $200.00 $0.00 42
    • 42. The Business Value of Better Health and Productivity  Market cap value impact from regaining 1 Day of productivity per year per FTE  58,000 employees, current 8 Days per FTE of health-related productivity loss 1 Day per FTE of Regained Productivity = $18.8M EBITDA impact 13x (EBITDA Multiple) $244.4M estimated market cap increase ÷ 292M shares $0.84 in additional per share value Loeppke R. “The Value of Health and the Power of Prevention”. Int J Workplace Health Manage. 2008; 1(2)95-108.
    • 43. Wellness Works and Prevention Pays Average ROI $3.27 Med/Rx Savings + $2.73 Absenteeism Savings $6.00 saved for every $1.00 invested In Comprehensive Wellness Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Affairs (Millwood). 2010; 29(2).
    • 44. Transformation beyond “Sick” Care to “Health” Care New Way Current Way Focus     “Sick Care” System Quantity/Cost of Service Illness, Injury and Absence Health “Benefit” as a Cost     Approach     Permission to Drs & Pts Coverage focused on Sickness Fragmented/Uncoordinated Prevention a Cost to Justify     Empowerment of Drs & Pts Aligned Incentives for Health Integration / Coordination Prevention as an Investment Results     Benefits for Poor Health EEs “Use it or Lose it” Patients Passive Recipients “Pay for Quantity/Volume”     Rewards for Better Health EEs “Use Wisely & Save” Consumers Active Participants “Buy Quality/Value” True “Health” System Quality/Value of Service Well-being and Engagement Value and Benefits of Health
    • 45. The Bottom Line Good Health is Good Business From the Exam Room to the Board Room 46