Population Health Management

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Population Health Management

  1. 1. NEW RESULTS WHAT WE DO NEXT GEN BENEFITS OUTCOME BASED Population Health Management Retirement Health to Wealth Replace Open Enrollment Paper Docs with our CD Rom! EMPLOYER STRATEGIES BROKER SERVICES VENDORS & TPAs CONSULTING SERVICES Lifestyle Risk Calculator This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  2. 2. Scott Hettesheimer Suite 1002 513-661-7581 Scott@GroupBenfitsExperts.com Population Health Management Copernican Evolution in HealthCare Management Benefits delivery platform, population health management, outcomes based wellness initiatives, disease treatment compliance and much more. Delivered from 1 Website. A vendor agnostic platform. AFFORDABILITY!
  3. 3. Overview Affordability and competitive benefits that retain and attract talent, can only be accomplished with better healthcare management and simplifying your benefits delivery. The Population Health Management system will create a healthier world with its one-of-a-kind behavior motivation process driven with Modifiable Risk Factor reporting. Unlike any other solution on the market, the Lifestyle Risk Calculator correlates behavior costs to retirement health to wealth. Outcomes based financial & clinical incentives drive engagement, creating significant outcome based measurable results. This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  4. 4. Problems How do we deliver all of our benefits from one website? How do we engage all of our employees and dependents? How do we simplify our benefits delivery? How do we improve benefits satisfaction? How can we manage all healthcare benefits by way of supply chain management processes? Limited Ability to Deliver The Strategy Cornerstone This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  5. 5. Benefits Delivery Increasing Engagement  Single Source Website, Login & Password  Simple to Use & Familiar User Interface  Managing All Health & Employer Communications  Presenting All Benefits From One Website  Healthcare  Qualified Retirement  Dental, Vision & Ancillary/Voluntary  Connecting All HealthCare Data  Claims  Pharmacy  Biometrics  Manual Input Available for Wellness & Members This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  6. 6. Benefits Delivery - User Interface Single Source Website, Login & Password Ex. A family health manager will be able to view all family activities and alerts through the News Feed As an authorized caregiver, user receives a notification that a family member has completed a physical activity challenge The News Feed is constantly updated "To-Do" lists identify tasks that are not complete . Users can add their own "To-Do" items for themselves and/or their family members Receive reminders of an upcoming doctor’s appointment
  7. 7. Benefits Delivery -User Interface Managing All Health & Employer Communications
  8. 8. Benefits Delivery -User Interface Peer Support Reinforces Engagement & Positive Change
  9. 9. Drill into specific health topics: medications, allergies, immunizations, visits, procedures, etc. Notifications: Based on a user’s preferences, the system will send out a variety of notifications, ranging from upcoming calendar appointments to a notification that new data has entered the user’s record Alerts: The system will notify a user if the system has identified a problem in the user’s record Benefits Delivery -User Interface Familiar & Simple
  10. 10.  On-the-go employees present biggest costs and biggest savings opportunities  Dossia system leverages aggregated data to engage employees with personalized text-based programs to promote health behavior change Benefits Delivery – Communications Engaging Hard but Critical-to-Reach Employees No computer. No internet. No Problem. Your employees don’t have to be web native to benefit Text-based engagement programs may include: Mobile Engagement Solution  Health awareness / communications  Patient decision support  Health care consumer support  Health rewards & incentives  Medication adherence  Preventive care reminders  Nutrition and activity promotion  Diabetes management
  11. 11.  Choose apps that are meaningful to you  Apps integrate with PHR  Many apps are free  Dossia vets all apps for quality, value and reliability Benefits Delivery - Services Health Marketplace… Because Your Health is Yours! All apps are segmented into 5 categories for easy search
  12. 12. Population Health Management Disparate Health Data; All Shareholders Now Connected
  13. 13. HealthCare Cost Equation Pre-Diagnosis: Reverse disease trending Slow disease progression Better disease management Avoid healthcare need After-Diagnosis: Negotiate deeper discounts Discover cheaper prices Shift more cost to member Unknown effects of ObamaCare In order to accurately manage risk, 100% of the risk must be identified. Historical claims data only identifies current healthcare spending or current diagnoses, a backward look of less than 20% of your members. According to CDC’s analysis: Forty-five percent of adults had at least one of three diagnosed or undiagnosed chronic conditions—hypertension, hypercholesterolemia, or diabetes; one in eight adults (13%) had two of these conditions; and 3% of adults had all three chronic conditions. Do You Know Who These People Are? This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  14. 14. Population Health Management Founded by a group of CEOs from some of the largest employers in the US, a platform was created that functions as the heart of your corporate benefits initiatives.
  15. 15. Population Health Management Promotion of Health American Journal of Health Promotion, 1989 “Health promotion is the art and the science of helping people change their lifestyle to move toward a state of optimal health. Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual health. Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior, and create environments that support good health practices.” Current Health Care Model Focuses On: – Disease Status rather than health status – Mortality rather than Morbidity. Traditional physical health risk factor(s) with less emphasis on behavior change and quality of financial and clinical state of health. Serious need to Change Your Benefits Delivery Platform.This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  16. 16. Population Health Management Real Health Data … Real Health Decisions … in Real Time! PRESENTING….. Hospitals Population Health Management & Dashboard™ Doctor’s Offices Health Plans Labs Pharmacies
  17. 17. Population Health Management …Total Personal Health Management System Unique Attributes:  Seamless integration  Consumer Friendly  Comprehensive clinical and non-clinical data: 360o view  Secure, Private  Automated, Pre-Populated Data  Single Sign-On  Sharing Capabilities Personal, Patient-Controlled, Private, Comprehensive, Lifelong Electronic Health Record Plus a Set of Personal Health Applications
  18. 18. Modifiable Risk Factors Power Your HRA with Personal Health Information
  19. 19. Modifiable Risk Factors Know Your Number Reporting
  20. 20. Modifiable Risk Factors Risk Factors Impact on Claims This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  21. 21. Modifiable Risk Factors Health Issues Related to Obesity  Sleep Apnea  Diabetes Type II  Hypertension  Cholesterol  Triglycerides  Cardiovascular Disease  Erectile Dysfunction  Degenerative Joint Disease  Gout  Gerd  Depression  Metabolic Syndrome  Venous Stasis  Asthma Achieving a healthy BMI – 24.9 or under improves “Quality of Life” in 95% of individuals and Mortality improves in 89% of individuals Heart disease and stroke Type 2 diabetes and cancer Colon cancer Gall stones Osteoarthritis in hip and knee joints Respiratory problems This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  22. 22. Modifiable Risk Factors Statistics Diabetes: 2008 Statistics: 24 million diabetics, 57 million pre-diabetes 2011 Statistics: 26 million diabetics, 79 million pre-diabetes • Heart Disease $448.5 billion in 2008. 16 billion more than in 2007 • Depression Medical cost is $44 billion annually (Mental Health America) • Obesity cost $147 billion annually (CDC 2006) This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  23. 23. Modifiable Risk Factors Statistics (Continued) – 65% to 85% of heart disease – 66% of cancers – 91% of diabetes – are caused by modifiable personal health behaviors – If adapted – 50% reduction in all cause mortality (Knoops et al., Rimm and Stampfer, 2004) This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  24. 24. Modifiable Risk Factors Leading Cause of Morbidity and Mortality  Tobacco Use  Unhealthy Diet  Physical Inactivity  Overweight and Obesity  Increasing in prevalence.  Only 10% of the population does not have any of 4 risk factors. (American Cancer Society) This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  25. 25. Lifestyle Risk Calculator Correlating Behavior Cost to Lost Retirement Income This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  26. 26. Personal Health Record Life Long; Electronic; Portable. Users may choose to share their record with wellness coaches and disease managers Health managers can monitor profile updates and progress through Dossia’s activity feed or the Dossia Dashboard Care coordinators are able to securely communicate through Dossia’s messaging system The Health Management System enables wellness and disease managers to contact members via the medium of their choice: Dossia messages, text and email
  27. 27. Outcomes-Based Wellness & Incentives Chronic diseases related to lifestyle account for 75% of national medical costs. Eleven separate studies by the Centers for Disease Control suggest that worksite wellness programs can produce significant improvements in employee health. - Centers for Disease Control, 2006 53% of U.S. adults think its fair to ask those with unhealthy lifestyles to pay more for their health insurance. (Up from 37% only three years ago.) - Wall Street Journal/Harris Interactive Poll 56% of employers plan to hold employees more responsible for the cost of health benefits. - Washington Post, March 12, 2010 This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  28. 28. Outcome Based Wellness Healthy Lifestyles Should Pay Less Outcomes-based wellness is like other insurance discounts for state of health.  Drivers with fewer tickets and accidents pay less  Non-smokers pay less for life insurance  Homeowners with security alarms pay less It is fair for employees who live healthy lifestyles to pay a lower contribution for their insurance. Non-smokers should pay less than smokers. This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  29. 29. Outcome Based Wellness Average, Measured, employer results; After several years of a participation-based program, little lifestyle changes are seen and typically cannot be measured. The Outcome Based Wellness driven with financial incentives produce different, measured results. • Participation/Engagement (96+%) • Measured improvement first year: • 16+% more members passed blood pressure goal. • 10+% went from obese (30+ BMI) to non-obese. • 11+% lowered their cholesterol levels. • 2+% quit smoking . • Cost-shift in year one ROI was $3+ saved to $1 spent. • Total Return on Investment for the first two years of the program, including risk reduction, was $6+ saved to $1 spent. • Non-incentives measures do not improve. Everything tied to money did. This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  30. 30. Outcome Based Wellness Average, Measured, employer results; An Analysis of the Cost Effectiveness •26% change in sick leave •27% change in health claims •40% change in workers’ comp •24% change in disability management Benefits for Employees include improvements in state of health, moral, quality of retirement – Health to Wealth. Reduce the overall cost of premium by integrating calculator into their activities of daily living. Provides employees the tools to help them live a healthy lifestyle and improve the quality of their life. This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  31. 31. Evidence Based Reporting Evidence Based Analysis; On-Demand Real, Measurable ROI Measure Interventions & Quantify Value • Who did what? • What were the outcomes? • What were annual health trends? • What were year-to-year results? • What did you spend? • What did you save? • What is ROI This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  32. 32. Evidence Based Reporting Health Transformation Starts Once You Know The Problems Advance a Culture of Health with:  3-year historic health assessment  Identification of key health cost trends  Identification of key intervention strategies
  33. 33. Evidence Based Reporting …And Their Related Cost Stratify Modifiable Risk:  By condition  By Rx use  By clinical data  By biometric data  By claims data  By individual or multiple factors This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  34. 34. Evidence Based Reporting See When & How your Population Engages Track Key Indicators of Health Engagement  Unique logins  Time on platform  Apps installed  Time on programs  Challenges initiated  HRA starts  HRA completions
  35. 35. Six Sources of Payer ROI  The aggregation point for varied health initiatives  Single sign-on enables secure integration of all health apps within a unified framework  No need to navigate to multiple web sites  No need to memorize multiple passwords Enables your health initiatives to integrate with PHI Integrates health apps with an individual’s PHI to create a holistic, personalized experience Applications are intuitive (i.e., Recipe Planner shows sodium-free recipes if PHI shows hypertension) Programs are interactive (i.e., Walking Program app displays progress on Measurements app) Integrated data design improves care coordination Sharing capabilities, notifications & core apps enable physicians and pharmacies to be alerted to adverse drug interactions Integration with with clinical technologies (e.g., EHR) enables physicians to see a patient’s complete health history
  36. 36. Six Sources of Payer ROI  Enables portability of self-reported and professionally-sourced data  Mitigates the incidence of duplicative, expensive diagnostic tests  Reduce risk of misdiagnosis, medical errors in emergent situations  Health Manager uses unadjudicated claim feeds  Health Language™ program translates medical jargon into “plain-spoken words”  Easy-to-read data enables laypeople to understand and, when appropriate, challenge inaccurate billing  Dashboard analyzes clinical, claim and Rx data in near real-time  Health Triggers & Health Rules enable automation of interventions to address modifiable risk  Drives personalized “just-in-time” interventions  Real-time data improves response time to emerging population health issues
  37. 37. Best Practices Evaluate your current culture. Does it support better behavior Form a team to develop your program. Implement effective communication programs. Manager education/Employee participation in program implementation. Communicate confidentiality. Design program to change behavior. Provide tools needed and incentive programs to motivate employees to change. Data management. Report Participation. Collect and store health behaviors and personal risk factors. Validate effectiveness and success. Meet HIPAA requirements. Evaluation is shared with organization and used for learning and improvement. Creation of a supportive social environment for individual to achieve their health goals. This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  38. 38. Create a Phased Strategy Begin by identifying good health standards, illustrating how each member’s biometric measurements compare. Our “Know Your Number” reporting identifies risk of chronic disease and illustrates peer comparisons. Incent for disease treatment compliance, BMI reductions and the creation of an exercise program – counting steps and walking. Employer impact – Break Even. Year 2. Establish formulas to earn a 20% contribution to medical premium. Biometric measurements confirm accomplishments. Employer Impact: up to 8% net savings. Year 3. Be aggressive and implement formulas that represent behavior change that achieves clinical outcomes that represent significant improvements in Biometric measurements. Employee Impact is up to 30% of premium contribution and possible loss of benefit incentives if not compliant with disease treatment. Employer financial impact up to 15% net savings. This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  39. 39. Benefits Satisfaction  We simplify the delivery of needed healthcare for all members  We help solve the Healthcare Need Crisis  We help solve the Retirement Crisis  We improve people’s lives – Health to Wealth HealthCare is Complicated This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  40. 40. Security The most important thing is the privacy and security of patient data. When the platform was built, it was done with complete HIPAA compliance. But beyond that, compliance with the privacy laws of all 50 states relative to adolescents and sexually transmitted disease. SOC3 security, which is the same standard that is used in the banking industry. In addition, security is tested annually by outside audit by companies like Intel, AT&T, and Walmart. Security certification is done every year from SysTrust, which is the gold standard in technology security. Security and privacy is without a doubt the most-important component of what we do… simply because of the nature and product provided. So, in addition: Fully compliant with HIPAA Privacy and Security regulations; the organization works with SysTrust auditors who do multiple SysTrust audits annually and certify HIPAA compliance. The staff is required to undergo yearly HIPPA training courses to make sure everyone is up to date on all HIPAA provisions. Extensive experience in integrating CCR, CCD, CDA, LOINC, ELINCS, HL7, HIE, CVX, EDI X12, ICD, CPT, HCPCS and other healthcare data standards. This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  41. 41. The Strategy Cornerstone Conclusions The Population Health Management System makes individuals’ aggregated health data actionable, all applications brought together on a simple user platform delivering personalized, data-driven strategies that enable users to get more value from healthcare spending, better manage chronic conditions and pursue a healthier lifestyle. Automated and targeted messaging fosters lasting engagement and behavior change, yielding long-term value to employers, employees and families. Employers overspend on health benefits for which they realize little value. The Population Health Management System is the solution for forward thinking employers that aim to rationalize their health benefits spending while engaging their employees as true partners in achieving high value healthcare, better satisfying their health needs. This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  42. 42. Services  Open Enrollment Custom CD Rom Creation  DOL Audit Compliance Manual  Benefits Business Plan Creation  ERISA Academy  Re-Invent Yourself Business Plan  Full Benefits Audit  New Small Group Self-Insured Solutions  Benefits Delivery Platform  Population Health Management  Lifestyle Risk Calculator Other Services: www.AdvancedBenefitDesignInstitue.com This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  43. 43. NEW RESULTS WHAT WE DO NEXT GEN BENEFITS OUTCOME BASED Population Health Management Retirement Health to Wealth Replace Open Enrollment Paper Docs with our CD Rom! EMPLOYER STRATEGIES BROKER SERVICES VENDORS & TPAs CONSULTING SERVICES Lifestyle Risk Calculator This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.
  44. 44. Contact: Advanced Benefit Design Institute, LLC 3254 Montana Ave., Suite 1003 Cincinnati, Ohio 45211 513-661-7581 scott@GroupBenefitsExperts.com http://www.AdvancedBenefitDesignInstitute.com This presentation contains proprietary information. It is intend for use only by our contracted brokers and employer groups. Any redistribution or other use is strictly forbidden. The benefit descriptions are intended to be a brief overview of some benefits available. For Agent/Broker use only. Not for distribution to the general public, nor for solicitation purposes.

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