0
www.healthwaysaustralia.com.au
Innovations in Population Health
12th Annual Health Insurance Summit
Dr Linda Swan
Managing...
www.healthwaysaustralia.com.au
• Population Health in Australia
• What is the cost of doing nothing?
• Innovations in Popu...
www.healthwaysaustralia.com.au
Population Health in Australia
3
www.healthwaysaustralia.com.au
The Ultimate Goal is to Improve Well Being
Social/
Emotional
Financial
Community
Physical
C...
www.healthwaysaustralia.com.au
Population Health
• Population health is focused on understanding the
health and disease in...
www.healthwaysaustralia.com.au
Healthy & Good
Health Habits
Wellness
Low Risk
Poor Health
Habits
Prevention
support
Health...
www.healthwaysaustralia.com.au
Australian Government Priority Areas
• Priority population groups
• Indigenous people
• Ove...
www.healthwaysaustralia.com.au
Recent Australian Government Initiatives
• Australian National Preventative Health Agency (...
www.healthwaysaustralia.com.au
If there was a single map of activity…
9
www.healthwaysaustralia.com.au
The Cost of Doing Nothing...
10
www.healthwaysaustralia.com.au
Months of
expensive hospital
care can be undone by
patients who just go
home and go about
t...
www.healthwaysaustralia.com.au
Health Status/Risk Matrix – Australia
1212
• Health/Risk profile determines the majority of...
www.healthwaysaustralia.com.au
Developing a Simulation Model
1313
Vetting with the Framingham Heart Study
Segment Average ...
www.healthwaysaustralia.com.au
Medical Cost Growth
1414
• Medical Costs grow over a five-year horizon
o Without interventi...
www.healthwaysaustralia.com.au
Medical Cost/Health Condition – Australia
1515
• Medical Costs by Health Condition
o The to...
www.healthwaysaustralia.com.au
Productivity Cost
• Productivity Costs grow over a five-year horizon
o The same conditions ...
www.healthwaysaustralia.com.au
Productivity Cost/Health Condition /
Australia
• Productivity Costs by Health Condition
o O...
www.healthwaysaustralia.com.au
Opportunity for Doing Something – Australia
•Five-Year, Cumulative Cost Savings through Int...
www.healthwaysaustralia.com.au
Innovations in Population
Health
19
www.healthwaysaustralia.com.au
Necessity is the mother of invention…
• Forward projections predict that healthcare costs w...
www.healthwaysaustralia.com.au
New models of Healthcare are needed…
Current State Future State
• Payment for Utilization
•...
www.healthwaysaustralia.com.au
Innovations in Population Health
22
• Using data to drive decisions – predictive modelling
...
www.healthwaysaustralia.com.au
Leveraging social media...
23
www.healthwaysaustralia.com.au
24
“Social Media is about sociology
and psychology more than
technology.”
- Brian Solis of ...
www.healthwaysaustralia.com.au
What social research telling us
Why aren’t people already well?
People get it.
But they fac...
www.healthwaysaustralia.com.au
Behaviours are contagious
We need to
individual.
treat the network, not just the
MeYou Heal...
www.healthwaysaustralia.com.au
Gamification
What Gamification Does:
Dynamics: Make clear what
to do and when to do it.
Mec...
www.healthwaysaustralia.com.au
Employing Innovative Mobile and Social
Applications
• Compelling web and mobile experiences...
www.healthwaysaustralia.com.au
Evidence of outcomes...
29
www.healthwaysaustralia.com.au
•25-year commitment initiated January 2, 2008
•1,000 telephonic “community” surveys
complet...
www.healthwaysaustralia.com.au
Well-Being is Predictive of Cost and Utilisation
Harrison, Pope, Coberley, and Rula. Evalua...
www.healthwaysaustralia.com.au
• >30% improvement in Perception of Health (overall health status)
• Statistically signific...
www.healthwaysaustralia.com.au
-7.8%
-7.2%
-6.1%
-13.4%
-12.0%
-11.3%
Diabetes Cardiovascular Dis Total
Difference in Admi...
www.healthwaysaustralia.com.au
Environmental Interventions
34
www.healthwaysaustralia.com.au
Blue Zones is a Community Transformation Effort
to Make the Healthy Choice the Easy Choice
...
www.healthwaysaustralia.com.au
Initiative in the Beach Cities in Southern California
Three Audiences:
Community (Gov/Schoo...
www.healthwaysaustralia.com.au
And the Iowa Blue Zones Project™
• The Healthiest State Initiative is a community and busin...
www.healthwaysaustralia.com.au
Conclusions
High Costs of Doing Nothing Different
• Both medical and productivity costs imp...
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  1. 1. www.healthwaysaustralia.com.au Innovations in Population Health 12th Annual Health Insurance Summit Dr Linda Swan Managing Director Healthways Australia Tuesday, 23 July 2013
  2. 2. www.healthwaysaustralia.com.au • Population Health in Australia • What is the cost of doing nothing? • Innovations in Population Health • Leveraging Social media • Evidence of outcomes • Environmental Interventions Content 2
  3. 3. www.healthwaysaustralia.com.au Population Health in Australia 3
  4. 4. www.healthwaysaustralia.com.au The Ultimate Goal is to Improve Well Being Social/ Emotional Financial Community Physical Career “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” - Preamble to the Constitution of the World Health Organisation as adopted by the International Health Conference, New York, 19-22 June, 1946 4
  5. 5. www.healthwaysaustralia.com.au Population Health • Population health is focused on understanding the health and disease in a community or population and then developing interventions that can improving health and well-being. • Fundamental to the approach is determining priority areas where investments should be focused to address the disparities in health status within a population. • Encompasses a range of interventions including preventative health, supported self care, disease management and integrated care 5
  6. 6. www.healthwaysaustralia.com.au Healthy & Good Health Habits Wellness Low Risk Poor Health Habits Prevention support Health & Lifestyle Risk Factors Prevention support Well-Managed Condition Supported Care Poorly Managed Condition Chronic Disease Support At Risk for Hospitalisation High Risk Chronic Disease support High Risk REQUIRES AN INTEGRATED HEALTH SUPPORT PLATFORM Total Population Management 100% 50-60% 15-20% 5% Active Care Management Prevention/ Risk Management Wellness Wellness programs designed to inspire healthier lifestyles at each stage of life Prevention Support Addressing lifestyle risks that lead to chronic disease Supported Self Care Periodic coaching, education and support to allow self management of conditions Chronic Disease Support Active education and encouragement to manage high cost chronic conditions High Risk Chronic Disease Support Intensive one-on-one support for those at high risk for hospitalisation 6
  7. 7. www.healthwaysaustralia.com.au Australian Government Priority Areas • Priority population groups • Indigenous people • Overseas born Australians • Rural and remote • Veterans • Socioeconomically disadvantaged • Prisoners • Priority age groups • Mothers and babies • Children • Young people • Older people 7 • Disease priorities • Cancer • Cardiovascular disease • Dementia • Injury prevention • Diabetes Mellitus • Asthma • Obesity • Mental Health • arthritis
  8. 8. www.healthwaysaustralia.com.au Recent Australian Government Initiatives • Australian National Preventative Health Agency (ANPHA) • Be the Influence - Tackling Binge Drinking • Donate life • eHealth • Fight Flu Campaign resources • Live Longer! - ATSI • National cervical screening program • National Seniors Productive Ageing Centre • National Skin Cancer Awareness Campaign • Quit for You - Quit for Two • STIs - Sexually Transmissible Infections • Swap It, Don't Stop It 8
  9. 9. www.healthwaysaustralia.com.au If there was a single map of activity… 9
  10. 10. www.healthwaysaustralia.com.au The Cost of Doing Nothing... 10
  11. 11. www.healthwaysaustralia.com.au Months of expensive hospital care can be undone by patients who just go home and go about their normal activities. 11 The Cost of Doing Nothing…
  12. 12. www.healthwaysaustralia.com.au Health Status/Risk Matrix – Australia 1212 • Health/Risk profile determines the majority of future costs o Health—Do they have more, less, or average amounts of chronic conditions (like obesity, diabetes, cancer, etc.)? o Risk—Are they more, less, or equally likely to engage in risky behaviors (like smoking, poor diet, poor stress management, etc.)? RiskStatus Health Status Australia High Low Healthier Sicker 12
  13. 13. www.healthwaysaustralia.com.au Developing a Simulation Model 1313 Vetting with the Framingham Heart Study Segment Average risk Low risk Average risk Low risk Male 35-44 6.00% 3.50% 6.93% 3.60% Male 45-54 12.50% 5.00% 13.80% 6.38% Male 55-64 18.50% 8.00% 24.28% 11.13% Female 35-44 1.50% 1.50% 3.00% 1.23% Female 45-54 6.50% 4.00% 9.15% 5.28% Female 55-64 12.00% 7.50% 20.23% 10.25% Framingham Risk Scores Simulation Risk Scores Ten-year risk projection comparison for the onset of coronary heart disease Overall, our model, built on national datasets (NHIS, MEPS, BRFSS) and epidemiology data, projects similar to slightly aggressive risk scores in comparison to Framingham. We build on this type of detailed-level data to create population views in the World Economic Forum Kiosk Application Simulation model developed by BCG and Healthways, with support of WEF Goals To assess the healthcare and productivity costs associated with the most costly chronic conditions and behaviors To show how the presence of a comprehensive well-being program would affect future healthcare costs and productivity 13
  14. 14. www.healthwaysaustralia.com.au Medical Cost Growth 1414 • Medical Costs grow over a five-year horizon o Without intervention, chronic conditions can be expected to progress more aggressively than with intervention o Costs are driven both by the community’s demographics and its Health/Risk profile 14
  15. 15. www.healthwaysaustralia.com.au Medical Cost/Health Condition – Australia 1515 • Medical Costs by Health Condition o The top five conditions account for about 68% of all medical expenses. 15
  16. 16. www.healthwaysaustralia.com.au Productivity Cost • Productivity Costs grow over a five-year horizon o The same conditions that require medical expenditures also contribute to lower productivity while an individual is at work. 16
  17. 17. www.healthwaysaustralia.com.au Productivity Cost/Health Condition / Australia • Productivity Costs by Health Condition o Obesity alone is responsible for 37% of all productivity loss o The top five conditions account for about 71% of all productivity loss 17
  18. 18. www.healthwaysaustralia.com.au Opportunity for Doing Something – Australia •Five-Year, Cumulative Cost Savings through Interventions in Modifiable Behaviors •By introducing comprehensive well-being improvement programs that address all eight behaviors: • Medical Costs reduced by 11.60% • Productivity Costs reduced by 8.21% • Total Costs reduced by 9.69% 18
  19. 19. www.healthwaysaustralia.com.au Innovations in Population Health 19
  20. 20. www.healthwaysaustralia.com.au Necessity is the mother of invention… • Forward projections predict that healthcare costs will exceed revenue available between 2020 – 2050 • 70% of the burden of disease is due to chronic disease. • Our ageing population is living longer • Poor data: poorly controlled disease, waste and poor transitions/lack of coordinated care • 1-2% of Australians drive around 50% hospital and medical expenditure. 20
  21. 21. www.healthwaysaustralia.com.au New models of Healthcare are needed… Current State Future State • Payment for Utilization • Fragmented Care • Patients • Episodic • Reactive • Variable Methods • Paper Intensive • Payment for Value • Coordinated Care • Populations • Longitudinal • Proactive • Evidence-based Care • Electronic Guiding Principles Use the lowest cost methods and modalities Focus on interventions with proven outcomes Ensure sustainable engagement of the individual. 21
  22. 22. www.healthwaysaustralia.com.au Innovations in Population Health 22 • Using data to drive decisions – predictive modelling • Behavioural change to increase self management • Targeted programs focused on the “2%” • Improved coordination/integration of care • Telemonitoring and telehealth • “Rationing” of access to expensive new technologies • Engaging corporates and business – sharing the load • Partnerships and collaboration • Leveraging social media
  23. 23. www.healthwaysaustralia.com.au Leveraging social media... 23
  24. 24. www.healthwaysaustralia.com.au 24 “Social Media is about sociology and psychology more than technology.” - Brian Solis of FutureWorks
  25. 25. www.healthwaysaustralia.com.au What social research telling us Why aren’t people already well? People get it. But they face problems… • • • • Not sure what to do Lack of time Reluctance to ask for support Easier to stop than to keep going MeYou Health is a Healthways company They want solutions that are: • Realistic about what they ask you to do • Convenient to factor into a busy life • Give immediate feedback
  26. 26. www.healthwaysaustralia.com.au Behaviours are contagious We need to individual. treat the network, not just the MeYou Health is a Healthways company
  27. 27. www.healthwaysaustralia.com.au Gamification What Gamification Does: Dynamics: Make clear what to do and when to do it. Mechanics: Provide the positive and negative feedback instilling reward/penalty and progress. Aesthetics: Drive an emotional and tactile connection to the dynamics and mechanics. Hunicke R, LeBlanc M, Zubek R. MDA: A Formal Approach to Game Design and Game Research MeYou Health is a Healthways company
  28. 28. www.healthwaysaustralia.com.au Employing Innovative Mobile and Social Applications • Compelling web and mobile experiences • Encourage people to become mindful of small actions they can take every day • Transforming social networks into support systems • Helping people understand how their personal decisions affect their well-being • Engaging, educating and empowering people to make better choices • Promoting personal growth and perceptible change Do – involves participants taking small actions each day Learn – involves participants learning about themselves, their support networks, and what makes them successful Change – involves creating healthy behaviours 28
  29. 29. www.healthwaysaustralia.com.au Evidence of outcomes... 29
  30. 30. www.healthwaysaustralia.com.au •25-year commitment initiated January 2, 2008 •1,000 telephonic “community” surveys completed per day, 7 days/week •1,700,000+ completed surveys •Design support and oversight from leading behavioral economists, psychologists, and experts in psychometric survey design and statistical analysis •Largest and most comprehensive health survey and database Domains Life Evaluation Emotional Health Physical Health Healthy Behavior Work Environment Basic Access Requires scientifically validated measurement tools 30
  31. 31. www.healthwaysaustralia.com.au Well-Being is Predictive of Cost and Utilisation Harrison, Pope, Coberley, and Rula. Evaluation of the Relationship Between Individual Well-Being and Future Health Care Utilisation and Cost. Pop Health Management, 2012. Higher Well-Being = Lower Cost Higher Well-Being = Lower Utilisation 10.1 % 18.4% 10.0% 14.2% 5.3% 9.6% Individual Well-Being Score Percent of Respondents with Hospital Utilisation in 12 Months After WBA Medium: >50-75 High: >75-100Low: 0-50 Hospital Admissions ER Visits $5,172 $3,765 $1,048 $3,399 $2,605 $77 1 $1,885 $1,507 $344 Individual Well-Being Score Medium: >50-75 High: >75-100Low: 0-50 Median Costs in 12 Months After WBA Total Cost Medical Cost Prescription Cost 31
  32. 32. www.healthwaysaustralia.com.au • >30% improvement in Perception of Health (overall health status) • Statistically significant decreases in BMI for both obese and overweight participants • Marked improvement in medication management (eg 46% increase in participants with up-to-date list of their medications) • Significant reduction in all key lifestyle risk factors. • Smoking rate reduced by >25% • Physical Inactivity reduced by > 25% • Poor diet reduced by > 15% • Obesity reduced by >5% • Excess alcohol consumption reduced by >5% Health Outcomes 32
  33. 33. www.healthwaysaustralia.com.au -7.8% -7.2% -6.1% -13.4% -12.0% -11.3% Diabetes Cardiovascular Dis Total Difference in Admission Rate Changein Treatment Vs ComparisonGroup 12 Month 18 Month *** ** *** ** *** *** -5.8% -14.1% -14.3% -20.1% -25.7% -25.7% Diabetes Cardiovascular Dis Total Difference in Readmission Rate Change in Treatment Vs ComparisonGroup 12 Month 18 Month ** ** ** ** ** P ≤ 0.01 Statistical significance controlling for age, gender, number of core diseases, and hospitalizations in prior 24 months (y/n) * P≤ 0.05, ** P ≤ 0.01, *** P ≤ 0.001 Statistical significance controlling for age, gender, number of core diseases, and hospitalizations in prior 24 months (y/n) Australian Published Outcomes 33
  34. 34. www.healthwaysaustralia.com.au Environmental Interventions 34
  35. 35. www.healthwaysaustralia.com.au Blue Zones is a Community Transformation Effort to Make the Healthy Choice the Easy Choice Blue Zones Power 9 Principles Move Naturally Eat Wisely Right Outlook Belong The Prototype Community Albert Lea, MN, 2008-2009 Healthways| Blue Zones Vitality Cities 2010 35
  36. 36. www.healthwaysaustralia.com.au Initiative in the Beach Cities in Southern California Three Audiences: Community (Gov/Schools) • School Policies / Mindfulness • Walking School Bus • Bike/Walk-ability Policy • Community Policy Bundle Organisations • Restaurant (Menu/Env. Changes) • Worksite (Employer Program) • Ambassador Citizens • Walking Moai teams • Purpose Workshops • Volunteering • Plant –Based Cooking Classes 36
  37. 37. www.healthwaysaustralia.com.au And the Iowa Blue Zones Project™ • The Healthiest State Initiative is a community and business- led, government-endorsed statewide initiative in which Iowa will set forth on a multi-year journey to improve the health and well-being of its residents. To measure the success of this strategic endeavor, the following goal will be established: Iowa is the Healthiest State in five years (by 2016) as measured by the Gallup Healthways Well-Being Index®. • The Blue Zones Project™, as the cornerstone of the Healthiest State Initiative, is an effort to transform 10 Iowa communities into Blue Zones Communities™ over the next five years. • This is 5 year partnership with Wellmark which also includes co-development of a Blue Zones Institute (to scale to other communities) and web-based services and collaterals for citizens, employers and communities. 37
  38. 38. www.healthwaysaustralia.com.au Conclusions High Costs of Doing Nothing Different • Both medical and productivity costs impose heavy financial burdens on communities • Without interventions, these costs can be expected to grow and compound The Primary Sources of These Costs are Known •Chronic conditions cause people to seek care (medical costs) and reduce their ability to work (productivity) •While behaviours do not have costs associated with them, the conditions they create and exacerbate can have substantial costs Intervening reduces costs and improves outcomes •Curtailing or eliminating behavioural risks can reduce costly chronic conditions •Addressing risks before they become conditions can be a significant source of savings 38
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