Shared Wellness Clinics
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Cooper Johnson: SVP Employee Benefits, S.S. Nesbitt & Co. Presenting: Shared Wellness Clinics Cooper is a student of employee benefits. Having spent his entire career consulting in this space, he has also worked at the forefront of moving S.S. Nesbitt & Co’s benefits practice from a brokerage-only focus in the early 2000s to a post-ACA, “beyond benefits” and holistic health plan design consulting practice.
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Shared Wellness Clinics
- 1. Title
- 2. HEALTHCARE COST DRIVERS BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 3. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company HEALTHCARE COST DRIVERS
- 4. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company HEALTHCARE COST DRIVERS
- 5. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company HEALTHCARE COST DRIVERS
- 6. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company HEALTHCARE COST DRIVERS
- 7. Onsite Clinics as part of the risk management strategy BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 8. Mitchell Grocery Corporation is a wholesale grocery distribution center serving more than 200 independent supermarkets in the Southeast. We distribute more than 20,000 items, including fresh meat, fresh produce, dairy, frozen food, ice cream, health and beauty care, and deli-bakery items. We offer a full line of Food Club controlled brand items and a second label line of Valu Time products. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 9. PLAN OVERVIEW • Rich, traditional health plan • No data in making decisions • No risk management • 850 employee participants BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 10. CHALLENGES FACED BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 11. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 12. HOLISTIC HEALTH CARE PLAN REDESIGN • Wellness is making our health care plan healthier • Telemedicine offered at no charge • Spousal carve out as a cost containment effort • Optional high-deductible plan option for employees BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 13. Hired Enrollment and Communications Firm: Postcards Mailers Posters One-on-One Meetings Group Meetings Activities: Newsletters Open Enrollment Announcements BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 14. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 15. BIOMETRIC SCREENINGS Inside the Clinic & Breakrooms Enhanced Preventive Care Benefits (cholesterol and glucose lab tests) CLINIC & HEALTH COACHING Right Staffing Intentionally Located Across the Street from our Distribution Center BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 16. BIOMETRIC SCREENINGS Starting 7/1, Non Participants: $520/Year Surcharge COMMUNICATIONS Announced a Year in Advance HEALTH COACHING Non Participants: $10/Week Surcharge if Required Visits Not Completed BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 17. VOI: SUCCESS STORIES “I told you about an avocado I bought last week and kept in fridge until Monday night. Well I peeled it and it was just soft so I put half in my salad. Best salad I have ever had!!!!!! Thank you for all you do to help us!” “I was a little uneasy about having “Coaching” sessions, but I have found they are a tremendous help to me … In just the couple of months … I have seen a huge improvement in my moods, health and attitude in general. What began as something I was reluctant to do has become something I look forward to.” One lady came into the clinic and had blood pressure of 214 over 128 and did not realize it! She was also diabetic with a blood sugar level of 267! This was in February of 2016. In May of 2016, her blood pressure was 130 over 72 and her blood sugar was at 100. Employee took a selfie of his fruit cup to show the clinic employee he was eating as advised! BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 18. CASE STUDY On-Site Clinic Three key initiatives were implemented: • Plan Design Changes • Wellness Program • Placement of an On- Site Clinic BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 19. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 20. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company USING DATA TO IDENTIFY RISK
- 21. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company RISK IDENTIFICATION & CONTROL 10% 12% 37% 41% Healthy and Low Risk 4% 28% 58% 10% Moderate Risk 1% 65% 31% 3% High and Very High Risk • Risk identification correlates with risk decrease – Groups with higher rates of no previous healthcare information also have higher rates of risk increase ABC Company, Inc.
- 22. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company RISK IDENTIFICATION & CONTROL 0 1 2 3 4 5 6 7 Years Years Years Years Years Years Years 18-30 Years 31-40 41-50 51-60 61-64 65-70 71-80 81-80 Employees & Spouses w/ Identified Risk Concurrent Risk – ABC Company, Inc. Concurrent Risk – Vital Incite Benchmark • Risk may be under identified – 19% fall into “No Information” • Benchmark = 15% – Increased risk after age 40 • 115 members age 41-64, no healthcare use/information – Identified risk lower than benchmark • Possibly driven by poor physical compliance
- 23. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company RISK IDENTIFICATION & CONTROL • Risk may be uncontrolled – 91 members at moderate/high risk, no previous care information – 556 members increased risk – 48 members ceased follow-up care • 45 moderate risk • 3 high risk No Information in 2017 Healthy User in 2017 Low Risk in 2017 Moderate Risk in 2017 High Risk in 2017 Very High Risk in 2017 No Information in 2016 (470) 237 82 60 78 11 2 Healthy User in 2016 (463) 63 178 121 93 7 1 Low Risk in 2016 (619) 48 134 216 203 17 1 Moderate Risk in 2016 (1,091) 45 89 216 634 97 10 High Risk in 2016 (170) 3 6 21 83 51 6 Very High Risk in 2016 (25) 1 12 3 9 2017 Total 396 489 635 1,103 186 29
- 24. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company CONDITION MANAGEMENT • Diabetes – Likely under identified • Prevalence = 7% vs 10% nationally – Only 40% complete recommended follow-up – Overall cost lower than benchmark, but pharmacy spend much higher ABC Company, Inc.Benchmark Percentage Spending $100+ Per Month on Medications 31% 49%
- 25. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company CARE COORDINATION • Care compliance is low – Only 34% had physical – Primary care use decreased to 57% Adult Wellness Exam Compliance
- 26. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company CONDITION MANAGEMENT Identification In Population CONDITION NAME Number of ID'ed Mbrs % of Pop ID'ed Prevalence Rate (CDC) DEPRESSION 354 16% DIABETES 154 7% 10% HYPERTENSION 448 21% 33% LIPID DISORDERS 413 19% PERSISTENT ASTHMA 246 11% Rx Treatment % of ID'ed Mbrs Treated with Rx % of ID'ed Mbrs Untreated with Rx % Treated with >=2 Rx Gaps 73% 5% 20% 25% 2% 11% 51% 7% 3% 17% 35% Biometric Control % of ID'ed Mbrs with Biometric % of Biometrics Controlled Employee & Spouse CONDITION NAME % of Pop ID'ed DEPRESSION 20% DIABETES 11% HYPERTENSION 30% LIPID DISORDERS 23% PERSISTENT ASTHMA 12% Benchmark % of ID'ed Mbrs Treated with Rx % of ID'ed Mbrs Untreated with Rx % Treated with >=2 Rx Gaps 12% 3% 11% 67% 9% 25% 35% 6% 10% 53% 10% 4% 18% 0% 29% % of ID'ed Mbrs with Biometric % of Biometrics Controlled 19% 58% 30% 74% 28% 74%
- 27. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company CONDITION MANAGEMENT • Hypertension – Likely under identified • Prevalence = 21% vs 33% nationally – Average cost lower than benchmark • Likely from fewer taking medications • Should confirm blood pressure controlled without meds – Control important to prevent complications 31% 49% Impact of Hypertension Employee & Spouse Total Member Count - ID w/ Condition 448 Avg. Plan Paid - ID w/ Condition $7,442 Member Count - w/out Condition 1,703 Avg. Plan Paid - w/out Condition $2,665
- 28. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company CONDITION MANAGEMENT • Persistent Asthma – Trends similar to hypertension 49% Impact of Asthma Employee & Spouse Total Member Count - ID w/ Condition 434 Avg. Plan Paid - ID w/ Condition $7,176 Member Count - w/out Condition 3,263 Avg. Plan Paid - w/out Condition $2,384
- 29. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company UTILIZATION & UNIT COST TREND • Inpatient visits have increased and grown longer Utilization Measures Units per 1,000 Members Prior Current Vital Incite Benchmark Trend Office Visits 3,760.8 3,637.0 4,218.9 -3.29 % Emergency Room Visits 27.7 28.7 240.7 3.85 % Inpatient Visits 4.6 5.8 55.5 25.95 % Inpatient Days 43.5 144.5 209.0 232.56 % Prescription Claims 9,597.4 9,675.2 12,956.9 0.81 %
- 30. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company UTILIZATION & UNIT COST TREND • Emergency room visit costs have increased dramatically Total Paid Plan Paid Utilization Measures Total Per Unit Per Unit Trend Total Per Unit Per Unit Trend Office Visits $2,219,285 $186 -2.08 % $1,479,115 $124 2.80 % Emergency Room Visits $556,204 $5,917 272.40 % $89,380 $951 1534.03 % Inpatient Visits $5,042,371 $265,388 -9.81 % $1,926,289 $101,384 -15.92 % Inpatient Days $5,042,371 $10,660 -65.84 % $1,926,289 $4,072 -68.15 % Prescription Claims $4,178,776 $132 1.79 % $3,710,516 $117 1.60 %
- 31. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company UTILIZATION & UNIT COST TREND • Per unit costs are much higher than benchmark $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 Inpatient Visits Per Unit Vital Incite Benchmark $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 Emergency Room Visits Inpatient Days $0 $20 $40 $60 $80 $100 $120 $140 $160 $180 $200 Office Visits Prescription Claims
- 32. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company SUGGESTED GOALS 2017 Suggested 2018 Goal 34% 50% 66% 70% 57% 70% 18% 14% 49% 35% 40% 55% 0% 60% Goal Improve Medical Spend through Care Coordination (EE & Spouses) Increase annual physical compliance Increase compliance with 2 year mammograms Increase primary care utilization (adults 21 and older) Reduce % of employees & spouses with no information Condition Management (EE & Spouses) Decrease % of diabetics spending $100 or more per month on medication Increase % of diabetics completing two or more A1c tests per year Collect biometrics (BMI, BP, A1c, LDL) on unique members
- 33. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company STRATEGIC PLAN - NEXT STEPS • Next Steps – Set goals for compliance – Promote preventive screenings, particularly annual physicals • Collect forms for compliance reports and biometrics analysis – Review wellness platform – Health Coaching for moderate or high risk
- 34. BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
- 35. Contact Us Learn more about S.S. Nesbitt and how we can support and help build your employee benefits program. COOPER JOHNSON Benefits Practice Leader Direct: 205-262-2650 S.S. Nesbitt & Co. | 3500 Blue Lake Drive, Suite 120 Birmingham, AL 35243 | www.ssnesbitt.com EmployeeBenefits@SSNesbitt.com BUSINESS INSURANCE | EMPLOYEE BENEFITS | PERSONAL INSURANCE An EBSCO Industries Company
Editor's Notes
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- Cindy to introduce Gary to speak on this slide.
- Family owned business started in 1945. Serves about 170+ independently owned grocery stores throughout the Southeast Own and operate 31 retail stores all located in Alabama The distribution center is located in Albertville and employs about 540 About 1,500 employees in our retail stores Many long-term employees at the distribution center, with over 23% of total employees having been with the company for 20 years or more
- First we want to share with you the larger overview of where our health plan was, and where we are today with wellness. Providing our employees with quality, low-cost insurance has been a priority. With skyrocketing costs in 2014, we decided to take measures to preserve this benefit for our employees. We started changing our plan to be a more consumer driven kind of plan. Some of the changes included higher deductibles, a spousal carve out, and other changes to make use of the plan to be more efficient. We also made a conscious decision to promote wellness by providing a low co-pay to see a physician and making many preventive services free to our employees. We decided to attack rising healthcare costs by helping our workforce become healthier. It was this line of thought that led us to opening a clinic to be used by our employees at no charge. We have also continued to push our plan to become a more consumer-driven health plan by giving our employees choices. We have both high- and low-deductible plans from which to choose. We have also provided Accident and Critical Illness policies to those employees who choose the high-deductible plan so as to lessen their risk at no extra charge to the company while at the same time providing savings to our employees. Free on-site physicals were provided to our employees.
- Along the way we encountered our fair share of challenges. The first was communications. Why? Widely spread employee base – warehouse, drivers, retail grocery Why? Employee education. Employees concerned about their privacy. But we also needed to show value immediately. We were very conscious to make sure the employees saw a benefit in each change that was made.
- Being a family-owned business with many of our employees experiencing the growth of the company, there really is a feeling of family. And, as you know, we in the South take care of our families. And so it is with health insurance and benefits. So much so that health insurance provided at low costs has become part of our company culture. And also, wellness is a perfect fit for our culture because it allows us to help our employees feel better, drive down their own personal health insurance costs, and avoid serious illnesses. In other words, it is a way for us to show our employees that we care. And we also promote the fact that these initiatives hold down health costs, which makes the company more financially secure.
- At the end of the day, wellness is one of several holistic health plan redesign pieces that we’ve been working on with S.S. Nesbitt to change from a cookie cutter health plan to a consumer-driven, option-rich plan. Our motto is not to just survive, but to thrive. This plan redesign is helping us do just that. We’ve had success with telemedicine, spousal carve out, and a second high-deductible plan option for employees.
- Communications has been so critical to an effective wellness plan. Creative samples of what our communications firm developed for us include these samples: 1) Newsletters 2) Postcards 3) Posters
- Before diving into the specifics of our wellness plan, we wanted to share some of our success stories with you. Our onsite clinic has provided tremendous stories about employee lives that have been changed. For example: Health coaching example - Patient who is an employee of B&G came in January 15 for his DOT physical and his health screening. When doing a DOT physical we have to check their urine. The results of the urine showed an elevated amount of glucose. Finger stick in the office was 196 and office HgAlc was 10.2. His weight at this time was 296. After starting Metformin, seeing Sonya, and following a strict diet he had the following results. Fruit Cup – Employee showing Sonya that he was eating like she had advised! He was so excited that he sent a picture! Unbelievable. Avocado Others: (Gary this may be too many to share, so I would recommend trimming this list) He has dropped 17 lbs. (279 now) and is down 8–10 inches in his waist. We also checked his HgAlc today, and it is down to 6.0! One driver has lost 40 lbs. in 2 months. There are several employees who have been successfully losing weight. One lady came into the clinic and had blood pressure of 214 over 128 and did not realize it! She was also diabetic with a blood sugar level of 267! This was in February of 2016. In May of 2016, her blood pressure was 130 over 72 and her blood sugar was at 100. One employee who smoked 2 packs a day in February had not smoked in a month as of May and had dropped his weight from 260 to 244. He was quitting smoking and was losing weight. How cool is that? Employees too numerous to mention here are quitting smoking by gradually cutting down on the cigarettes they are smoking per day and using Wellbutrin . Employees did not realize that they needed to eat 5 servings of fruit and vegetables per day. They are discovering this and are losing weight and feeling better. While we have no requirement for spouses to have a physical and attend wellness coaching like we do with our employees, spouses are seeing the results of the coaching and are voluntarily coming in and having a biometric screening followed by coaching sessions.
- The group compares better than benchmark at maintaining risk for healthy/low risk users and is also maintaining or improving moderate risk users better than benchmark. This might be driven by less risk ID due to poor physical compliance. There were 45 members identified as moderate risk in 2016 that stopped following up with care in 2017. The high/very high risk members are also improving risk better than benchmark, however there were 3 members identified as high risk in 2016 that stopped following up with care in 2017.
- Risk may be under identified with 19% of the population falling into ‘No Information’ comparing to Vital Incite benchmark at 15%. Risk increases above normal at age 41 for those identified with risk and there are 115 members between ages 41-64 years old that did not use healthcare in 2017 and may have unidentified risk. The group compares better than benchmark at maintaining risk for healthy/low risk users and is also maintaining or improving moderate risk users better than benchmark. This might be driven by less risk ID due to poor physical compliance. There were 45 members identified as moderate risk in 2016 that stopped following up with care in 2017. The high/very high risk members are also improving risk better than benchmark, however there were 3 members identified as high risk in 2016 that stopped following up with care in 2017.
- The group compares better than benchmark at maintaining risk for healthy/low risk users and is also maintaining or improving moderate risk users better than benchmark. This might be driven by less risk ID due to poor physical compliance. There were 45 members identified as moderate risk in 2016 that stopped following up with care in 2017. The high/very high risk members are also improving risk better than benchmark, however there were 3 members identified as high risk in 2016 that stopped following up with care in 2017.
- Diabetes The diabetes prevalence rate is 7% which may be under identified as the national CDC prevalence rate is 9.7%. The average cost of a diabetic for this group is $12,560 per year comparing lower than benchmark at $14,406. The pharmacy spend for diabetics is higher, however the medical spend is lower. If biometrics were available for this group then A1c control could be measured and further analysis to see if the higher investment in medications is leading to lower medical spend. 49% of the diabetics taking medications are spending over $100 per month on their medications. This is much higher than expected. Follow-up A1c testing compliance is low with only 40% of the diabetics completing the recommended twice per year testing.
- Physical compliance is low with only 34% of employees and spouses having a physical in 2017, however compliance is slightly higher for those ages 41-60 years old. Mammogram compliance increased in 2017 with 66% of women 40 and older having a mammogram in the last two years. Primary care utilization decreased in 2017 with 57% of adults seeing a primary care practitioner. Polypharmacy is a concern with this group but does compare lower than benchmark with 10% of adults taking 12 or more active ingredients. The prospective risk decreased in 2017, however that could be a result of less risk identification.
- Diabetes The diabetes prevalence rate is 7% which may be under identified as the national CDC prevalence rate is 9.7%. The average cost of a diabetic for this group is $12,560 per year comparing lower than benchmark at $14,406. The pharmacy spend for diabetics is higher, however the medical spend is lower. If biometrics were available for this group then A1c control could be measured and further analysis to see if the higher investment in medications is leading to lower medical spend. 49% of the diabetics taking medications are spending over $100 per month on their medications. This is much higher than expected. Follow-up A1c testing compliance is low with only 40% of the diabetics completing the recommended twice per year testing.
- Hypertension The hypertension prevalence rate is 21% which may be under identified as the national CDC prevalence rate is 33%. The average cost of a hypertensive is $7,442 per year which is lower than benchmark at $11,761. There are fewer hypertensives taking medication for this group when compared to benchmark and with biometrics blood pressure control could be assessed to see if the group is controlling blood pressure without medications. Control is important to prevent complications and risk migration. When a moderate risk hypertensive moves into high risk the cost increases $8,458 per year.
- Hypertension The hypertension prevalence rate is 21% which may be under identified as the national CDC prevalence rate is 33%. The average cost of a hypertensive is $7,442 per year which is lower than benchmark at $11,761. There are fewer hypertensives taking medication for this group when compared to benchmark and with biometrics blood pressure control could be assessed to see if the group is controlling blood pressure without medications. Control is important to prevent complications and risk migration. When a moderate risk hypertensive moves into high risk the cost increases $8,458 per year.