Linda Swan

www.healthwaysaustralia.com.au
Innovations in Population Health
12th Annual Health Insurance Summit
Dr Linda Swan
Managing Director
Healthways Australia
Tuesday, 23 July 2013

• 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

Population Health in Australia
3

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

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

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

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

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

If there was a single map of activity…
9

The Cost of Doing Nothing...
10

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…

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

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

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

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

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

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

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

Innovations in Population
Health
19

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

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

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

Leveraging social media...
23

24
“Social Media is about sociology
and psychology more than
technology.”
- Brian Solis of FutureWorks

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

Behaviours are contagious
We need to
individual.
treat the network, not just the

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

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

Evidence of outcomes...
29

•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

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

• >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

-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

Environmental Interventions
34

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

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

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

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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