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David Vassilaros
Sr. Vice President, Operations
Benecon
Population Health
Management
The employer & broker perspective
population health management
2	
  
noun; “the art and practice of getting
people to do stuff they probably don’t
really want to do because you know
stuff about their health they don’t think
you know or even know themselves”
Employer definition
PPACA & leverage
3	
  
4	
  
15%	
  
85%	
  
Small	
  employers	
  (<200)	
  
Self-­‐funded	
   Fully-­‐insured	
  
Employers who care the most
91%	
  
9%	
  
Large	
  employers	
  (5,000+)	
  
Self-­‐funded	
   Fully-­‐insured	
  
60%	
  
40%	
  
All	
  U.S.	
  employers	
  
Self-­‐funded	
   Fully-­‐insured	
  
5	
  
Hi, my name is Data. Big Health Data.
So a guy walks into a bar…
That’s ok, I already know who you are. And why
you went to the doctor last week.
Hi	
  I’m…	
  
6	
  
Data is the new “black”
What they’re actually gettingWhat employers think they’re getting
7	
  
“The Bet”
8	
  
The 9.6% question
How much are employers willing
to invest to turn their data into
healthy employees, and
ultimately health cost savings?
Employers & brokers must answer these questions:
1.  Do they really want to do something?
2.  Are they willing to use their influence to leverage
change?
3.  Do they understand data isn’t perfect?
4.  What are they willing to invest?
9	
  
Adding value to
self-funding
BeneconPLUS
take control of claim costs
Maximize value
11	
  
data	
   repor?ng	
  	
  	
  analysis	
  	
  	
  interven?on	
  analysis	
   interven?on	
  repor?ng	
  	
  
take	
  control	
  
howitworksBenefit informatics
value	
  to	
  you	
  
no	
  	
  
addiAonal	
  	
  
cost	
  
carriers	
  share	
  
claim	
  data	
  with	
  BI	
  
Benecon	
  access	
  via	
  
secure	
  web	
  
Benecon	
  runs	
  
reports,	
  analysis	
  
can’t	
  fix	
  what	
  isn’t	
  
measured	
  
focus	
  on	
  your	
  actual	
  
claim	
  trends	
  
savings	
  &	
  control	
  
12	
  
Unleash the power
13	
  
data	
  reporAng	
  1	
  
data	
  analysis	
  2	
  
real	
  intervenAon	
  	
  3	
  
savings & control
14	
  
Nurse	
  
NavigaAon	
  
Tailored	
  
Support	
  
Healthy	
  
Goals	
  
Culture	
  of	
  
Health	
  
ConsultaAon	
  on	
  creaAng	
  
own	
  healthy	
  culture	
  
Research	
  
Support	
  	
  	
  
PaAent	
  advocacy	
  	
  
Set	
  and	
  achieve	
  healthy	
  goals	
  
Diet,	
  exercise,	
  stress	
  relief,	
  sleep	
  &	
  more	
  	
  
CerAfied	
  health	
  coach	
  &	
  experienced	
  RN	
  
Webinars	
  
Lunch	
  &	
  Learns	
  
WriVen	
  materials	
  
Listening to Employers: How
health systems can support pop
health management
Health	
  System	
  PerspecAve	
  
John	
  Holmes	
  
VP	
  Finance,	
  Pop	
  Health	
  &	
  Payor	
  ContracAng	
  
WellSpan	
  Health	
  
The	
  current	
  state	
  of	
  
health	
  care	
  is	
  
unsustainable.	
  
	
  
SO  WHAT  CAN  EMPLOYERS  DO  
ABOUT  IT?
•  There	
  are	
  several	
  conflicts	
  that	
  need	
  to	
  be	
  resolved/
managed:	
  
	
  
	
  	
  -­‐	
  healthcare	
  exp	
  growth	
  >	
  revenue	
  growth	
  
	
  
	
  	
  -­‐	
  engaging	
  employees	
  in	
  their	
  own	
  health	
  w/out	
  being	
  
big	
  brother	
  
	
  
	
  	
  -­‐	
  finding	
  a	
  health	
  partner	
  who	
  can	
  help	
  you	
  vs	
  just	
  
milk	
  you	
  
	
  
•  What	
  role	
  do	
  health	
  systems	
  have	
  in	
  all	
  this?	
  
	
   	
  	
  
HEALTH  SYSTEMS  &  POP  HEALTH
•  TradiAonal	
  health	
  care	
  vs.	
  pop	
  health	
  –	
  electrician	
  
example	
  
	
  
•  Health	
  systems	
  learning	
  how	
  to	
  get	
  paid	
  for	
  value	
  &	
  
keeping	
  folks	
  healthy	
  -­‐	
  complete	
  retooling	
  necessary	
  
	
  
•  Having	
  skin	
  in	
  the	
  game	
  -­‐	
  financial	
  risk	
  (follow	
  the	
  
money)	
  
	
  
•  Intended	
  result	
  -­‐	
  consistent	
  alignment	
  of	
  objecAves	
  w/
employers	
  
	
  
ENGAGING  YOUR  HEALTH  SYSTEM
•  Need	
  to	
  define/explain	
  our	
  pop	
  health	
  journey	
  &	
  
how	
  it	
  impacts	
  community	
  
	
  
•  What	
  are	
  we	
  doing	
  to	
  accomplish	
  the	
  Triple	
  Aim:	
  
	
  	
  -­‐	
  Improving	
  paAent	
  experience	
  
	
  	
  -­‐	
  Improving	
  employee	
  health	
  
	
  	
  -­‐	
  Reducing	
  cost	
  of	
  health	
  care	
  
	
  
•  What	
  insurers	
  are	
  we	
  partnering	
  with?	
  
	
  
•  Engaging	
  employers	
  to	
  reduce	
  their	
  healthcare	
  
costs	
  
POP  HEALTH  ISSUE:  ACCESS
•  Provider	
  access	
  &	
  pop	
  health	
  are	
  a	
  conundrum	
  
	
  
	
  	
  -­‐	
  Employees	
  want	
  complete	
  provider	
  access	
  
	
  	
  -­‐	
  Employers	
  want	
  to	
  control	
  costs	
  (unAl	
  they	
  are	
  the	
  
employee!)	
  
	
  	
  -­‐	
  Health	
  systems	
  need	
  to	
  manage	
  care	
  within	
  their	
  
span	
  of	
  control	
  
	
  
•  Suggested	
  soluAon:	
  employee	
  choice	
  w/product	
  
offerings/benefit	
  design	
  
	
  
	
  	
  -­‐	
  IncenAves	
  for	
  narrow	
  network	
  (with	
  access)	
  
	
  	
  -­‐	
  Unlimited	
  access	
  will	
  cost	
  employees	
  more	
  
POP  HEALTH  ISSUE:  COST
•  Narrow	
  network	
  trade-­‐off	
  s/b	
  lower	
  employer/employee	
  
cost	
  (codeword:	
  bigger	
  discounts	
  vs.	
  tradiAonal	
  network)	
  
	
  
•  Status	
  of	
  our	
  system’s	
  clinical	
  transformaAon	
  –	
  where	
  are	
  
we	
  with	
  retooling?	
  	
  How	
  does	
  this	
  help	
  keep	
  healthcare	
  
costs	
  down?	
  
	
  
•  What	
  is	
  being	
  done	
  to	
  promote	
  price	
  transparency	
  (ease)	
  to	
  
protect	
  health	
  systems	
  from	
  niche	
  retail	
  providers?	
  
	
  
•  How	
  are	
  our	
  providers	
  incented	
  to	
  work	
  (volume	
  or	
  value)?	
  	
  
Is	
  there	
  (their)	
  skin	
  in	
  the	
  game	
  financially?	
  
Clinical  TransformaCon
LIFT-­‐PCMH	
  	
  
(by	
  prac?ce)	
  	
  
Quality	
  Improvement	
  Teams	
  
Care	
  CoordinaAon	
  Teams	
  	
  
PracAce	
  Specific	
  ReporAng	
  
Case	
  
Management	
  	
  
(care	
  of	
  the	
  individual)	
  
Rising	
  risk	
  and	
  high	
  uAlizer	
  
populaAons	
  
U?liza?on	
  
Management	
  	
  
(op?mal	
  use	
  of	
  services)	
  
System	
  UM	
  CommiVees:	
  
Pharmacy	
  
Laboratory	
  
Imaging	
  
Procedural	
  emerging	
  technology	
  
Hospital	
  UR	
  
Disease	
  
Management	
  	
  
(focusing	
  on	
  the	
  care	
  
con?nuum)	
  
Service	
  Line	
  Projects	
  
POP  HEALTH  ISSUE:  QUALITY
•  Need	
  to	
  define	
  what	
  consAtutes	
  quality	
  in	
  your	
  
health	
  system	
  –	
  you	
  can’t	
  do	
  it	
  all	
  
	
  
•  Avoid	
  cycling	
  thru	
  quality	
  measures	
  as	
  flavors	
  of	
  
the	
  month	
  –	
  sAck	
  with	
  them	
  
	
  
•  Look	
  to	
  be	
  as	
  consistent	
  in	
  your	
  P4V	
  opportuniAes	
  
as	
  much	
  as	
  possible	
  
	
  
•  Make	
  quality	
  a	
  gateway	
  to	
  financial	
  reward	
  vs.	
  an	
  
amerthought	
  
Targeted  PopulaCon  Health  
Management  IntervenCon  for  
Migraines
Q  &  A
Listening to Employers: How Health Systems Can Support
Population Health Management
Employer Coalition Perspective
Diane N. Hess, CLU CEBS
Interim Executive Director
Business Group on Health
Vision – To provide a forum and a voice for the
business community on healthcare through
collaboration among stakeholders
Mission – To promote continuous improvement in
the quality and cost of healthcare for our
member companies, their employees and
dependents
Our Strategy
What we know about healthcare
cost drivers
—  Statistically 80% of claims come from less than
20% of covered population
—  Who is in the 20% can change from year to year
—  A large portion of healthcare costs could be
avoided
—  It is difficult to get people’s attention until they
need care and then it may be too late!
—  Managing health is a long term process
BGH members and healthcare
—  Costs have continued to escalate and in our market now
exceed the national average
—  Employers continue to look for tools to help mitigate
cost increases
—  Many are using wellness programs to engage employees
and covered dependents in the efforts to stem the tide
of ever-increasing costs
—  Obesity/Diabetes is a major driver of costs in our
market
—  Plan designs and procedures have become increasing
complicated
What employees really want…
Good
CheapFast
What employers really want…
Good
CheapFast
How does ‘population health’ fit
into the conversation?
1.  What are we trying to manage - health or sick care?
2.  How do we get employees engaged in the process?
3.  Since population health management is a long term
strategy, how do we get short-term buy-in from the
C-Suite?
4.  How do all the new delivery models impact
employee behavior and the overall health of the
population?
The challenge - the new ‘divide’
Before ACA, coverage is all we talked about -
Insured Uninsured
The challenge - the new ‘divide’
After ACA?
Gov’t mandated, fully insured plans
controlled by few carriers /
providers
Value-designed, self-funded plans
using open markets, innovative
providers, products and services
Small Group / Individual
Large Group
What the market looks like
Carrier Provider
Provider
Gov’t
Carrier
Gov’t
Before ACA After ACA
$
$
Current Outcomes
(Industry sectors will dominate)
—  Market consolidation of both carriers and health
systems: (less choice)
—  Economies of scale
—  Market power and influence (narrow networks)
—  Protect current industry players
—  Providers absorb more financial ‘risk’
—  More Gov’t regulation / refinements
—  Wellness regulation: EEOC, ACA, ADA
—  Compliance requirements / reporting
—  Medicare/Medicaid payment changes
Where we need to go
“Free markets will always undermine central planning.”
Alan Greenspan, former Federal Reserve Chairman
Disintermediation: disˌin(t)ərmēdēˈāSH(ə)n/
—  reduction in the use of intermediaries between
producers and consumers
—  The opportunity to deliver a product or service to a
consumer with a higher perceived value than the
incumbent by changing the delivery method
Resulting Outcomes
(The market will dominate)
—  Personalized technology (me-centered)
—  Crowd sourcing
—  Retail health / specialty niche players
—  Smaller, patient-centered facilities with lower overhead
—  Use of lower priced labor (PA’s, certified nurse practitioners)
—  Concierge services (peer-to-peer)
—  Alternative convalescent care (home, rehab, self-monitoring)
—  Data & price transparency
BGH Initiatives
—  ACTRx Diabetes Management Program
—  CoActive
—  Wellness education
—  Data Initiative
Questions?
Thank you…

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Listening to employers how health systems-master

  • 1. David Vassilaros Sr. Vice President, Operations Benecon Population Health Management The employer & broker perspective
  • 2. population health management 2   noun; “the art and practice of getting people to do stuff they probably don’t really want to do because you know stuff about their health they don’t think you know or even know themselves” Employer definition
  • 4. 4   15%   85%   Small  employers  (<200)   Self-­‐funded   Fully-­‐insured   Employers who care the most 91%   9%   Large  employers  (5,000+)   Self-­‐funded   Fully-­‐insured   60%   40%   All  U.S.  employers   Self-­‐funded   Fully-­‐insured  
  • 5. 5   Hi, my name is Data. Big Health Data. So a guy walks into a bar… That’s ok, I already know who you are. And why you went to the doctor last week. Hi  I’m…  
  • 6. 6   Data is the new “black” What they’re actually gettingWhat employers think they’re getting
  • 8. 8   The 9.6% question How much are employers willing to invest to turn their data into healthy employees, and ultimately health cost savings?
  • 9. Employers & brokers must answer these questions: 1.  Do they really want to do something? 2.  Are they willing to use their influence to leverage change? 3.  Do they understand data isn’t perfect? 4.  What are they willing to invest? 9  
  • 11. take control of claim costs Maximize value 11   data   repor?ng      analysis      interven?on  analysis   interven?on  repor?ng     take  control  
  • 12. howitworksBenefit informatics value  to  you   no     addiAonal     cost   carriers  share   claim  data  with  BI   Benecon  access  via   secure  web   Benecon  runs   reports,  analysis   can’t  fix  what  isn’t   measured   focus  on  your  actual   claim  trends   savings  &  control   12  
  • 13. Unleash the power 13   data  reporAng  1   data  analysis  2   real  intervenAon    3   savings & control
  • 14. 14   Nurse   NavigaAon   Tailored   Support   Healthy   Goals   Culture  of   Health   ConsultaAon  on  creaAng   own  healthy  culture   Research   Support       PaAent  advocacy     Set  and  achieve  healthy  goals   Diet,  exercise,  stress  relief,  sleep  &  more     CerAfied  health  coach  &  experienced  RN   Webinars   Lunch  &  Learns   WriVen  materials  
  • 15. Listening to Employers: How health systems can support pop health management Health  System  PerspecAve   John  Holmes   VP  Finance,  Pop  Health  &  Payor  ContracAng   WellSpan  Health  
  • 16. The  current  state  of   health  care  is   unsustainable.    
  • 17. SO  WHAT  CAN  EMPLOYERS  DO   ABOUT  IT? •  There  are  several  conflicts  that  need  to  be  resolved/ managed:        -­‐  healthcare  exp  growth  >  revenue  growth        -­‐  engaging  employees  in  their  own  health  w/out  being   big  brother        -­‐  finding  a  health  partner  who  can  help  you  vs  just   milk  you     •  What  role  do  health  systems  have  in  all  this?        
  • 18. HEALTH  SYSTEMS  &  POP  HEALTH •  TradiAonal  health  care  vs.  pop  health  –  electrician   example     •  Health  systems  learning  how  to  get  paid  for  value  &   keeping  folks  healthy  -­‐  complete  retooling  necessary     •  Having  skin  in  the  game  -­‐  financial  risk  (follow  the   money)     •  Intended  result  -­‐  consistent  alignment  of  objecAves  w/ employers    
  • 19. ENGAGING  YOUR  HEALTH  SYSTEM •  Need  to  define/explain  our  pop  health  journey  &   how  it  impacts  community     •  What  are  we  doing  to  accomplish  the  Triple  Aim:      -­‐  Improving  paAent  experience      -­‐  Improving  employee  health      -­‐  Reducing  cost  of  health  care     •  What  insurers  are  we  partnering  with?     •  Engaging  employers  to  reduce  their  healthcare   costs  
  • 20. POP  HEALTH  ISSUE:  ACCESS •  Provider  access  &  pop  health  are  a  conundrum        -­‐  Employees  want  complete  provider  access      -­‐  Employers  want  to  control  costs  (unAl  they  are  the   employee!)      -­‐  Health  systems  need  to  manage  care  within  their   span  of  control     •  Suggested  soluAon:  employee  choice  w/product   offerings/benefit  design        -­‐  IncenAves  for  narrow  network  (with  access)      -­‐  Unlimited  access  will  cost  employees  more  
  • 21. POP  HEALTH  ISSUE:  COST •  Narrow  network  trade-­‐off  s/b  lower  employer/employee   cost  (codeword:  bigger  discounts  vs.  tradiAonal  network)     •  Status  of  our  system’s  clinical  transformaAon  –  where  are   we  with  retooling?    How  does  this  help  keep  healthcare   costs  down?     •  What  is  being  done  to  promote  price  transparency  (ease)  to   protect  health  systems  from  niche  retail  providers?     •  How  are  our  providers  incented  to  work  (volume  or  value)?     Is  there  (their)  skin  in  the  game  financially?  
  • 22. Clinical  TransformaCon LIFT-­‐PCMH     (by  prac?ce)     Quality  Improvement  Teams   Care  CoordinaAon  Teams     PracAce  Specific  ReporAng   Case   Management     (care  of  the  individual)   Rising  risk  and  high  uAlizer   populaAons   U?liza?on   Management     (op?mal  use  of  services)   System  UM  CommiVees:   Pharmacy   Laboratory   Imaging   Procedural  emerging  technology   Hospital  UR   Disease   Management     (focusing  on  the  care   con?nuum)   Service  Line  Projects  
  • 23. POP  HEALTH  ISSUE:  QUALITY •  Need  to  define  what  consAtutes  quality  in  your   health  system  –  you  can’t  do  it  all     •  Avoid  cycling  thru  quality  measures  as  flavors  of   the  month  –  sAck  with  them     •  Look  to  be  as  consistent  in  your  P4V  opportuniAes   as  much  as  possible     •  Make  quality  a  gateway  to  financial  reward  vs.  an   amerthought  
  • 24.
  • 25. Targeted  PopulaCon  Health   Management  IntervenCon  for   Migraines
  • 26.
  • 28. Listening to Employers: How Health Systems Can Support Population Health Management Employer Coalition Perspective Diane N. Hess, CLU CEBS Interim Executive Director
  • 29. Business Group on Health Vision – To provide a forum and a voice for the business community on healthcare through collaboration among stakeholders Mission – To promote continuous improvement in the quality and cost of healthcare for our member companies, their employees and dependents
  • 31. What we know about healthcare cost drivers —  Statistically 80% of claims come from less than 20% of covered population —  Who is in the 20% can change from year to year —  A large portion of healthcare costs could be avoided —  It is difficult to get people’s attention until they need care and then it may be too late! —  Managing health is a long term process
  • 32. BGH members and healthcare —  Costs have continued to escalate and in our market now exceed the national average —  Employers continue to look for tools to help mitigate cost increases —  Many are using wellness programs to engage employees and covered dependents in the efforts to stem the tide of ever-increasing costs —  Obesity/Diabetes is a major driver of costs in our market —  Plan designs and procedures have become increasing complicated
  • 33. What employees really want… Good CheapFast
  • 34. What employers really want… Good CheapFast
  • 35. How does ‘population health’ fit into the conversation? 1.  What are we trying to manage - health or sick care? 2.  How do we get employees engaged in the process? 3.  Since population health management is a long term strategy, how do we get short-term buy-in from the C-Suite? 4.  How do all the new delivery models impact employee behavior and the overall health of the population?
  • 36. The challenge - the new ‘divide’ Before ACA, coverage is all we talked about - Insured Uninsured
  • 37. The challenge - the new ‘divide’ After ACA? Gov’t mandated, fully insured plans controlled by few carriers / providers Value-designed, self-funded plans using open markets, innovative providers, products and services Small Group / Individual Large Group
  • 38. What the market looks like Carrier Provider Provider Gov’t Carrier Gov’t Before ACA After ACA $ $
  • 39. Current Outcomes (Industry sectors will dominate) —  Market consolidation of both carriers and health systems: (less choice) —  Economies of scale —  Market power and influence (narrow networks) —  Protect current industry players —  Providers absorb more financial ‘risk’ —  More Gov’t regulation / refinements —  Wellness regulation: EEOC, ACA, ADA —  Compliance requirements / reporting —  Medicare/Medicaid payment changes
  • 40. Where we need to go “Free markets will always undermine central planning.” Alan Greenspan, former Federal Reserve Chairman Disintermediation: disˌin(t)ərmēdēˈāSH(ə)n/ —  reduction in the use of intermediaries between producers and consumers —  The opportunity to deliver a product or service to a consumer with a higher perceived value than the incumbent by changing the delivery method
  • 41. Resulting Outcomes (The market will dominate) —  Personalized technology (me-centered) —  Crowd sourcing —  Retail health / specialty niche players —  Smaller, patient-centered facilities with lower overhead —  Use of lower priced labor (PA’s, certified nurse practitioners) —  Concierge services (peer-to-peer) —  Alternative convalescent care (home, rehab, self-monitoring) —  Data & price transparency
  • 42. BGH Initiatives —  ACTRx Diabetes Management Program —  CoActive —  Wellness education —  Data Initiative