Cleveland HeartLab 2013 Symposium

1. Leveraging the Tools of Technology with the Power of Prevention
Ron Loeppke, MD, MPH, FACOEM, FACPM
U.S. Preventive Medicine

2. Content Attestation and Disclosure
I am an employee and shareholder of U.S. Preventive Medicine
and the content in my presentation, is unbiased,
and to the extent possible, evidence-based.

3. Overview
 Articulate how to leverage the Power of Prevention with the Tools of Technology
 Delineate the Converging Trends that are advancing the value of population
health management for Employers, ACOs/PCMHs , Physicians and Consumers
 Review the solid Business Case for why employers are investing in Prevention
and Population Health Management
 Analyze published outcome studies and ROIs from comprehensive Prevention
and Population Health Management initiatives.

4. Converging Trends Driving the Demand for Prevention
 Epidemiological Trends
 Political Trends
 Cultural Trends
 Financial Trends

5. Converging Trends Driving the Demand for Prevention
Epidemiological Trends:
• The Growing Economic Burden of Illness and Health Risks in Society

6. Healthcare Costs: Which Matters More
Age or Health Risk?
Annual Medical Costs
$11,965
$11,909
$10,785
$7,991
$12,000
$5,114
$8,927
$5,710
$9,000
$7,989
$6,625
$4,620
$6,000
$3,353
$2,565
$5,756
$3,000
$3,734
$1,776
0 $2,193
$4,613
$2,740
$0
19-34
35-44
45-54
55-64
Age Range
Edington. AJHP. 15(5):341-349, 2001
65-74
75+
High
Med Risk
Low

7. As Health Risks go
so go Health Costs
Dr. Dee Edington
Zero Trends

8. Converging Trends Driving the Demand for Prevention
Epidemiological Trends:
• The Growing Burden of Illness and Burden of Health Risks in Society
• The Positive Potential of the Compression of Morbidity

9. Compression of Morbidity
Live Healthier Longer and Die more Suddenly at Lower Cost
Health
“Sudden Death in Overtime”
“Acceptable QOL”
“Disability”
Age
The compression of morbidity relates to postponing the age of onset of
morbidity, disability and cumulative health costs--even though life expectancy is
increased--largely by reducing health risks
Hubert, Bloch, Oehlert and Fries. Lifestyle Habits and Compression of Morbidity.
J Gerontol A Biol Sci Med. June, 2002; 57 (6) M347-51

10. Converging Trends Driving the Demand for Prevention
Epidemiological Trends:
• The Growing Burden of Illness and Burden of Health Risks in Society
• Compression of Morbidity
Political Trends:
• Bipartisan Support for Prevention
• Aligning Incentives among Consumers, Providers, Employers
• ACOs/P4P/PCMH… and ultimately the Consumer Centered Health Home
2/4/2011
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11. Focusing on the “Health” in Health Reform Legislation
 National Prevention Strategy and Council
 Employer-Based Wellness Program Incentives for Employees
 Grants for Small Businesses to Provide Workplace Wellness
 ACOs and PCMHs
 Medicare Coverage of Annual Wellness Visit
 Medicare Better Health Rewards Program

12. Converging Trends Driving the Demand for Prevention
Epidemiological Trends:
• The Growing Burden of Illness and Burden of Health Risks in Society
• Compression of Morbidity
Political Trends:
• Aligning Incentives among Consumers, Providers, Employers
• ACOs/P4P/PCMH…Consumer Centered Health Home
Cultural Trends:
• Wellness is the new Green: Ultimate Personal Sustainability
• Social Networking/Game Theory Innovations in Healthcare

13. Gamification in Healthcare
 Since 2004 One Game has
been played 50 Billion hours
(5.93 Million Years)
 183 M people are “Gamers”
(> 13 hours per week)
 97% of Youth play regularly
 25% of > 50 y/o play regularly
 Future Nobel Prizes in
Medicine
Copyright 2010 U.S. Preventive Medicine

14. Gamers Succeed Where Scientists Fail:
Molecular Structure of Retrovirus Enzyme Solved, Doors Open to New AIDS Drug
 Science Daily (Sep. 19, 2011) — Gamers have solved the
structure of a retrovirus enzyme whose configuration had
stumped scientists for more than a decade.
 The gamers achieved their discovery by playing Foldit,
an online game that allows players to collaborate and
compete in predicting the structure of protein molecules.
 They did it in only three weeks..
 The Center for Game Science, in the Department of Computer Science and
Engineering at the University of Washington, is where gamers, students, scientists
and scholars apply gaming principles and play games (like Foldit) to innovate
breakthroughs in fields as diverse as biology, education and nanotechnology.

15. Converging Trends Driving the Demand for Prevention
Epidemiological Trends:
• The Growing Burden of Illness and Burden of Health Risks in Society
• Compression of Morbidity
Political Trends:
• Aligning Incentives among Consumers, Providers, Employers
• ACOs/P4P/PCMH…Consumer Centered Health Home
Cultural Trends:
• Wellness is the new Green: The Ultimate Personal Sustainability Index
• Social Networking/Game Theory Innovations in Wellness
• Mobile/Wireless Tech, EMRs, etc. Transforming the Healthcare Industry

16. How the Digital Revolution
will create better healthcare
Dr. Topol is a Cardiologist at Scripps and Editor–in-Chief of Medscape

17. Mobile Technology: The World’s most ubiquitous platform
Globally, more people have access to cell phones than
drinking water, electricity or a toothbrush.
*Source: IMS Report: The World Market for Internet Connected Devices, 2012.
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18. TRANSFORMING
HEALTHCARE
By 2020, ~160 million Americans monitored and
treated remotely for at least one chronic condition
Johns Hopkins University. Chronic Conditions: Making the Case for Ongoing Care. Retrieved
10/20/12, from http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf
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19. Prescription Apps - Wireless Engagement
 Poised to transform healthcare as we know it
 Always with you, always on
 Perpetual Connectivity/Communication
– Information into Knowledge
– Reminders/Notifications
– Knowledge into Action
– Clinical and Social support
– Action into Results
Mobile Health App
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20. Mobile Health Manager App: In Development
Pedometers
Mobile Fitness Apps
Glucose Meters
Blood Pressure
Devices
Tracking
Devices
Activity
Armbands
Sleep Managers
Mobile Weight Loss Apps
Scales
Labs
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21. Mobile Health Manager Kits
Diabetes
CHF
COPD/Asthma
Wellness & Prevention

22. Mobile Health Manager for Diabetes: In Development

23. Mobile Diabetes Manager: Physician Summary Report
 Glucose
–
–
–
–
–
Target Range
% on Target
Highest/Lowest reading
Avg Glucose overall
Avg pre/post meal glucose
 Weight
– Current + Goal
 Nutrition
– Avg calories + carbs / day
 Medication
– Current List
– # missed doses
– % adherence
 Diabetes Health Checklist Items
 Exercise
– Avg weekly minutes
– % Goal
– Most frequent activity
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24. Converging Trends Driving the Demand for Prevention
Epidemiological Trends:
• The Growing Burden of Illness and Burden of Health Risks in Society
• Compression of Morbidity
Political Trends:
• Aligning Incentives among Consumers, Providers, Employers
• ACOs/P4P/PCMH…Consumer Centered Health Home
Cultural Trends:
• Wellness is the new Green: The Ultimate Personal Sustainability
• Social Networking/Game Theory Innovations in Wellness
• Mobile/Wireless Tech, e-PHRs, etc. Transforming the Healthcare Industry
Financial Trends
• The Problem: The Cost Crisis is largely due to the Health Crisis

25. Patients with chronic diseases account for 75% of U.S. healthcare costs
Of the $2 trillion spent on U.S. health care
Of every dollar spent…
…75 cents went towards treating patients with
one or more chronic diseases
In public programs, treatment of chronic diseases constitute an
even higher portion of spending:
More than
96 cents in
…and
83 cents in Medicaid
Medicare…
“The United States cannot effectively address escalating health care costs
without addressing the problem of chronic diseases.”
-- Centers for Disease Control and Prevention
10/29/2013
Proprietary and Confidential
U.S. Preventive Medicine
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26. Converging Trends Driving the Demand for Prevention
Epidemiological Trends:
• The Growing Burden of Illness and Burden of Health Risks in Society
• Compression of Morbidity
Political Trends:
• Aligning Incentives among Consumers, Providers, Employers
• ACOs/P4P/PCMH…Consumer Centered Health Home
Cultural Trends:
• Wellness is the new Green: The Ultimate Personal Sustainability
• Social Networking/Game Theory Innovations in Wellness
• Mobile/Wireless Tech, e-PHRs, etc. Transforming the Healthcare Industry
Financial Trends
• The Problem: The Cost Crisis is due in large part to the Health Crisis
• The Bigger Problem: Total Cost Impact of Poor Health to Employers

27. The Bigger Problem: The Full Cost of Poor Health
Personal Health Costs
Medical Care
Pharmaceutical costs
Productivity Costs
Absenteeism
Short-term Disability
Long-term Disability
Iceberg of Full Costs
from Poor Health
Presenteeism
Overtime
Turnover
Temporary Staffing
Administrative Costs
Replacement Training
Off-Site Travel for Care
Customer Dissatisfaction
Variable Product Quality
Sources: Loeppke, R., et al., "Health and Productivity as a Business Strategy: A Multi-Employer Study", JOEM.2009; 51(4):411-428. and Edington
DW, Burton WN. Health and Productivity. In McCunney RJ, Editor. A Practical Approach to Occupational and Environmental Medicine. 3rd edition.
Philadelphia, PA. Lippincott, Williams and Wilkens; 2003: 40-152

28. Evidence Based Preventive Medicine is a Key Solution
Centers for Disease Control and Prevention has found that:
 80% of Heart Disease and Type II Diabetes as well as
 40% of Cancer are Preventable
– if people just:
» stopped smoking,
» ate healthy and
» exercised

30. Health is not a Spectator Sport

31. Whole Population Health Management
Wellness/Health Promotion
Early Detection
Early Intervention/Care Mgt
Total Population
Low Risk
Medium Risk
High Risk
LS Risk
DM Risk
Population of One

32. The Fundamental Formula for Success
BH + BHC = LC
Better Health + Better Health Care = Lower Cost
When Financial Risk is linked to Clinical Risk
Outcomes will Drive Incomes
Population Health Management is the Key

33. Health System Primary Care Innovation/Value Based Care Model:
Empowering the Dr-Pt Relationship
Health Inventory
& Biometric
Screenings
Health Coaching/
Concierge
Meet with
Primary Care
Physician
“Triple Aim”
and
Physician/Clinician
Satisfaction
Population Health
Management
IT Integrator Platform
Advanced Medical Home
Model and
Team Based Care
(incl. EHR)
Care
Coordination for
Chronic
Conditions
Pharmacy
Utilization &
Compliance

34. Physician Review
34

35. Physician Review

36. Consumer and Provider Prevention Score
Consumer Prevention Score
Based on an individual’s
assessment and actions
towards a healthy lifestyle
685
Provider Prevention Score
Bob Smith
Sue Jones
750
722
Steve Wonder
844
Based on Dr. Welby’s aggregate
score of patients managed

37. Aligned Incentives with Physician and Employee/Consumer
 Example of Points for Physicians and Patients to receive $ incentive:
Evidence Based Medicine Quality Criteria
Quality Points
Preventive screenings (e.g. USPTF age/gender specific
recommended mammograms, colon cancer screenings)
2
Disease-specific treatment and monitoring –
eg. Diabetics receiving HbA1C at least every 6 months
3
Diabetics – Maintain participation in Disease Management
or Lifestyle Management program per criteria
5
Physician Reviewing HRA with Patient
2
 Performance Savings Bonus split in thirds (Drs/Pts/Employer)
 Added $1.00 of Abs/Pres Savings for every $1.00 Med/Rx Savings
 Quality Points Value for Physicians and Patients
 1 Quality Point = $19.39
Loeppke R, Nicholson S, et al. “The impact of an integrated population health enhancement and disease management program on
employee health risk, health conditions and productivity”. Population Health Management. 2008: 11(6); 287-296.

38. Technology in a Workplace Wellness Program

39. Overall Health Risk Reduction with 2 Year TPP Participation
Net Movement of Health Risk Levels in Cohort
Baseline vs Year 2 on Prevention Plan
N = 7,804
71%
60%
5531
4666
29%
23%
2291
1775
11%
847
Low
Moderate
6%
498
High
Loeppke, R; Edington, D; Bender, J; Reynolds, A. “The Association of Technology in a Workplace
Wellness Program with Health Risk Factor Reduction” Journal of Occupational and Environmental Medicine: 3/2013

40. Health Risk Reductions with 2 Year TPP Participation (Total N = 7,804)
# People and % of the
# People and % of the
Baseline High Risk
Baseline High Risk Group
Group remaining High
Reducing Risk out of
Risk after
High Risk after
Year 2
Year 2
Individual
Risks
# People and % of overall
population (7804) with
High Risk in Baseline
Year
Blood Pressure
923 (12%)
(M=142/90)
179 (19%)
(M=143/90)
744 (81%)
(M=123/77)
HDL
328 (4%)
(M=31)
134 (41%)
(M=30)
194 (59%)
(M=41)
Cholesterol
836 (11%)
(M=263)
353 (42%)
(M=265)
483 (58%)
(M=208)
Fasting Blood
Glucose
1616 (21%)
(M=116)
926 (57%)
(M=123)
690 (43%)
(M=92)
Body Mass
Index (BMI)
3338 (43%)
(M=33)
2937 (82%)
(M=34)
401 (12%)
(M=26)
Loeppke, R; Edington, D; Bender, J; Reynolds, A. “The Association of Technology in a Workplace
Wellness Program with Health Risk Factor Reduction” Journal of Occupational and Environmental Medicine: 3/2013

41. Diabetes Care Management:
Inpatient Days per 1000 Diabetic Members per Year
N = 299
1361
1400
1200
1000
800
600
400
458
301
261
200
0
Proprietary and Confidential U.S. Preventive Medicine

42. Diabetes Care Management:
Total Costs Per Diabetic Per Month across 3 Years in Program
N = 299
$1,400.00
$1,200.00
$1,000.00
$800.00
$1,262.15
$849.17
$691.85
$667.20
$600.00
$400.00
$200.00
$0.00
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43. The Business Value of
Better Health and Productivity
 Market cap value impact from regaining 1 Day of productivity per year per FTE
 58,000 employees, current 8 Days per FTE of health-related productivity loss
1 Day per FTE of Regained Productivity =
$18.8M EBITDA impact
13x (EBITDA Multiple)
$244.4M estimated market cap increase
÷ 292M shares
$0.84 in additional per share value
Loeppke R. “The Value of Health and the Power of Prevention”. Int J Workplace Health Manage. 2008; 1(2)95-108.

44. Wellness Works and Prevention Pays
Average ROI
$3.27
Med/Rx
Savings
+
$2.73
Absenteeism
Savings
$6.00 saved
for every $1.00 invested
In Comprehensive Wellness
Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings.
Health Affairs (Millwood). 2010; 29(2).

45. Transformation beyond “Sick” Care to “Health” Care
New Way
Current Way
Focus




“Sick Care” System
Quantity/Cost of Service
Illness, Injury and Absence
Health “Benefit” as a Cost




Approach




Permission to Drs & Pts
Coverage focused on Sickness
Fragmented/Uncoordinated
Prevention a Cost to Justify




Empowerment of Drs & Pts
Aligned Incentives for Health
Integration / Coordination
Prevention as an Investment
Results




Benefits for Poor Health
EEs “Use it or Lose it”
Patients Passive Recipients
“Pay for Quantity/Volume”




Rewards for Better Health
EEs “Use Wisely & Save”
Consumers Active Participants
“Buy Quality/Value”
True “Health” System
Quality/Value of Service
Well-being and Engagement
Value and Benefits of Health

46. The Bottom Line
Good Health
is
Good Business
From the Exam Room
to
the Board Room
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