051407 Anthem Lumenos Short Presentation


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  • 051407 Anthem Lumenos Short Presentation

    1. 1. Isn’t it time someone created a healthier health plan? We thought so, too.
    2. 2. The Facts are Startling 50% of health care costs and premature death, illness and disability are due to health behavior-related conditions “ Health” and “health care” are only remotely related – 35% of all health care costs are wasteful or inefficient 75% of surgical procedures are elective and 1/3 of all elective surgeries are unnecessary Only 50% of high dollar claimants can be predicted from claims from one year to the next Sources: IFTF/CDC MBGH/Juran Institute Rand Corporation
    3. 3. The Medical Cost of the “Big 3” <ul><li>Average 10% of total claims costs attributable to obesity </li></ul><ul><li>60% of Americans exceed ideal BMI (body mass index) </li></ul><ul><li>Soon to become the leading cause of death </li></ul><ul><li>Average 10% of total claims costs attributable to tobacco </li></ul><ul><li>25% of Americans smoke </li></ul><ul><li>Leading cause of death. . . Still </li></ul><ul><li>60% perform no substantial activity or exercise </li></ul>62% of the rise in private insurance costs from 1987-2002 was due to population risk factors and their treatment Source: Thorpe, et al, Health Affairs, June 2005
    4. 4. Focus on Health Improvement Incentives Matter
    5. 5. $50 account allocation for online completion (limited to one/family each year) $200 added to account for mastering HealthModels for each enrolled family member Goals achieved with knowledge, skills and functional provider-patient relationship $100 added to account for enrollment for each eligible family member Participation in Personal Health Coach program Engaging with Personal Health Coach to identify goals, educate and manage their disease Identify, Improve Risk & Care Integrated & Incentivized Strategy Identify Health Risk Assessment Engage Personal Health Coach Enrollment Graduate Competency Mastery with Personal Health Coach
    6. 6. HealthModels ® <ul><li>Asthma </li></ul><ul><ul><li>Adult </li></ul></ul><ul><ul><li>Pediatric </li></ul></ul><ul><li>Cardiology </li></ul><ul><ul><li>Coronary Artery Disease </li></ul></ul><ul><ul><li>Congestive Heart Failure </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>High Cholesterol </li></ul></ul><ul><li>COPD </li></ul><ul><li>Diabetes Mellitus (Type I,II and Gestational) </li></ul><ul><li>General Health Model </li></ul><ul><ul><li>Other Chronic Conditions </li></ul></ul><ul><li>Gastroesophageal Reflux Disease </li></ul><ul><li>Low Back Pain </li></ul><ul><li>Maternity </li></ul><ul><li>Cancer </li></ul><ul><li>Pediatric </li></ul><ul><ul><li>Special Conditions </li></ul></ul><ul><li>Rehabilitation </li></ul><ul><li>Solid Organ Transplants </li></ul>
    7. 7. <ul><li>$50 account allocation for successful completion (available for employee and spouse; limited to one/lifetime) </li></ul><ul><li>Counseling calls with tobacco treatment specialist </li></ul><ul><li>Individualized plan, decision support for pharmacotherapy and nicotine replacement fulfillment </li></ul><ul><li>Individualized participant and physician correspondence, unlimited access to toll-free support </li></ul><ul><li>$50 account allocation for successful completion </li></ul><ul><li>Telephonic course sessions address diet and healthy eating, physical activity and exercise, stress management, maintenance and relapse prevention </li></ul><ul><li>Phone counseling facilitated by a registered dietician or health educator </li></ul><ul><li>Includes course manual containing educational lessons for additional phone counseling sessions </li></ul><ul><li>Calls scheduled at 1-to-2 week intervals </li></ul>Where to Begin - Healthy Lifestyle Programs Tobacco Cessation Program Weight Management Program
    8. 8. Integrated & INCENTIVIZED Plan <ul><li>Overall, we want 3 things from people </li></ul><ul><ul><li>Understand your health </li></ul></ul><ul><ul><li>Say “yes” to any opportunity to participate with a Personal Health Coach plan </li></ul></ul><ul><ul><li>Stick with it </li></ul></ul><ul><ul><li>Wherever there is an opportunity to say “no,” we want to place an incentive. </li></ul></ul>
    9. 9. Integrated & INCENTIVIZED Plan <ul><li>Keys to well designed incentives </li></ul><ul><ul><li>We know what behaviors we want and why </li></ul></ul><ul><ul><ul><li>Get preventive care </li></ul></ul></ul><ul><ul><ul><li>Quit smoking </li></ul></ul></ul><ul><ul><ul><li>Increase exercise </li></ul></ul></ul><ul><ul><ul><li>Improve diet </li></ul></ul></ul><ul><ul><ul><li>Get appropriate care for condition or illness </li></ul></ul></ul><ul><ul><li>Reward “participation” not outcomes </li></ul></ul><ul><ul><ul><li>Outcomes don’t exist in a vacuum – if all desired behavior changes occur, outcomes will follow (allow the odds to work in your favor) </li></ul></ul></ul><ul><ul><ul><li>You don’t want to alienate those who might benefit most from a coaching program </li></ul></ul></ul>
    10. 10. Integrated & INCENTIVIZED Plan <ul><li>Keys to well designed incentives, continued </li></ul><ul><ul><li>Incentives help initiate the behavior change </li></ul></ul><ul><ul><ul><li>We can’t change an individual’s behavior. It is up to that individual to follow through on the change. </li></ul></ul></ul><ul><ul><li>Keep strategy simple and engaging </li></ul></ul><ul><ul><ul><li>If it is difficult to explain, it may be too complicated. Participation and results will be lacking. </li></ul></ul></ul><ul><ul><li>Message from the top very important </li></ul></ul><ul><ul><ul><li>CEO, CFO, etc </li></ul></ul></ul><ul><ul><ul><li>Better to also “live” the message </li></ul></ul></ul><ul><ul><ul><li>“We care about your health and your health is important to our business.” </li></ul></ul></ul>
    11. 11. Focus on Health Improvement Why Should We Care About Behaviors?
    12. 12. An example – Heart Disease and Stroke <ul><li>Accounts for 40% of all deaths </li></ul><ul><li>In 2007, the cost of heart disease and stroke is expected to exceed $210 billion in direct and indirect costs </li></ul><ul><li>$60 billion in health care spending attributed to high blood pressure </li></ul><ul><li>Major risk factors for heart disease </li></ul><ul><ul><li>High blood pressure, high blood cholesterol, tobacco use, diabetes, physical inactivity and poor nutrition </li></ul></ul>American Heart Association/ CDC
    13. 13. Risk Factors – Controllable or Modifiable 1 American Heart Association 2 What Healthy People Know Reasonable portions; 5 or more servings of colorful fruits and vegetables, nuts and two whole grains daily; Fish twice per week; Mono- and polyunsaturated oils (olive or soybean) 2 Poor Nutrition 65% are overweight, 30% clinically obese Walk as if late for an appointment, Takes a minimum of 10 minutes for health benefit, Add 3 brisk 10 minute walks per day 2 Physical Inactivity About 21 million diabetics in US; 95% are Type 2 diabetes; 80% of Type 2 diabetes directly related to being overweight, obese (diabesity) Diabetes Quit before 30, no change in lifespan . . On average; On average, smokers live 10 years less 2 Tobacco Use Improved diet, exercise, quit tobacco use 1 High blood cholesterol Improved diet, exercise, quit tobacco use, moderate alcohol 1 High blood pressure
    14. 14. What does this mean for your client? <ul><li>Improved health care costs (premium) </li></ul><ul><li>Better health outcomes for employees </li></ul><ul><li>More productive work force </li></ul><ul><li>Increased levels of satisfaction with benefit plan and employment </li></ul>
    15. 15. Health Management – Personal Health Coach Observed strong correlation between offering incentives, enrollment and cost trend. -3.2% 6.0% Cost Trend 4.0% 2.0% Avg. Enrollment in PHC Program Incentives No Incentives -3.8% 7.1% Cost Trend > 3% Enrollment w/PHC < 3% Enrollment w/PHC
    16. 16. Health Management – Health Assessment Observed strong correlation between offering incentives and completion of health risk profile. There appears to be an emerging correlation between completion and cost trend. -1.2% -0.1% Cost trend 38.1% 1.2% Completion Rate Incentives No Incentives -2.3% -0.9% Cost trend > 50% Completion Rate < 50% Completion Rate
    17. 17. Consumer Support Online Health Site and Tools
    18. 18. Online Tools and Services Available Health tools Linkage to Personal Health Coach Health Assessment Claim Detail
    19. 19. Compare Hospital Costs Information that is more meaningful to consumers
    20. 20. Prescription Drug Cost Estimator
    21. 21. Compare Rx Costs at Local Pharmacies
    22. 22. Simplified EOBs and Health Statements <ul><li>We are taking the complexity out of health care products through new Explanations of Benefits and Monthly Health Statements that are friendly, using plain language and defined from a consumer’s point of view. </li></ul>Explanation Of Benefits Monthly Health Statement
    23. 23. What’s Next Continued Innovation
    24. 24. Local Prices and Mobile Access for Rx <ul><li>Locate lower-cost prescriptions online and on-the-go </li></ul>Use a web-enabled cell phone to quickly lookup drug alternatives and their prices Compare prescription prices of local pharmacies with this online tool
    25. 25. Healthy Holiday House Party <ul><li>1,000 in-home parties held on Saturday, December 2 </li></ul><ul><li>Potluck-style party with a focus on healthy eating through the holiday season </li></ul><ul><li>Hosts chosen through a special screener </li></ul><ul><li>Sponsors provided giveaways, Web content and special offers </li></ul><ul><li>Hosts and attendees access party Web site: </li></ul><ul><ul><li>Party planning </li></ul></ul><ul><ul><li>Recipe sharing and rating </li></ul></ul><ul><ul><li>Nutritional info </li></ul></ul><ul><ul><li>Blogging </li></ul></ul>
    26. 26. Ignite Online Communities <ul><li>Online Community </li></ul><ul><ul><li>Consumers discuss and share ideas with one another around health topics of their choosing, such as fitness, nutrition, specific conditions and preventive care. </li></ul></ul><ul><ul><li>WellPoint also provides health related content via blogs and allows consumers to comment and provide feedback. </li></ul></ul>
    27. 27. Results
    28. 28. Proven Results <ul><li>Lumenos consumers reported: </li></ul>increased knowledge in managing their health care Source: Lumenos 2005 Customer Satisfaction Survey 53 % 36 % 19 % 62 % more active involvement in health behaviors health improvement since joining Lumenos switched to a generic prescription drug … and a 93% satisfaction rate
    29. 29. Positively Impacting Costs $2,200 $2,400 $2,600 $2,800 Per Member Per Year 2004 Pre Lumenos 2005 Industry Trend 2005 With Lumenos + 8% – 9% $2,521 $2,723 $2,299