9/1/2015 Developing a Three to Five Year Strategy For Health Promotion/Wellness Philip A....

04/19/23

Developing a Three to Five Year StrategyFor Health Promotion/WellnessPhilip A. Smeltzer Peter C. Dandalides, MDSenior Consultant Medical Director

Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth. 2

Agenda

Key Concepts to Guide Our StrategyProcess Steps that Build MomentumCritical Components of Successful ProgramsHow to Measure Success


Key Concepts to Guide Our Strategy


Healthcare Cost = (Price x UtilizationHealthcare Cost = (Price x Utilization )) - Cost Sharing- Cost Sharing

oFactor represents efficient consumption and delivery of healthcare resources

Improving the oFactor results in lower care costs and improved worker productivity

The oFactor for the US health care delivery system is 1.25 (reflects 25% waste)

Our Focus – “The Optimization Factor”

ooxx

Managed Care ConsumerismData Analytics

ooFactor

Note: Used with permission from Travis Klavohn


Cost and Utilization

4.2% Trend Paid PMPM Health Care Cost

52.6 Inpatient admissions/1000 (norm 48)

264 Bed-days/1000 (norm 235)

Engagement/Activation

4% Health Management Program Active Engagement Rates

– 1.37% Case Management

– 0.72% Disease Management

– 4.23% Inpatient Care Management

60% of actively engaged members Achieved Health Goal(s)

Clinical Quality

EBM Compliance Rates

– 48% - Diabetes (44%)

– 42% - CHF (36%)

– 64% - CAD (63%)

10% Improvement in Health Risk Scores

Service Quality

94% program participants satisfied

Vendor performance and guarantees

Balanced Scorecard ExampleFour Critical Performance Domains


Optimization Execution Model

Solutions are value driven and data based

Results are captured across four key metrics domains

Primary

Data

Collection

Strategy Health

Promotion

Total

Absence

Management

Delivery

System

Value

Chain

Service Engagement

Cost Quality

Data Based Decisions Built on Evidence Based Practices

Employer-Focused Financial Analysis

Optimization • Risk Score Reduction• Behavior Change• Increased Quality of Life


Annual Cycles that Continuously Increase Program Intensity

SeniorLeadership

Buy-InFact-Based

Decisions

EmployeeHealth Teams

With a Champion

NetworkMarketing

Evaluate,Modify,

ContinueSuccess

Plan YourWork

Work YourPlan


Worksite Climate Values and Beliefs

Policies, Benefit Design Organization

Website Health PoliciesSpecial Promotions Employee Assistance Risk Reduction ActivitiesLow-Risk Maintenance Know Your Numbers Physical Activity Nutrition Awareness Medical Facility

Individual (Stratification by Individual)

Coaching Sessions Low-Risk Maintenance Disease Management

High-Risk ReductionHealth Advocate

Triage to Resources

Health Risk Appraisals

Incentives

Measurement

Worksite Health is a Complex Environment


Health Risk Appraisal

Health Screenings

Self Care Campaigns

Monthly Activities

Health Literacy

Physical ActivityDaily Minimum

Associate Engagement

( HRA + 1 Program)

Health Body Weight

Building a Foundation

First HRA CampaignDevelop TeamsBuild Wellness Champion NetworkOrganizational Audit

Employee Engagement

Data Driven DecisionsLeadership EngagementScorecard Distribution

Increased EngagementInitial Outcomes

Annual StudyPartner SummitIncentive & Rewards

Accelerating Impact

CertificationRecognition

Full Integration

ROI Study ResultsWellness Support fromEmployees

50% 70%

25%40% 60%

65%40%20%

35%40% 50%

30%

Develop a Three to Five Year Plan that Builds Over Time


Key Components


EmployeeHealth Teams

WellnessChampions

SocialNetworking

OrganizationalClimate

Front LineLeader Support

CommunicationStrategy

EvaluationPlan


Process Steps that Build Momentum


Employer Campaigns for Health Promotion

Company Size

1 10,000

% Who

Promote


Cost0 $ 10,000

PopulationDistribution

20-30%< $250 90-95% < $ 2,000

Chronic& High AcuityConsumers1-5% > $10,000

Better Health = Less Expense


Cost0 $ 10,000

PopulationDistribution

The goal is to move a large part of the population to the better health and lower expense side

Disease and Case ManagementAttack the tail

Better Health = Less Expense


Health Risk Segmentation

37%

42%

21%

Low Risk

Medium Risk

High Risk

OptumHealth Normative Data

[4-39]

[26-58]

[15-65]


ModerateRisk

HighRisk

LowRisk

NetChange4%

17%

13%

[-1%]

[+1%]

Risk Migration is the Holy Grail!


Critical Components of Successful Programs


Multiple Sectors of Health & Productivity

Health and productivity –the big picture

Employee Assistance

Health Care Benefits

Absenteeism

Productivity

Presenteeism

Workers’ Compensation

Disability

Turnover


Personal Components for a Comprehensive Approach

Healthy behavior – the big picture

Physical Spiritual

Emotional

SocialIntellectual

Occupational


Employee Health Team Development Process

Health PromotionSuccess

SupplyBudget $$

TeamCharter

Human ResourceOversight

Form aMultidisciplinary

Team

WriteJob

Descriptions

GarnerFormal

Appointments


Lifestyle-related medical costs

Schroeder, S. New England Journal of Medicine 2007;357: 1221-8.

Determinants of Health

Behavioral patterns:

58%

Environmental exposures: 7%

Health careimpact: 14%

Social circumstances: 21%


Health Action Process Approach (HAPA)

MotivationMotivation DecisionDecision

MaintenanceSelf Efficacy

ActionPlanning

CopingPlanning

ActionSelf Efficacy

OutcomeExpectancies

RiskPerception

RecoverySelf Efficacy

Initiative

Maintenance

Recovery

1Intention 2Planning 3Action

Relapse

Adapted from R. Schwarzer, Health Psychology 2008


Age --> 18 25 30 35 40 45 50 55 60 65 ---->

Heart Health

Blood PressureCholesterol

MenWomen

DiabetesBody Composition

Cancer

BreastColorectal

Bone

Osteoporosis

Behavioral

Depression

Immunizations

FluPneumonia

Adult Preventive Care Timeline

Men and Women at least every 2 years

Men

Women

Women, every 1 to 2 years

2 question screening test

Annually

Once

Women

BMI, waist circumference, waist to hip ratio; for risk assessment

USPSTF Guide to Preventive Services. Accessed at http://www.ahrq.gov/clinic/pocketgd09/

Preventive Health is a Foundation Activity

Men/Women every 5-10 years

http://www.ahrq.gov/clinic/pocketgd09/

Confidential property of OptumHealth. Do not distribute or reproduce without express permission from OptumHealth.

24

Milestone DescriptionProcess or Outcome

PopulationSegment

Increased Costs

PotentialSavings

Strength of Evidence

Utilization IssuesCenter of Excellence Use Process All $Provider Selection (in/out network) Process All $Shared Decision Making Process All $Place of Service (UC vs ED) Process All $

Preventive Services - Evidence BasedBreast Ca Screening Process female 50-74, 1-2 years $$$Cervical Ca Screening Process female > 21, 3 years $$

Annual Influenza Process All $Colorectal Ca Screening Process 50-75, $$$

Health Risks - OutcomesHealth Risk Appraisal Survey Process All $Tobacco Free Process/Outcome All $$Healthy Body Weight Process/Outcome All $$$Active Lifestyle Process/Outcome All $

Biological Markers - OutcomesBlood Pressure Process/Outcome 2 years, age >18 $Lipids (TC and HDL) men 35, women 45 $BMI Process/Outcome All $WHR Process/Outcome All $WC Process/Outcome All $

Incentive Strategy and Design Program Options


How to Measure Success


Evaluation of program impact – Short to Long Term

Enrollment Participation Completion

rates

Participants Employee

team Leadership Non-

participants

Total Program

area specific

Hard dollars

Soft dollars

Pharmacy Medical Productivity

set

Process metrics

Satisfaction scores

OutcomesReturn on investment


Within each age group, as risks increase, costs increase

$0 $5,000 $10,000 $15,000 $20,000

Low Risk

Medium

High

65-74

55-64

45-54

35-44

19-34

Costs Follow Risks

OptumHealth normative data 2010


-0.45

-0.4

-0.35

-0.3

-0.25

-0.2

-0.15

-0.1

-0.05

0

0.05

0.1

Per

cen

t o

f Im

pac

t

Financial Workplace ProductivityMedical Claims

Worker’s Comp

Disability Claims

Absenteeism

Productivity

Presenteeism

-26%

-32%

-28%

-32%

-40%

4%

Healthier Employees – Work Harder and Cost Less

Chapman L. Meta-analysis AJHP. 2005

Program participants are more productive and incur less cost


Workers' Compensation Cost per EE54% Excess

$49 $49 $49

$83

$113

$0

$50

$100

$150

$200

Low Medium High

Excess

Baseline

$133$162

Evaluating Success

Group Health Cost per EE14% Excess

$2,641 $2,641 $2,641

$955$525

$0

$1,000

$2,000

$3,000

$4,000

$5,000

Low Medium High

Excess

Baseline

Excess costs are defined as those costs associated with medium and high risk individuals over and above the costs associated with low risk status.

The calculation provides a theoretical estimate of potential cost savings assuming every medium and high risk person was reduced to low risk.



Health Screenings

Self Care Campaigns

Monthly Activities

Health Literacy

Physical ActivityDaily Minimum

Associate Engagement

( HRA + 1 Program)

Health Body Weight

Building a Foundation

First HRA CampaignDevelop TeamsBuild Wellness Champion NetworkOrganizational Audit

Employee Engagement

Data Driven DecisionsLeadership EngagementScorecard Distribution

Increased EngagementInitial Outcomes

Annual StudyPartner SummitIncentive & Rewards

Accelerating Impact

CertificationRecognition

Full Integration

ROI Study ResultsWellness Support fromEmployees

50% 70%

25%40% 60%

65%40%20%

35%40% 50%

30%

Develop a Three to Five Year Plan that Builds Over Time


Summary

Key Concepts to Guide Our Strategy– Continuous Improvement with a Strong Foundation

Process Steps that Build Momentum– Population Health Management with Risk Migration

Critical Components of Successful Programs– Programs to Influence Behavior Change

How to Measure Success– Start with Process Build to Cost Effectiveness

04/19/23For more information about Health and Productivity Solutions from OptumHealth, contact your OptumHealth sales executive or visit www.optumhealth.com

OptumHealth | Optimizing Health and Well-Being | www.optumhealth.com© 2011 OptumHealth, Inc All Rights Reserved.

Philip A. Smeltzer(502)228-6974

[email protected]

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