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Speaker Name: Rav MaharajDirector of Business Development Asia Pacific

Date: 29th July 2015

PHI’s role in preventive health

14th Annual Health Insurance Summit

Copyright © 2015 Healthways, Inc. All rights reserved.

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Today’s Conversation:

• Promoting preventative health initiatives in

response to rising health spending

• A holistic well-­being and total population approach

• What does this mean for the payers

• Proven Outcomes in our local market

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Promoting health prevention in response to rising health spending

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• Chronic diseases account for 75% of health care spending

• 80% of chronic disease is preventable through

• exercising on a regular basis

• stopping smoking

• eating healthier

è 60% of health care costs are related to life style

and thus (in principle) preventable

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Sources: Centers of Disease Control and Prevention (CDC): The Power of Prevention. 2009;; Anderson G. Chronic conditions: making the case for ongoing care. Baltimore, MD: Johns Hopkins University;; 2004.

Unhealthy Life-Style - Main Driver of Growing Health Care Expenditures

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Chronic Disease Trends in Australia

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Chronic disease is the leading cause of death and disability in Australia *

50% of Australians have 2-­3 risk factors for chronic disease **

50% of all Australian aged 45-­64 have one or more chronic disease ***

80% of premature heart disease, stroke and diabetes could be prevented ****

*Australian Institute of Health and Welfare. Chronic diseases. 2012. http://www.aihw.gov.au/chronic-diseases/** Australian Institute of Health and Welfare. Risk factors contributing to chronic disease 2012. http://www.aihw.gov.au/publication-detail/?id=10737421466***Preventing chronic diseases, a vital investment. WHO Global report, 2005****The burden of disease and injury in Australia 2003 – 2007. http://www.aihw.gov.au/publication-detail/?id6442467990

Chronic Disease Trend in Australia

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Asia Pacific Trends

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Asia Pac Trend

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A holistic approach to well-being

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To dramatically change outcomes, we had to tackle the root causes of poor health, not simply the bad behaviours that lead to it.

• Performance• Longevity• Disease Prevalence

• Stress• Family• Education• Safety• Culture• Community• Access

Causes

Outcomes • Cost• Productivity• Quality of Life

• Motivation• Finances• Hope• Work• Support• Purpose

Behaviours • Utilisation• Diet• Exercise

• Condition Management

• Smoking

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We learned that well-being has five elements physical is only one of them.

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Purpose Social Financial Community PhysicalLiking what you do each day and being motivated to achieve your goals

Having supportive relationships and love in your life

Managing your economic life to reduce stress and increase security

Having good health and enough energy to get things done

daily

Liking where you live, feeling safe and having pride in your

community

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Measuring Wellbeing Gallup and Healthways initiated a 25-year partnership in 2008 to define and measure well-being.

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• Global Wellbeing Measure • Australia ranked 40th/145• Global well-­being info.healthways.com/wellbeingindex

Gallup, Healthways Global Wellbeing Measure

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When well-being is high,performance goes up and costs go down

fewer unscheduled absences

lower presenteeism

more days of “best work” in a 28-­day period

higher reported job performance

5%

24%

5%

6%

reduced likelihood of emergency room visit

reduced likelihood of incurring healthcare costs

reduced likelihood of hospital admission

2.2%

1.7%

1%

Harrison PL et al., “Evaluation of the Relationship Between Individual Well-­Being and Future Health Care Utilization and Cost,” Population Health Management, 2012.

Healthways cross-­sectional analysis.

For every point increase in well-­being, individuals were:

On average, an individual with a 10% higher well-­being score will have:

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What does this mean for the payers?

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• Premium increase

u Dissatisfied members

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Claims CostPremium

=Loss ratio =

u Differentiated market positionu Innovative productsu Higher retentionu Higher salesu Higher profitability

• Claims management• Network management• Limited reimbursement and benefits

u Dissatisfied members and providers

Conventional approach

• Sustainable Engagement• Behaviour Change• Measurable Outcomes

u Lower Medical Cost u Higher Productivity

Well-­Being Improvement

Unit Costs x UtilisationPremium

An Insurer’s Perspective

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• Engage people in the context of their life and in their communities

• Align programs with individuals sense of purpose and personal goals

• Strengthened support through connections with friends, family and co-­workers.

• Close the gaps not just in physical health but just as importantly in emotional, financial and social health.

• Improve their well-­being.

People with Higher Well-Being Cost Less and Perform Better

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Wellbeing Focused

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Adopting a total population approach

• Hospitalisation avoidance

• Discharge support, re-hospitalisation avoidance

Highest risk±2% population20% costs

• Disease Management (including Coaching)

• Tele-monitoring

High risk±13% population40% costs

• Healthy lifestyle change

• Well-Being Coaching

Medium risk±70% population30% costs

• Healthy lifestyle change

• Digital well-being improvement solutions

Low risk±15% population10% costs

Policy intervention

Healthy withGood Health

Habits

Healthy but Poor Health

Habits

Health and Lifestyle

Risk Factors

Well-ManagedChronic

Condition

Poorly ManagedChronic

Condition

High Risk ofHospitalization

Total Population Approach

Report Impact

Establish Plan

Clinical, claims, Rx, lab, biometrics, well-being, device, social networks

Analyze & Forecast Stratify population1 Collect data

Proprietary

Analytics and

Predictive Models

Engage and Support

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2 3

4

5

6

Healthy

At Risk

High Risk

þ Individualized well-being plan and guidance

Self-directed Virtual coaching

Individual and Group Live Coaching

Ongoing Treatment Plan Support

High Risk and Episodic Care

Transition Management

Community /Social

Determinants

Physician and individual directed well-being actions

All progress and outcomes communicated to PCP / Patient / Sponsor

18 Copyright © 2015 Healthways, Inc. All rights reserved.

How we impact Well-Being to create value

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Mobile Apps

Web

Telephone

Social media

Face-­to-­face

Daily routine, Environment

wearables

Telemonitoring

Engagement – find people where they are…(…not where we want them to be)

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Blue Zones Project®

SilverSneakers

Financial Well-Being (Dave Ramsey)

High Risk Cost AvoidanceInnergyTM

QuitNet®

Disease ManagementWellbeing improvementTelemonitoring

Well-Being ConnectTM & Well-BeingPlusTM

Groups & Challenges , wearables On-site CoachingSilverSneakers®

Purpose WorkshopsLeading for Well-BeingWell-Being Ambassador

SilverSneakersWalkadooTM

Physician Directed Population Health

Purpose

Social

Community

PhysicalPhysical MedicineWholeHealth NetworksDr. Dean Ornish Program for Reversing Heart Disease

Financial

Healthways Well-Being Improvement Solutions

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Proven OutcomesUltimately, people with higher well-being are healthier, higher performing and less costly.

Common sense but also scientifically proven.

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We’ve contributed more than 80 peer-reviewed studies to the science of well-being ourselves.

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Original Article

Impact of a Chronic Disease Management Program onHospital Admissions and Readmissions in an Australian

Population with Heart Disease or Diabetes

G. Brent Hamar, DDS, MPH,1 Elizabeth Y. Rula, PhD,1 Aaron Wells, PhD,1 Carter Coberley, PhD,1

James E. Pope, MD,1 and Shaun Larkin, HlthScD2

Abstract

Chronic disease management programs (CDMPs) were introduced in Australia to reduce unnecessary healthcare utilization by the growing population with chronic conditions; however, evidence of effectiveness is needed.This study evaluated the impact of a comprehensive CDMP, My Health Guardian (MHG), on rate of hospitaladmissions, readmissions, and average length of hospital stay (ALOS) for insured individuals with heart diseaseor diabetes. Primary outcomes were assessed through retrospective comparison of members in MHG (treatment;n = 5053) to similar nonparticipating members (comparison; n = 23,077) using a difference-in-differences ap-proach with the year before program commencement serving as baseline and the subsequent 12 or 18 monthsserving as the program periods. All outcomes were evaluated for the total study population and for disease-matched subgroups (heart disease and diabetes). Statistical tests were performed using multivariate regressioncontrolling for age, sex, number of chronic diseases, and past hospitalization status. After both 12 and 18 months,treatment members displayed decreases in admissions (both, P £ 0.001) and readmissions (both, P £ 0.01), andALOS after 18 months (P £ 0.01) versus the comparison group; magnitude of impact increased over time for these3 measures. All outcomes for both disease-matched subgroups directionally mirrored the total study group, butthe diabetes subgroup did not achieve significance for readmissions or ALOS. Within the treatment group,admissions decreased with increasing care calls to members (12 and 18 months, P < 0.0001). These results showthat MHG successfully reduced the frequency and duration of hospital admissions and presents a promisingapproach to reduce the burden associated with hospitalizations in populations with chronic disease. (PopulationHealth Management 2012;XX:XXX–XXX)

Introduction

Chronic disease accounts for over 70% of Australiandisease burden, measured by disability-adjusted life-years,

and is expected to increase to 80% by 2020.1 Cardiovasculardisease (CVD) and diabetes represent 2 of the most prevalentchronic diseases affecting Australians today. According to the2007–2008 National Health Survey, 3.4 million (17%) and898,800 (4%) Australians have CVD and diabetes, respective-ly.2,3 Appropriate cost-effective approaches are needed to mit-igate the impact of the anticipated increased burden of chronicconditions on health care utilization and costs.1

Recent evidence demonstrates that prevalence of diseasein Australia is associated with high health care utilizationand increasing medical expenditures. Of the 7.8 million

hospital separations in Australia in 2007–2008, CVD was theprimary cause for 475,000 hospitalizations and played asecondary role in another 797,000 hospitalizations.4,5 Ac-cording to 2004–2005 data, diabetes was the principal causeof 74,490 hospitalizations and was a contributing cause in upto 7 times that many (531,069).6 In addition, over the periodof 2000–2001 to 2004–2005, a 35% increase in the rate of di-abetes-related hospitalizations was observed.6 As health careutilization increased, Australia also experienced a more than2-fold increase in health expenditure over 10 years, from$52.6 billion in 1999–2000 to $121.4 billion in 2009–2010.7 ForCVD, more than half of all expenditures ($3 billion) were forpatients admitted to the hospital.5

However, evidence suggests that patients with effectiveself-management skills make better use of health care

1Center for Health Research, Healthways, Inc., Franklin, Tennessee.2The Hospital Contributions Fund of Australia (HCF), Sydney, Australia.

POPULATION HEALTH MANAGEMENTVolume 00, Number 00, 2012ª Mary Ann Liebert, Inc.DOI: 10.1089/pop.2012.0027

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• Reduction in hospital admission and readmission rates as well as ALOS after 12 and 18 months

• heart disease: 7.2% / 12.0% reduction in hospital admission after 12 / 18 months

• diabetes: 7.8% / 13.4% reduction in hospital admission after 12 / 18 months

• The positive impact for program participants increased on all measures the longer they were in the program.

• The program showed a clear dose-­response (the more calls the higher the reduction in admission rates)

Impact on HospitalisationAustralian CDM Program

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Results from this study confirm and longitudinally extend previously published program utilisation outcomes

Results show Hospital utilisation for members with heart disease & diabetes was significantly reduced over the 4-­years:

• 11.4% reduction in hospital admissions• 36.7% reduction in readmissions• 17.2% reduction in hospital bed days

• Participants were 27% and 45% less likely to have any admission or readmission, respectively, over the 4 year study period

http://www.biomedcentral.com/1472-­6963/15/174/abstract

Long term impact on hospitalisation Australian CDM Program

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Science and InnovationWe are built on

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We offer Comprehensive Well-Being Improvementbeyond physical health to include all areas of well-being

Our outcomes and business results Are Proven

in improving well-beingOver 30 Years of Experience

We are built on

Creating a healthier world, one person at a time

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We share your passion for making a real difference in people’s lives. Let us be your trusted guide to

healthcare’s future.

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Rav MaharajDirector, Business Development

T: +61 408 215 159E: rav.maharaj@healthways.com

HealthwaysYour Way to Well-­Being