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

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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  

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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 getting What employers think they’re getting

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“The Bet”

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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?

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Adding value to self-funding

BeneconPLUS

take control of claim costs

Maximize value

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data   repor?ng      analysis      interven?on  analysis   interven?on  repor?ng    

take  control  

how

it w

orks

Benefit 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  

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Unleash the power

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data  reporAng  1  

data  analysis  2  

real  intervenAon    3  

savings & control

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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  

Specialist  Physician  Champions  

Clinical  EffecAveness  Teams  

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

Cheap Fast

What employers really want…

Good

Cheap Fast

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…