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Taking Health Care Consumer Engagement to the Next Level: The Employer’s Role Paul Landgraf Guardian Industries [email protected]
Taking Health Care Consumer Engagement to the Next Level: The Employer’s Role
Paul LandgrafGuardian [email protected]
About Guardian Industries
Headquartered in Auburn Hills, Michigan Privately held companies with 19,000 employees 60 work locations in 21 countries, on five continents Large manufacturer
– World’s largest mirror manufacturer– World’s 2nd largest manufacturer of flat glass– Tier 1 supplier of auto glass and body trim– One of the largest manufacturers and distributors of fiberglass
and building materials Unique culture
– Accountability extends to personal health– Significant leadership support
The Challenge: Guardian’s Largest Expenses
Raw Materials Labor, Administration, Payroll Taxes Freight Depreciation Maintenance and Repair Furnace Energy Electricity/Utilities Health Care Packaging Guardian Management point of view: “Employee health and productivity are business issues”
The Ongoing Problem
1 plant, 374 employees, average age = 40– 87% participated in screenings and HRA– 42% classified as obese (BMI over 30)– 30% had blood pressure over 140/90– 32% have never had complete physical– 26% reported tobacco use– 63% seldom or never exercise– 59% had 5 or more health risks– 68% reported their own health as either good or
excellent
Reinventing HealthGuard
Started in 1984 -- “Seven Steps For Better Living”– 1. Exercise– 2. Diet– 3. Limiting alcohol use– 4. Avoidance of smoking and illegal drugs– 5. Blood pressure awareness and control– 6. Use of seat belts– 7. Developing positive attitudes.
It may sound dated today, but the expectations were clear Today our focus has changed
– It is not about turning joggers into marathoners; the problem is getting members off the couch
– Not a traditional “wellness” perspective; now much more clinical, outcomes driven, we talk about health
What Do We Want Folks to DO?
Health screenings and physicals Health risk assessments Exercise, “Winner’s Circle” participation HealthGuard activities and education Preventive care No tobacco on U.S. property Respond to Care Considerations and participate
in Disease Management if contacted
AHA/ ACC Guideline
CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval.
Guardian Health Risks
0% 10% 20% 30% 40% 50%
Glucose
Cholesterol
Smoking
Body Mass Index
Blood Pressure
2006
2007
N =1,581
AHA/ ACC GuidelineSOLVD study: ACEI
reduces CHF mortality by 11.3% and
hospitalization by 18%
CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval.
CareEngine: Identifying Gaps in Care
AHA/ ACC Guideline
CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval.
Who is Spending the Money?
2%
4%
94%
41.7%
19.2%
39.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% of Population % of Health Care Costs
Condition Management – Where’s the Savings?
Fendrick and Chernow will be releasing a review of the current literature, critical of most study protocols
Need to “separate the dolphins from the tuna” Target well – ROI is greatest when you
– Identify the highest risk patients– Availability of effective services, real clinical value– Services have low current use– Price responsive so people will readily comply
ROI is lost when lower risks are swept in, patient would have done intervention anyway, or will not do the intervention; look at copays, reach rates, opt-ins
We focus on the chronically and acutely ill
The Problem
Wanted to improve engagement in Condition Management, especially in higher risk groups
Strategy – the carrot or the stick? We wanted to address two issues How to increase engagement in Condition Management,
and How to improve drug therapy adherence Willing to consider Value Based Insurance Design
approach, but dolphins v. tuna problem Use Condition Management and VBID, by using CM
engagement to trigger drug cost incentive
Finding a Solution - CM Simulation
What drug classes should be subject to incentives? How much benefit incentive did we need to
provide? What would the savings be from improved drug
adherence? Did we expect overall savings from adherence,
minus the cost of the incentives? How does the PBM provide the incentive? How will this be communicated?
Clinical opportunity scenarios used to model savings
CLINICAL RISK SCENARIOS MEDICATIONS APPLICABLE
Related care considerations
Lipid-lowering agents (e.g., statins)CAD or Cerebrovascular disease or Peripheral arterial disease or Diabetes
On RX but not in a specific clinical scenario
Related care considerationsInhaled corticosteroids
Respiratory (Asthma, COPD)
Related care considerations
ACE inhibitors or ARBs
CAD or Cerebrovascular disease or peripheral arterial disease or Diabetes
CHF
Chronic kidney disease plus Hypertension
Refractory hypertension*
On RX but not in a specific clinical scenario
Related care considerations
Beta-blockers
CAD
CHF
Chronic kidney disease plus Hypertension
Refractory hypertension*
On RX but not in a specific clinical scenario
Related care considerationsInjectable, inhaled, and oral meds for diabetes
Diabetes
A Final Thought – Health and Your Culture
Questions?
