Healthcare Solutions Participate Change... Save August 25, 2016 1 - - PowerPoint PPT Presentation

Sustainable Onsite Healthcare Solutions

Participate… Change... Save

August 25, 2016

BCBS of NC Trend 11.3%

Medical Trend Increase: Reality Check

Real Healthcare Cost Increases

• At 11.3% trend, healthcare costs will DOUBLE in

6.4 years

• If your costs are $7,500 per employee now, in

just over six years it will be $15,000

• This is completely UNSUSTAINABLE!
• It will be very difficult to continue to pass much
• f the cost to employees

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Healthcare Economics

Source: Projection of Chronic Illness Prevalence and Cost Inflation 2000

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Number of People With Chronic Conditions (in millions)

Cost of Chronic Conditions

$1,081 $2,844 $5,074 $7,761 $10,414 $14,768

$1,000 $3,000 $5,000 $7,000 $9,000 $11,000 $13,000 $15,000 1 2 3 4 5+

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Average Per Capita Health Care Spending

Source: Projection of Chronic Illness Prevalence and Cost Inflation 2010

Number of Chronic Conditions

Early

Detecting a serious condition in the first half of the disease development process reduces the cost of treatment by 63% and increases the likelihood of full recovery by 300%. New England Journal of Medicine

What do we know? detection

treatment costs

reduces

management

Risk

Specialty Care

Reduces

What do we know?

Improved health, greater self-efficacy skills and better access to front-end components of the delivery system would facilitate increased utilization of preventive and primary care and depend less on downstream utilization of specialty care and emergency care. Healthcare Reform Magazine

Population Risk Management & Workplace Health Centers April 29, 2014

What do we know?

• The primary intermediate barrier to effective and efficient chronic

care is under-utilization of high value services.

• 80% of patients with a chronic disease receive only half the care

that evidence-based protocols suggest they should receive.

Colorado Business Group on Health Donna Marshall, Executive Director September 14, 2015

80% Non-compliant

Healthcare Economics

Our current healthcare system does not provide an economic incentive for providers or members to control costs. With no supply & demand controls, healthcare expenses will continue to rise.

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Healthcare Economics

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• Demand only increases

– Elective procedures did go down with economic downturn

• Supply always matches demand

– Demand increases are consistent and predictable – Very little over capacity – Very little supply shortages

• Supply increases can cause increased demand
• End user is not end purchaser
• When we really need care, there is no price that we

would not pay

• No stake holder outside of employers are financially

incented to keep costs down

• Annals of Family Medicine: Each physician would have

to spend 21.7 hours per day to provide all recommended acute, chronic and preventive care for a panel of 2,500 patients.

Washington Post 2012

• Traffic safety is no more a core competency for auto

body shops than wellness, prevention, and care coordination are for most community hospitals.

Journal of Healthcare Management, 2014

Current Healthcare System

“The U.S. health care system is structured around diagnosis and treatment rather than wellness and prevention. We have a ‘sick’ care system rather than a ‘health’ care system.”

– American Hospital Association, Health for Life – www.aha.org

Not trained to prevent Not staffed to prevent Not located to prevent Not paid to prevent

Current Healthcare System

Create Health Accountability Reduce Demand Healthcare Improve Affordability and Accessibility to Healthcare

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What can we actually do about it?

Car Care

We Must Remove Bar

Barrie riers rs to

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Measure

• f health Risks

Convenience

drives participation

Incentives

drive change

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A road Map

Change

for

Ac Account countabili ability ty

Prescribe a Balanced Approach

Resources

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Personal

Resources

• Annual Health Risk Assessment
• Preventive & primary care
• Diagnosis/treatment of minor conditions
• Prescriptions
• Blood and laboratory analyses
• Chronic condition management
• Care coordination
• 20-30 minute appointments – no waiting
• Convenient and free

Typical Scope of Services

Acute Visits: Minor Illness/ Sick Visits Allergy Symptoms Bronchitis / cough Earache / ear infection Flu-like symptoms Mononucleosis Motion sickness prevention Sinus infection / congestion Pink eye & styes Sore throat / strep throat Upper respiratory infection Urinary tract/bladder infection Acute Visits: Minor Injury (off job) Blisters Bug bites & stings Minor burns Minor cuts & lacerations Minor wounds & abrasions Splinter removal Employee Risk Factors Wellness Coaching Wellness Exams Compliance Monitoring Chronic Visits: High Blood Pressure High Cholesterol Diabetes Management Weight Management Smoking Cessation Nutrition and Exercise Counseling Care Coordination Visits: Help to establish a PCP Referrals to a PCP Referrals to a specialist Referrals to a dietician

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Health Management

Money

Saves Measured in Claims

Emergency Room Specialist Care Hospital Days Drug Costs Lower cost primary care

Soft Savings

Work time Productivity

How

Achieving High-Performance Plans with Onsite Health Centers

95% 94% 90% 83% 77% 73% 73% 70% 62% 54%

Improve employee access to convenient health care services Decrease time away from work Deliver and promote screening and preventive health services Enhance worker productivity Improve integration of health and productivity efforts Improve quality and consistency of care Improve support of chronic condition care Manage and revers lifestyle health risks Reduce medical costs / reduce increase in medical trend Provide concierge medical service as a perk

Organizations Strongly Agree in rating health centers: Benefits of Onsite Clinics

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Case Study

• Local Government has been with Synergy

Healthcare for three full years

• 1,900 employees & 800 spouses on the health plan
• Large enough employer with enough “life years”
• f experience to be fairly credible

Participate Change Save

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3 Steps…

Participate

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Step 1

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Participation Incentive Program

1. Employees and Spouses must participate in the health risk assessment. 2. Based on their number of medical high risks, they must visit the onsite clinic or their personal physician based on the following schedule: # of High Risks Required Visit Compliance Periods None 1 1 of the first 2 compliance periods (added 2015) 2-3 2 of the 3 compliance periods 4+ All 3 compliance periods All wellness participants with 1 high risk must visit the clinic at least one time to go

• ver their HRA results.
• Don’t just give them the information, incent them to speak multiple times to a medical

professional about their results.

• HRA alone may bring 5-10% of members to make changes.
• HRA and compliance visits will bring 20-30% to make significant changes.

Participants in both the 2013 & 2014 HRA Risk Factor Baseline Follow-Up Change Obese - BMI > 30 41.5% 44.4% 7.0% Hypertensive >=140/90 13.8% 17.8% 28.8% Anti-Hypertensive Meds 30.6% 31.7% 3.9% Total Cholesterol > 200 35.8% 33.2%

• 7.2%

LDL > 130 22.1% 23.8% 7.7% HDL < 40 17.6% 22.2% 26.6% Triglyceride > 150 20.4% 19.5%

• 4.2%

Lipid-lowering Meds 23.2% 23.1%

• 0.4%

BMI 29.7 30.0 1.2% Weight 191.5 193.5 1.0%

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Step 1 Results

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Step 1 Results…Risk Change

Participants in both the 2013 & 2014 HRA 0-1 Risk Change 2-3 Risks Change 4+ Risks Change Increased Risk 306 38.8% 103 28.6% 7 9.6% Jumped Risk Tier 192 24.4% 47 13.1% Improved Risk 57 7.2% 142 39.4% 47 64.4% Stepped Down Risk Tier 99 27.5% 39 53.4% No Change 425 53.9% 115 31.9% 19 26.0% No Risk Tier Change 539 68.4% 214 59.4% 34 46.6% Total 788 360 73

• Members that had to go to the clinic saw improvements
• Members that didn’t have to go to clinic had a high number get worse

Don’t Get Worse!

Change

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Step 2

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Health Improvement Incentive Program

In addition to the incentive for Health Risk Assessment participation and compliance, there will be another wellness incentive, based on the results of the HRA. To qualify for the incentive, employees must do one of the following:  1 or fewer high risk factors on the HRA  Improve one of your high risks from last years HRA  Make an improvement after HRA and verified by the clinic

Improvements

Screening Test High Risk % Decrease Required Blood Pressure-Systolic 140 or higher 10% Blood Pressure-Diastolic 90 or higher 5% Blood Glucose 100 or higher 5% Triglycerides 200 or higher 10% Total Cholesterol 240 or higher 10% HDL Cholesterol 40 or less (Males) 30 or less (Females) Increase 5% LDL Cholesterol 160 or higher 10% Body Mass Index 30 or above Reduce 1 BMI point

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Step 2 Results

Participants in both 2014 & 2015 HRA Risk Factor Baseline Follow-Up Change Obese - BMI > 30 41.4% 40.6%

• 1.9%

Hypertensive >=140/90 16.6% 12.1%

• 27.1%

Anti-Hypertensive Meds 29.4% 31.0% 5.4% Total Cholesterol > 200 34.2% 31.5%

• 7.8%

LDL > 130 24.9% 21.8%

• 12.4%

HDL < 40 22.0% 19.6%

• 10.9%

Triglyceride > 150 20.8% 22.9% 10.1% Lipid-lowering Meds 22.1% 23.3% 5.4% BMI 29.7 29.6

• 0.3%

Weight 191.9 191.3

• 0.3%

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Step 2 Results…Risk Change

Separate two year risk changes 0-1 Risk 13 to 14 14 to 15 2-3 Risks 13 to 14 14 to 15 4+ Risks 13 to 14 14 to 15 Health Declined 38.8% 24.0% 28.6% 18.6% 9.6% 4.6% Jumped Risk Tier 24.4% 14.8% 13.1% 10.8% Health Improved 7.2% 15.0% 39.4% 51.2% 64.4% 83.8% Stepped Down Risk Tier 27.5% 37.5% 53.4% 71.5% No Change 53.9% 60.9% 31.9% 30.1% 26.0% 11.5%

By adding a standards based health improvement incentive program, we saw 34% more members drop down in their risk tier and 26% less members get worse.

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Total Risk Change

Aggregate number of members by risk tier Number of High Risk Factors 2014 2015 Change 0 – 1 1,024 1,097 +7.1% 2 – 3 548 502

• 8.4%

4+ 130 103

• 20.8%

Not just employee participation…productive employee participation.

Save

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Step 3

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Cost by Number of Risk Factors

2014 - 2015 Change Number of High Risk Factors Average Claims Relation to Average Participants $4,489 0 – 1 $4,241

• 5.5%

2 – 3 $4,985 +11.1% 4+ $4,506 +3.8% Non-participants $5,774 +28.6%

Small health improvements by a lot of members brings down the risk of the total member population and must show positive claim

• utcomes overtime.

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Participants vs. Non-Participants

2012-13 2013-14 2014-15 Non Participant to Participant +9.1% +21.1% +28.6%

We have seen a widening of cost between participants and non- participants. There was a 22% further decrease in cost for members actively participating in onsite wellness programs.

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Diabetic Cost

All Diabetics Diabetics HRA Diabetics HRA & Wellness 2014-15 $10,153 $6,421 $2,438

Annual claim costs for diabetics

Change Claims Improved Glucose <100 37.7% $5,796 Glucose Increased >125 7.9% $8,390

382 pre-diabetics on the 2014 HRA that took the 2015 HRA

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Medical Spend Compared to Trend

2012-13 2013-14 2014-15

Net Claim Cost per Member (Includes children) $4,318 $4,213 $4,491 Carrier Trend 6.8% 7.9% Projected Cost per Member $4,612 $4,976 Savings to Projections $399 $485 Gross Claim Savings $1,455,000 $1,824,000 Clinic/wellness Cost ($423,000) ($434,000) Annual Net Savings to Trend $1,022,000 $1,390,000

This employer has seen a 2.2% annual increase over the past two full plan years as compared to the carriers 7.4% average.

Annual Number of Clinic Visits Cost per Visit Community Cost per Visit Annual Savings 1,520 $103.19 $143 $60,511

Costs Savings per Clinic Visit

Below is the cost savings per clinic visit as compared to the cost of the community providers. Cost includes the following:

• 1.8 visits per hour
• 20 to 30 minute appointments vs. 10 minute community average
• All lab costs
• Wellness administration
• Annual and new hire health risk assessments

Thank You!

A Sustainable Onsite Healthcare Solution

Sav Savings ings Resources Change

Convenience

Education

Dean Kiradjieff

Business Development Manager Direct: (980) 505-8404 Cell: (704) 564-4608 deank@synergyhealthcare.net www.synergyheathcare.net

I look forward to hearing from you soon!