Jill A. Berger

1

• Jill A. Berger
• NBCH Conference - Evidence Based Plan Designs
• July, 2006

MARRIOTT CONFIDENTIAL AND PROPRIETARY
INFORMATION The contents of this material are con
fidential and proprietary to Marriott
International, inc. and may not be reproduced,
disclosed, distributed or used without the
express permission of an authorized
representative of Marriott. Any other use is
expressly prohibited.
2
Company Overview

• Management company with approximately 2,800
  operating units worldwide
  
• In US and 66 other countries and territories
• Associates
• 75,000 associates participating in benefits
• 160,000 covered lives

3
What is Marriott Doing?

• Marriotts medical benefits are an important part
  of our total compensation package to attract and
  retain talent
  
• Marriott, like our competitors, is experiencing
  high increases in medical costs
  
• Marriott is developing long-term strategies to
  manage high-risk illnesses, improve patient
  safety and increase productivity
  
• This strategy is intended to balance Marriotts
  need to control costs, improve quality and to
  retain a competitive benefit program for our
  associates

4
Engaging Associates As Consumers

• Individuals need to be engaged over decisions
  affecting their health care
  
• Encourage engagement through multiple mediums,
  including paper, electronic, health care coaches
  
• Learn about our specific associate population
  through the segmentation project
  
• Work with health care partners who can help us
  achieve our goals
  

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ActiveHealth Management

• Its About the Medicine
• Getting care right is critical to saving money
• A Focus on Innovative Solutions Marrying
• A Health Management Company
• technology enables a broad range of solutions
  that look at 100 of a population, 100 of the
  time
  
• Spans health status ranging from well to
  catastrophically ill across a population
  
• Demonstrated ROI
• HIPAA Compliant

Evidence-Based Medical Information
Technology
Patient Data


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It All Starts with the CareEngine
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Data detail claims/Dx
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Informed Care Management Nurse Care Managers
for Members

• Ongoing monitoring of clinical issues
• Engagement of patient with education, targets,
  monitoring
  
• Nurses speak Spanish
• Materials summarized in Spanish

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Impact

• Moreand more accurateCare Considerations made
• Opportunities uncovered from patient-supplied
  data
  
• Higher compliance with care considerations
• Integration of patient and physician engagement
• Higher compliance with Care Plans
• Active engagement toward understanding clinical
  targets
  

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Making Essential Medication More Affordable
Evidence-Based Formulary
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Patients Make Poor Decisions

• Higher cost sharing reduces quality of care and
  leads to lower compliance
  
• Lower compliance leads to more adverse outcomes
• Typically measured through E.R. visits
  complications
  
• Average reduction of one drug per day leads to
  25 more adverse events
  

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Value Based Insurance Design Implementation
Issues

• Clinical benefit must be easily and accurately
  identified on patient level
  
• Information systems must be advanced to reap full
  potential

Source Fendrick AM, Chernew ME. Am J Managed
Care. 2006118-20.
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Patient Identification and Targeting Expands
Value

• Identifying high value non-users
• Lowers expenses
• Increases benefit by finding unexploited
  opportunities
  
• Targeting
• Lowers expenses by filtering inappropriate users
• Maintains benefit by identifying high value
  users
  

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Evidence-Based Formulary Goals

• Identify members with chronic conditions and
  offer them significant discounts on medication
  that would
  
• Improve member compliance
• Improve quality of care
• Decrease adverse events
• Decrease healthcare costs for both members and
  employers
  
• Improve member satisfaction
• Utilize information technology to identify and
  target appropriate members
  

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Evidence-Based Formulary

• Offered co-pay reductions for certain classes of
  medication for highly prevalent chronic
  conditions
  
• 0 generic/50 brand reduction for select drug
  classes statins, ACE inhibitors, diabetic drugs,
  beta-blockers, inhaled steroids
  
• Identified members via CareEngine
• Members currently taking the drug(s) and
  communicated program benefits/details to members
  
• Members not on the drug(s) who should be on the
  drug(s) based on documented presence of
  appropriate chronic disease

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University of Michigan Study

• Study design
• Use a pre-post, control group for impact
  evaluation
  
• ActiveHealth Management client was used as
  control group
  
• Model to be evaluated for 5 clinical categories
  and conditions
  
• Analysis was based on patient specific data
• Financial and clinical outcomes
• Measured effect of benefit redesign by comparing
  differential change in both financial and
  clinical outcomes between Marriott employees and
  a comparable employer
• Findings to be expected with custom formulary
• Decrease adverse events
• Decrease health care trend

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Initial Findings

• Although 2005 data is not yet complete, we can
  see a major shift in the co-pay levels for Rxs
  filled by Marriott members in the 5 target drug
  classes
• And no similar shift for prescriptions filled in
  other drug classes
  
• And no similar shift for prescriptions filled in
  target drug classes or other drug classes in the
  control group
  
• This confirms that the program has been
  implemented largely or completely as planned by
  the PBM

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Conclusion

• The following are essential to the promotion of
  clinical excellence and cost control
  
• Technologically based solutions.
• Evidence-based plan designs
• Patient engagement represents an integral phase
  in this evolution.