Improving the Healthcare Investment

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Improving the Healthcare Investment

• Michael L Taylor MD FACP
• Caterpillar Inc
• Chair, The Center for Health Value Innovation

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Caterpillar Inc

• Self-Insured
• 150,000 covered lives in US
• Employees and retirees
• Spouses and dependents
• 30,000 union retirees
• 650M annual spend on health care
• Average age of EE 41
• Average turnover lt10
• Long term approach to health care strategy

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Productivity as a Business Advantage
2006
2010
2020
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Health Promotion

• Healthy Balance News
• Online tools on CatHealthBenefits.com
• Health Promotion Exams
• Work.Life.Solutions.
• Food Service Management
• Tobacco cessation
• Health risk assessment
• Lifestyles for Health --DM
• Health coaches worksite wellness

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Health Promotion

• Strategy is to improve employees efficacytheir
  confidence in their ability to make good
  decisions
• Getting more from the doctor visit
• Checklists
• Tips on the interaction
• What to look for in a relationship
• Plan for the visit
• Patient as partner-knowledgeable and engaged
• Know your numbers

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Healthy Balance
Demographics
Claims
Pharmacy
Self reported
Data Warehouse
Biometric data
Risk Grouping
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Risk Stratification weighted risk factors

• Risk Factors
• BP High
• BMI Moderate
• HDL cholesterol Moderate
• LDL cholesterol High
• Triglyceride Low
• Physical activity Moderate
• Alcohol use Low
• Smoking Highest
• Self-rated wellness Low
• Saturated fat in diet Low

Perfect score 100 Low risk 100-92 Moderate risk
90-70 High risk lt70
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Healthy Balance
Low Risk
Mod Risk
High Risk
Highest Risk
HB News Web Resources Self-care book Activity
programs Coach if desired
More comprehensive coaching
HB coach to control 1 risk factor
Prevent manage diabetes
Prevent CV disease
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Focus areas for coaching

• Smoking cessation
• Increased physical activity
• Weight management
• Nutrition
• Biometric screening
• Cancer prevention screening tests

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• Data drives programs

Health risk questionnaires provide self-reported
indicators of health status
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Benefit Plan Design

• Maximize the Value
• Value Quality/cost
• Prevention follow the US Preventive Services
  Task Force guidelines
• Colorectal cancer screening
• Breast and Cervical cancer screening

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Enhancing the Pharmacy Value

• 4 tier closed formulary
• 35 monthly co-pay for non-preferred brands
• 20 monthly co-pay for preferred brands
• 5 monthly co-pay for some generics
• 0 monthly co-pay for most generics
• Walmart contract for direct purchasing

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Enhancing the Pharmacy Value

• Use the pharmacy benefit plan to drive results
• 2 examples
• Statins
• Fenofibrate

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Fenofibrates

• Fibric acid derivative
• Lowers serum triglycerides
• Increase HDL-cholesterol levels
• Newer formulation smaller particle site
• All have similar safety and efficacy profiles

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Drugs dont work in patients who dont take
them. C. Everett Koop, MD
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Enhancing the Pharmacy Value

• Pharmacy benefit design can be an important
  driver to increase patient treatment with
  medications and ongoing adherence
• True win-win for employers and employees
• Compliance increased
• Employee cost decreased
• Employer cost decreased

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Enhancing the Pharmacy Value

• Questions and discussion