School Employee Health Care Board Conference

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School Employee Health Care Board Conference

• Joe San Filippo
• Chief Health Care Strategist
• Nationwide Better Health

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Total Population Health Management

Understanding Health Risks
Disease Management
Population at risk who have filed a claim

Water Level
Water Level
Health Promotion/ Lifestyle Management
Population with risk but not sick
Total Population
Population with no known risk factors
Health Maintenance
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Boden WE et al. NEJM 2007356
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Treatment Groups
OMT (n1138)
PCI (n1149)
Both groups received OMT, which included
cardio-protective medications (e.g., ASA, BB,
ACE-inhibitors, anti-platelet agents, statins) as
well as smoking cessation, exercise, weight
control and nutrition counseling.
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Cumulative Event Rates at 4.6 Years
6
Approximate Mortality Reduction Potential of Drug
Vs Lifestyle Interventions in Patients with
Coronary Disease
Low dose aspirin 18 Statins 21 ß
Blockers 23 ACE Inhibitors 26
Smoking cessation 35 Physical activity 25 Moder
ate alcohol 20 Combined lifestyle changes 45
Drug
Lifestyle
Iestra JA et al. Circ 2005112924
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Two meta-analyses now suggest that regular
exercise can reduce the overall risk of
cardiovascular events by up to
50
Powell KE et al. Annu Rev Publ Health
19878253 Berlin JA et al. Am J Epidemiol
1991134232
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Dose- Response Curve
Benefit
A Sedentary B Moderately Active C Active
A
B
C
Low
High
Baseline Activity Status
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(No Transcript)
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Conventional Risk Factors for Coronary Heart
Disease
JAMA 2003290891 JAMA 2003290898
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Lifetime Risk Age 50
Lloyd-Jones DM et al. Circ 2006113791
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HRA Stratification ReferralsDisease Management
and Lifestyle Management
Disease Management Referrals

• Diabetes
• Confirmed CAD
• Confirmed Hypertension
• Confirmed Hyperlipidemia
• Maternity
• COPD
• Asthma
• Depression
• Recurrent Long-term Lower Back Pain

Referrals From Triggers
Trigger Questions
HRA
Lifestyle Management Referrals

• Unconfirmed CAD or Hyperlipidemia
• Unconfirmed Hypertension
• Anxiety / Stress
• Overweight
• Physical Activity / Exercise
• Tobacco Cessation

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Proprietary RiskScreen
Combines predictive modeling that identifies and
stratifies members with our proprietary business
rules, so that we effectively prioritize and
manage co-morbidities
Pharmacy Claims Data
Medical Claims Data
Stratification / Intervention Elements
RiskScreen Process

• Predictive Modeling
• HealthCheck HRA
• Gaps in Care
• TreatmentCompliance

Population With Risk Factors
Low Acuity
High Acuity
Moderate Acuity
Our predictive modeling tool determines relative
risk scores unique to conditions and identifies
risk 12 months prior to an episode.
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Disease Management Program
Core Conditions
Optional Coverage
Precursors

• Diabetes
• Coronary Artery Disease
• Congestive Heart Failure
• Chronic Obstructive Pulmonary Disease
• Low Back Pain
• Asthma

Hypertension Hyperlipidemia
All Chronic Conditions
Arthritis GERD HIV Self Referral
Depression
Runs through six weeks post-partum
Maternity
tailored to member during treatment cycle
Oncology
Obesity
1 year program
Core Conditions represent the health conditions
where we can have the maximum impact on improving
health and reducing costs.
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Disease Management Process
Identification
High Acuity
Low Acuity
Moderate Acuity
Welcome Kit
Components of the Disease Management Process
Telephonic Outreach
Clinical Assessment
Determine Appropriate Program
LOW Intervention
MODERATE Intervention
HIGH Intervention
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Disease Management Process
Methods of Identification
Identification

• RiskScreen Predictive Modeling
• Health Risk Assessment
• Biometric Screening
• Referral Opportunities
• Case Management
• Disability Management
• EAP
• Lifestyle Health Coaching
• Maternity Management
• Nurse Advice Line
• On-site opportunities (health fairs, clinics)
• Self referral
• Utilization Management

High Acuity
Low Acuity
Moderate Acuity
Welcome Kit
Telephonic Outreach
Clinical Assessment
Determine Appropriate Program
LOW Intervention
MODERATE Intervention
HIGH Intervention
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Disease Management Process
Identification
High Acuity
Low Acuity
Moderate Acuity
Welcome Kit Contents
Welcome Kit

• Welcome letter
• Disease-specific educational materials
• Instructions to access specific lifestyle
  management kits online
• Self-assessment tool to encourage engagement with
  a coach
• Member experience brochure

Telephonic Outreach
Clinical Assessment
Determine Appropriate Program
Note if member self-refers they will only
receive applicable disease-specific literature
LOW Intervention
MODERATE Intervention
HIGH Intervention
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Disease Management Process
Identification
High Acuity
Low Acuity
Moderate Acuity
Welcome Kit
Telephonic Outreach
Telephonic Outreach

• Up to 8 calls in 30 days
• Track time of day and day of week to maximize
  outreach

Clinical Assessment
Determine Appropriate Program
If we are unable to contact member during initial
outreach phase, well continue to contact them
via phone and mail for the remainder of the year.
LOW Intervention
MODERATE Intervention
HIGH Intervention
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Disease Management Process
Identification
High Acuity
Low Acuity
Moderate Acuity
Welcome Kit
Telephonic Outreach
Clinical Assessment
Clinical Assessment

• Lifestyle
• Functionality
• Disease specific behaviors
• Disease specific clinical values

Determine Appropriate Program
LOW Intervention
MODERATE Intervention
HIGH Intervention
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Disease Management Process
Identification
High Acuity
Low Acuity
Moderate Acuity
Welcome Kit
Telephonic Outreach
Low acuity members may ultimately be assigned to
any level of intervention.
Clinical Assessment
Program Interventions
Determine Appropriate Program

• Results of the clinical assessment as well as
  member's readiness determines the most
  appropriate program and intensity level

LOW Intervention
MODERATE Intervention
HIGH Intervention
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Disease Management Success
Following Physicians Medication Regimen
100
98
Avoiding Costs per member/per year
12,672
Diabetes
50
50
Cardiac Disease
12,077
1,340
Asthma
0
Typical Compliance
NBH Program Compliance
US food and Drug Administration Dept of
Health and Human Services 2006 AND National
Council on Patient Information and Education
2008Based on 2007 NBH operational outcomes
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Program Measurement Behavior Changes for the
Population
Alcohol consumption lt2 drinks / day Willing to
make changes to improve health Blood pressure
tested Cholesterol checked yearly Going to
doctor Taking medication (compliance) Pneumonia
vaccination in last 5 years Urine tested for
protein (yearly) Flu Shot in last 12 months Feet
examined yearly Eye exam yearly Understand
diabetes and type Monitoring blood
sugar Exercising 3 times/week Following a special
diet
0
-5
5
10
15
20
25
30
35
40
Percent Change
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Program Measurement Clinical Changes for the
Population
Post DM HbA1c Level
Pre DM HbA1c Level
48
30
n 696
n 390
n 593
n 899
52
70
HbA1c lt 7
HbA1c gt 7
HbA1c gt 7
HbA1c lt 7 or Met Goal
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Outcomes
Diabetes
Asthma
Hypertension
Coronary Artery Disease
Excludes members with diabetes, CAD or CHF
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Maternity Program
Differentiators
Enrollment by Trimester
3rd Trimester
N807

• Dedicated maternity nurse
• Enroll All expectant mothers, starting in first
  trimester not just high risk as many programs
  do
• Extends through postpartum
• Same nurse manages all chronic and co-morbid
  conditions

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44
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2nd Trimester
1st Trimester
High Risk Very High RiskDesignations by
Trimester
3rd Trimester
N253
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38
46
1st Trimester
2nd Trimester
Source 2007 NBH Outcomes
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Maternity Program NICU Results
Results

• For 2007, preterm birth rate is 10.6 (National
  average 12.5)
• NICU days per 1000 NBH has 1,302 days /1000
  newborns
• Low birth weight and very low birth weight rate
  for NBH for 2007 is 7.7 (National average
  8.1)
• NBH reports 8.8 million in savings for NICU
  admissions for 2007

We reduce the average NICU length of stay by
21.
Average Savings
51,099
Source 2007 NBH Outcomes