Innovative Use of Data Mining/Warehousing for Employee Activation
- 1. Innovative Use of Data Mining/Warehousing for Employee Activation Business Health Agenda March 13, 2009 Lisa R Schmidt, CEBS System Director, Health, Welfare and Wellness Benefits
- 2. Reflection
- 3. Our Belief It’s possible to stabilize health care spending Appropriate use of tactics drives best performance Many best-performing companies have adopted CDHPs, but for us this is just one component of a larger consumer-oriented model Increasing CDHP enrollment is key to moderating cost trends
- 4. Providence’s story 48,000 employees, 68,000 covered lives Health care organization Multiple TPA’s, plan designs, self and fully insured plans Organization-wide medical trend exceeding 12% (2007) Spend projection in 2008 $340 million; 91% employer paid
- 5. Providence’s story Wanted to understand our employee cost data Looked for a transparent, unbiased, integrated solution Actionable results based on data Ability to analyze and report out results in a financially sound fashion Wanted our own tool – chose Thomson Reuters NetEffect
- 6. Providence’s case for wellness Wellness and health promotion is really about people Wellness/health promotion is about cost management You can learn about people through data By understanding your data, you can understand people Once you understand people, you can build a story
- 7. For Every 100 Employees 20% of healthcare expenditures are attributable to preventable illness 40% of healthcare expenditures are attributable to modifiable risk 11,500 hours of productivity per year are lost due to health conditions 60 are sedentary 25 smoke 10 have diabetes 50 have high cholesterol 24 have high blood pressure 50 are distressed or depressed 27 have active cardio disease * Source: National Health Center for Health Promotion and Disease Prevention
- 8. Selling wellness as an employee strategy Human resources and employees don’t speak the same language What really matters to your employees? You must know your employees data in order to tell a story to inspire people to change
- 9. Cost shifting, or total population health management? Providence is striving to become a BEST PRACTICE employer We are stabilizing and reversing medical trend Choice of population health management over cost shifting-we chose PHM
- 10. Make actionable decisions based on factual data Remove guesswork and assumptions Build financial support for strategy Drive employee change behaviors through data New Organizational Philosophy Our Approach-Thomson Reuters NetEffect
- 11. What we learned There are many positive actions that Providence could take to reduce the need for and/or cost of care Primary prevention – Health decision support Early detection of disease – Case management Lifestyle behavior change – Improve outcomes of care Disease management – Promote guideline compliance Use data to target opportunities and prove impact of programs
- 12. What we learned Our benefit trend is catastrophically unsustainable Revenue 4% Costs 12%++ Our cost sharing models are not effective Our costs are being driven by conditions that should be diagnosed early and treated Our employees are suffering from lifestyle related conditions We are getting older, and not better
- 14. Cost of Obesity (in millions) Providence employee benefit plans-2007 paid claims *$370 per member per year cost for conditions related to being obese
- 15. Medical Cost Trend Alaska Best Performer: 1% Trend Average Performer: 6% Trend Poor Performer: 11% Trend; Providence fell in this category in 2007 MM $18 MM increase $1 MM increase Oregon MM $59 MM increase $4 MM increase California $21MM increase Washington MM MM $59 MM increase $4 MM increase $2 MM increase $9 MM increase $10MM increase $28 MM increase $28 MM increase
- 16. Chronic Conditions 15.2% of Providence’s members suffer from a chronic condition 4.8% of Providence’s claims costs are due to chronic conditions CAD: Coronary Artery Disease; CHF: Chronic Heart Failure Self-insured data only – Thomson Risk Profiler paid claims 6/06 – 5/07
- 17. Lifestyle Related Conditions 28% of Providence’s members endure claims related to lifestyle conditions 20.1% of Providence’s claims costs are due to lifestyle conditions Self-insured data only – Thomson Risk Profiler paid claims 6/06 – 5/07
- 18. Segment the Population: 2007 Chronic Disease Acute Conditions Moderate Risk Low Risk Catastrophic Illness High Risk Low Risk 58.0% (62.1%) of the population has medical claims under $1,500 8.4 % (9.7%) of medical expenses are in this group 33.9% (31.4%) of the population has medical claims of $1,500 to $9,999 35.6% (36.6%) of medical expenses are in this group 7.4% (5.9%) of population has claims of $10,000-$49,999 37.3% (33.4%) expenses are in this group Maintain Health Manage Health Improve Health Percentages in orange represent Watson Wyatt’s NDC norms Source: Providence medical claims data incurred August 1, 2006, through July 31, 2007, and paid through September 30, 2007 0.7% (0.6%) of population has claims of $50,000+ 18.7% (20.3%) expenses are in this group Illness Burden Allowed PMPY 0.57 $534 1.45 $3,875 3.09 $18,564 8.85 $93,191 Risk Reduction/ Self-Care Disease and Case Management Prevention/Early Detection/ Self-Care
- 19. Your Health Rewards Program Biometric Health Screening StayWell® Health Assessment StayWell® NextSteps® Health Coaching Incentive Free & Clear Quit for Life Tobacco Cessation Nurse Advice Line and Medically Reviewed Information
- 22. Plan redesign 2009 CDHP plan design commitment goal: 100% HA participation for employees and spouses Cost sharing offset by HA participation HSA introduced as retirement supplement vehicle
- 24. Health Assessment participation June 2007 through May 2008 139 completed (15.5%) July 2008 through September 2008 76 completed (12.6%)
- 25. Health Assessment participation July 2008 – January 2009 615 completed (93%) 188 spouses (57%)
- 26. Results of Work to date Trend results encouraging More accurate data revises trend Most progress in regions with highest employee populations Best performer has most integrated delivery system
- 27. What’s next Address cost sharing and access issues that encourage employees to use more health care services
- 28. Other possibilities Illness Burden Management Short term strategies Longer term strategies
- 29. Questions??