Dee Eddington by linxiaoqin

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									  Health Management as a Serious
         Business Strategy
         Dee. W. Edington
    THE UNIVERSITY OF MICHIGAN
HEALTH MANAGEMENT RESEARCH CENTER




                      University of Michigan Health Management Research Center
  UM-HMRC Corporate Consortium
Kellogg                                Crown Equipment
JPM Chase                              Delphi Automotive
Progressive                          Southern Company
We Energies                        Florida Power & Light
General Motors                     Affinity Health System
Foote Health System
Medical Mutual of Ohio                        *The consortium
                                               members provide
St Luke’s Health System                       health care
Cuyahoga Community College                    insurance for over
                                               two million
Blue Cross Blue Shield Rhode Island           Americans. Data
                                               are available from
United Auto Workers-General Motors            eight to 18 years.
Wisconsin Education Association Trust         Meet on First
                                               Wednesday of
Southwest Michigan Healthcare Coalition       each December in
                                               Ann Arbor
Australian Health Management Corporation
                                        University of Michigan Health Management Research Center
University of Michigan Health Management Research Center
                                      UM-HMRC
                                      Ann Arbor



                                     X




New way to do Health and Productivity Management
  In the United States and Throughout the World

                              University of Michigan Health Management Research Center
Next Generation Health Management,
 Champion Companies, Zero Trend
1. Total Case: Research to Business Case to Application Workshop
     -Eight hours of presentation and interactive discussion
2. Total Case: Business Case to Application Workshop
     -Four hours of presentation and interactive discussion
3. Business Application Seminar: (120 minutes)
4. Business Application Presentation: (75 minutes)
5. Business Application Presentation: (60 minutes)
6. Executive Summary Presentation: (30 minutes)

                                           University of Michigan Health Management Research Center
                                 Agenda
      Health Management as a Serious
              Business Strategy
        Michigan PHA: September 21, 2006

Introductory Comments
• Do-Nothing Strategy
• Business Concepts to Build the Business Case
• Next Generation Programming

Slides available via e-mail attachment
                                          University of Michigan Health Management Research Center
Introductory Comments




              University of Michigan Health Management Research Center
         Why are You Here?

Health Management as a Business Strategy
  Along the way, “…someone moved the
               cheese…”

        Health or Economics?

Healthy People or Productive People?
                         University of Michigan Health Management Research Center
           Two Questions
1. Why do I have Health Insurance?

2. Who is in the center of the
                  Healthcare Industry?



                        University of Michigan Health Management Research Center
Moving the Paradigm                                 From
    “The Cost of Healthcare”
       (Treating disease) To


“The Total Value of Healthcare”
    (Managing health status) To

          “Health is Free”
    (Healthcare Costs < Total Benefits)
Adopt the Quality Strategy: Fix the Systems
                           University of Michigan Health Management Research Center
       Section I
The Do-Nothing Strategy




                   University of Michigan Health Management Research Center
      The Natural Flow
of Health Risks and Behaviors




                  University of Michigan Health Management Research Center
     Health Risks and Behaviors
       Health Risk Measure        High Risk Criteria
       Alcohol                    More than 14 drinks/week
       Blood Pressure             Systolic >139 or Diastolic >89 mmHg
       Body Weight                BMI 27.5
       Cholesterol                Greater than 239 mg/dl
       Existing Medical Problem   Heart, Cancer, Diabetes, Stroke
       HDL                        Less than 35 mg/dl
       Illness Days               >5 days last year
       Life Satisfaction          Partly or not satisfied
       Perception of Health       Fair or poor
       Physical Activity          Less than one time/week
       Safety Belt Usage          Using safety belt less than 100% of time
       Smoking                    Current smoker
       Stress                     High
        OVERALL RISK LEVELS
Low Risk      0 to 2 high risks
Medium Risk   3 to 4 high risk
High Risk     5 or more high risks
                                               University of Michigan Health Management Research Center
Risk Transitions
Time 1 – Time 2                                      High Risk            2,373 (50.6%)

                                                     (>4 risks)
                                                                         4,691 (10.8%)
                                                     1,961
          Medium Risk                               (18.4%)              5,226 (12.1%)
           (3 - 4 risks)
                                                                                               892
 4,546     10,670 (24.6%)              1640 (35.0%)                                          (3.2%)
(42.6%)
                                                                  678
           11,495 (26.5%)                                       (14.4%)
                            5,309 (19.0%)             4,163 (39.0%)
                                                                       27,951 (64.5%)

                                                                       26,591 (61.4%)
                                                     Low Risk
Mean of three years between measures                (0 - 2 risks)        21,750 (77.8%)
Modified from Edington, AJHP. 15(5):341-349, 2001
                                                              University of Michigan Health Management Research Center
 The Natural Flow
of Health Care Costs




              University of Michigan Health Management Research Center
 Cost Transitions
 Time 1 – Time 2                                     High Cost           37,701 (55.7%)

                                                     ($5000+)
                                                                       67,680 (19.0%)
                                                     26,288
          Medium Cost                               (20.6%)            73,427 (20.6%)
          ($1000-$4999)
                                                                                              9,438
 75,500   127,644 (35.8%)            23,043 (34.0%)                                          (5.9%)
(59.1%)
                                                                 6,936
          130,785 (36.7%)                                       (10.2%)
                           32,242 (20.0%)             25,856 (20.3%)
                                                                      160,951 (45.2%)

                                                                      152,063 (42.7%)
                                                    Low Cost
N=356,275 Non-Medicare Trad/PPO                     (<$1000)            119,271 (74.1%)
Modified from Edington, AJHP. 15(5):341-349, 2001
                                                              University of Michigan Health Management Research Center
     Total Medical and Pharmacy Costs
             Paid by Quarter for Three Groups
 9000
 8000              Serious disease
 7000
                   Minor Disease
 6000
 5000              No Disease

 4000
 3000
 2000
 1000
    0
        Q_12 Q_10 Q_8 Q_6 Q_4 Q_2            Q0    Q2     Q4       Q6       Q8       Q10 Q12
Musich,Schultz, Burton, Edington. DM&HO. 12(5):299-326,2004
                                                          University of Michigan Health Management Research Center
          Costs Associated with Risks
                Medical Paid Amount x Age x Risk

                                                                          $7,123
                                                              $5,813

                                                  $4,530
                                                                                       $4,401
       $7,000
                                                                                                     $3,216
       $6,000                                                   $4,718
       $5,000                      $2,098
                                                    $3,364
                                                                            $3,069
       $4,000                            $2,667           $3,894
                                                                                           $2,480
       $3,000                 $1,550          $2,912
                                     $2,110                            $2,605       $2,200
       $2,000             $1,351                     $2,941
                                                                                                        High Risk
                                         $2,081                  $1,851                              Medium Risk
       $1,000                  $1,523                                         $1,641
                 $1,122                                                                          Non- Participant
           $0                                                                                 Low Risk
                 19-34        35-44      45-54      55-64       65-74         75+




Edington. AJHP. 15(5):341-349, 2001
                                                                          University of Michigan Health Management Research Center
This is the Way Americans Have
 been Living their Lives for 60
             Years

 Are We Willing to Accept the
     Consequences of the
     Do-Nothing Strategy?


                   University of Michigan Health Management Research Center
        Section II
 Key Business Concepts
To Build the Business Case




                 University of Michigan Health Management Research Center
     Business Concept

Total Value of Health Status




                  University of Michigan Health Management Research Center
  Relative Costs of
    Poor Health:
Total Value of Health                                                  Direct Costs:
                                                                       Medical & Pharmacy




   Indirect Costs:                                                                       Worker’s
                                                                                         Compensation
                     Presenteeism               LTD          STD         Absenteeism

                                                        Time-Away-from-Work
Edington, Burton. A Practical Approach to Occupational and
Environmental Medicine (McCunney). 140-152. 2003
                                                              University of Michigan Health Management Research Center
Same Risk and Behavior Factors
            Drive
  All the Outcome Measures




                    University of Michigan Health Management Research Center
    Medical/Drug Cost Comparison by Risk Status
                        Illness Days >6/yr*                 $1,129
                                                                                                                $5,145
                Existing Medical Problem*                    $1,303
                                                                                          $3,434
                                                             $1,234
                   Use Medication/Drugs*                                       $2,557
            High BP (SBP >139, DBP >89)*                     $1,228
                                                                              $2,416
              Physical Health (fair or poor)                  $1,318
                                                                     $1,817
                                                             $1,277
              Physical Activity <1x/week*                           $1,756                         Low Risk
                                                            $1,144                                 High Risk
                 20% or more overweight*                            $1,750
                               Stress (high)                  $1,310
                                                                  $1,607
                                                                $1,416
                                Health Age                        $1,593
                                                               $1,374
                 Life partly or not satisfied                     $1,592
                 Job partly or not satisfied                    $1,415
                                                                $1,460
                           Cholesterol>239                      $1,421
                                                                $1,418
                                                                $1,434
                           Current Smoker                     $1,336
                 Safety Belt Usage <100%                         $1,473
                                                             $1,278
               Alcohol Drinks >14 weekly*                       $1,428
                                                            $1,157
                                                     $691
                                 Zero Risks
  *p<.05.
                                                $0   $1,000 $2,000 $3,000 $4,000 $5,000 $6,000
Yen, Witting, Edington. AJHP. 6:46-54, 1991                                     University of Michigan Health Management Research Center
          Total Disability Cost by Risk Status
            1998-2000 Mean Annual Costs
         Use Medication/Drugs 1**                   $850
                                                                          $1,585
        Job partly or not satisfied**                   $950
                                                                   $1,355
                      Health Age 2**                     $1,020
                                                          $1,057
                                                                                                    Low Risk
     Physical Health (fair or poor)**                   $965                                        High Risk
                                                                        $1,544
        Existing Medical Problem**                      $997
                                                               $1,215
     High BP (SBP >139, DBP >89)                        $993
                                                            $1,164
                   Cholesterol>239                      $1,015
                                                          $1,071
         20% or more overweight**                    $896
                                                           $1,103
                  Current Smoker**                      $977
                                                             $1,163
        Physical Activity <1x/week*                      $1,005
                                                           $1,088
                Illness Days >6/yr**                $846
                                                                                           $2,175
        Alcohol Drinks >14 weekly*                     $1,021
                                                        $1,051
         Safety Belt Usage <100%**                     $1,006
                                                        $1,051
        Life partly or not satisfied**                $964
                                                            $1,216
                      Stress (high)**               $860
                                                              $1,273
                            No risks         $390

                                         0   500    1000           1500            2000          2500          3000
Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002
                                                                   University of Michigan Health Management Research Center
  Estimated Loss of Productivity by Risk Status
                                                     18%
 Use Relaxation Medication**                                            27%
                                                       20%
         Life Dissatisfaction**                                   25%
                                                       20%
                  High Stress**                                   24%
                                                           21%
    Safety belt Usage <90%**                                     24%
                                                           21%
         Job Dissatisfaction**                                   24%          Low Risk
           Current Smokers**                               21%                High Risk
                                                                 24%
                                                           21%
       Poor Physical Health**                                 23%
                                                            21%
    Physical Activity <1x/wk**                                 23%
                                                            21%
                  BMI>=30.0**                                  23%               Burton, Chen,
                                                            22%
                     High BP*                                 23%
                                                                                 Conti, Schultz,
                                                               23%
                                                                                 Pransky, Edington.
        Alcohol Drinks >14/wk                               21%                  JOEM. 47(8):769-
              High Cholesterol                                   24%             777. 2005
                                                       20%
                                              12%
                     Zero Risks


*p<.05, **p<.01               0%   5%   10%    15%   20%         25%      30%        35%

                                                      University of Michigan Health Management Research Center
       Business Concept
Excess Costs follow Excess Risks




                    University of Michigan Health Management Research Center
        Excess Medical Costs due to
               Excess Risks
   $6,000                                                                             $5,520
                  Excess Costs
   $5,000
                  Base Cost
   $4,000                                              $3,460                         $3,321
                                       $3,039
   $3,000
                                         $840          $1,261
                   $2,199
   $2,000

   $1,000

        $0
               Low Risk (0-2          HRA Non-      Medium Risk                High Risk (5+
                  Risks)              Participant    (3-4 Risks)                  Risks)


Edington, AJHP. 15(5):341-349, 2001
                                                       University of Michigan Health Management Research Center
       Excess Disability Costs due to
               Excess Risks
                                      36% of Absence, STD, Worker’s Comp
    $1,500
                  Excess Costs                                                            $1,248
                  Base Cost
    $1,000
                                                             $783
                                         $666                                              $757
                     $491               $175                 $292
      $500


         $0
               Low Risk (0-2        HRA Non-            Medium Risk               High Risk (5+
               Risks) N=685         Participant         (3-4 Risks) N-            Risks) N=366
                                     N=4,649                 520




Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002       University of Michigan Health Management Research Center
     Excess On-The-Job Loss due to
             Excess Risks
     30.0%
                         Excess Costs
                         Base Cost

     20.0%                                                                             12.2%
                                                    6.2%


     10.0%
                        14.7%


      0.0%
                Low Risk (0-2 Risk          Medium Risk (3-4             High Risk (5+ Risks)
                    N=17,947                 Risks) N=6,959                    N=3,469


Burton, Chen, Conti, Schultz, Pransky, Edington. JOEM. 47(8):769-777. 2005

                                                             University of Michigan Health Management Research Center
     Business Concept
Total Value of Health Status
      to an Organization




                  University of Michigan Health Management Research Center
          Association of Risk Levels with
            Corporate Cost Measures
            Outcome            Low-         Medium-      High-                Excess
            Measure             Risk          Risk        Risk                 Cost
                              (N=671)       (N=504)     (N=396)             Percentage
        Short-term             $ 120          $ 216      $ 333                    41%
        Disability
        Worker’s               $ 228          $ 244      $ 496                    24%
        Compensation
        Absence                $ 245          $ 341      $ 527                     29%
         Medical &            $1,158         $1,487     $3,696                     38%
         Pharmacy
        Total                 $1,751         $2,288     $5,052                     36%
Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002
                                                        University of Michigan Health Management Research Center
      Business Concept
Stratification of the Population
       for Intervention




                    University of Michigan Health Management Research Center
Stratification In the Health Promotion
              Opportunity
9000
8000           Serious disease
7000
               Minor Disease
6000
5000           No Disease

4000     Health Promotion
         Opportunity
3000
2000
1000
   0
       Q_12 Q_10 Q_8 Q_6 Q_4 Q_2   Q0   Q2     Q4         Q6        Q8       Q10 Q12
                                             University of Michigan Health Management Research Center
Predictability to be at High Cost
     0.9
                                 Se=0.83                                                               Low intervention (71%)
                                 0.83
     0.8
                                                   Se=0.79                                             High Intervention (29%)
                                                   0.79
                  0.75
                  Se=0.75
     0.7

                                                                      0.64

     0.6
                                                                                         0.57
                                                                                                            0.54

                                                                                                                           0.52
     0.5
 %




     0.4



     0.3



     0.2                                                                                                                   0.19
            Sp=(1-0.10)=0.90                                                                                0.18
                                                                                        0.18
             0.10              Sp=(1-0.07)=0.93                      0.14
     0.1                       0.07                                  Sp=(1-0.14)=0.86
                                                   0.08
                                                   Sp=(1-0.08)=0.92
       0
           base             t1                t2                t3                 t4                  t5             t6
                                                              Time                                                                Se=Sensitivity
                                                                                                                                  Sp=Specificity

                                                                                               University of Michigan Health Management Research Center
  Business Concept
   Change in Costs
Follow Change in Risks




               University of Michigan Health Management Research Center
            Change in Costs follow Change in Risks
   Cost increased

                    $600

                    $400

                    $200

                      $0
   Cost reduced




                    -$200

                    -$400

                    -$600
                            3    2        1         0       1               2               3
                            Risks Reduced               Risks Increased
Overall: Cost per risk reduced: $215; Cost per risk avoided: $304         Actives:
Cost per risk reduced: $231; Cost per risk avoided: $320       Retirees<65: Cost
per risk reduced: $192; Cost per risk avoided: $621 Retirees>65: Cost per risk
reduced: $214; Cost per risk avoided: $264

Updated from Edington, AJHP. 15(5):341-349, 2001.       University of Michigan Health Management Research Center
    Change in Presenteeism follows
    percent increased
           Change in Risks

                        2.0%
                        1.0%
                        0.0%
    Percent reduced




                        -1.0%
                        -2.0%
                        -3.0%
                        -4.0%
                        -5.0%
                        -6.0%
                                 2       1          0                1                     2

                                Risks Reduced                Risks Increased
Burton, Chen, Schultz, Edington 48:252-263, 2006.       University of Michigan Health Management Research Center
Business Concept
 Change in Costs
Follow Engagement




            University of Michigan Health Management Research Center
Cost Savings Associated with Program
   Involvement from 1985 to 1995
    250%


    200%


    150%


    100%

                                      Zero or One HRA (N=804)
    50%                               Two or More HRAs (N=522)

     0%
           0   1   2   3    4    5     6       7         8        9       10

                   Programming Year
                                           University of Michigan Health Management Research Center
 Yearly Average Disability Absence
       Days by Participation
       25                                                                                 23.3
                  Participant                                           21.2
       20         Non-Participant                     17.6

       15                                                                                     17.2
                                          12                    14.1       15.7
                               8.8                                             The average annual
       10
                                               8.7                             increase in absence days
                                    6.9                                        (1995 – 2000):
                     6.6
        5                                                                       Participants: 2.4
                                                                                Non-Participants: 3.6
        0
                95             96         97               98             99                 0
                 Pre-Program               Program Years


Schultz, Musich,                           1.2 Work Days
                             $200                                               $623,040
McDonald,                           X        Participant X 2,596 participants =
Hirschland,Edington.
                           Work Day                                               Year
                                                Year
JOEM 44(8):776-780,
2002                                                                   University of Michigan Health Management Research Center
          Section III
Health Management as a Serious
       Business Strategy
   Next Generation Program
      Healthy Companies
          Zero Trend

                    University of Michigan Health Management Research Center
     Three Key Business Beliefs

1. Individuals Can Maintain Low-Risk Health
   Status even as they Age

2. An Employer and a Health Plan can Help its
   Members Maintain Low-Risk Health Status

3. The Major Economic Benefit is in Paying
   Attention to Individuals with Low-Risk Health
   Status



                               University of Michigan Health Management Research Center
    Strategies for
Population Management




               University of Michigan Health Management Research Center
  Where are the Opportunities for
  Population Health Management?
    9000
    8000           Serious disease           Medical & Care
                                             Management Opportunity
    7000
                   Minor Disease
    6000
    5000           No Disease                    Disease Management
           Health Promotion                      Opportunity
    4000
           Opportunity
    3000
    2000
    1000
       0
           Q_12 Q_10 Q_8 Q_6 Q_4 Q_2   Q0   Q2       Q4        Q6        Q8       Q10 Q12
Medical and Drug Costs only                      University of Michigan Health Management Research Center
Create an Integrated and Sustainable
Approach                                                        Health Advocate
                                                                • Provide Direction
                                                                • Get the Care You Need                      Health Plan Design
                                                                • Coaching & Outreach
                  Behavioral Health                                                                          Environmental
                  • Work/Family                                                                              Design
                  •Work Life Plus


        Health Portal                                                                                                  Disease Management
        • Stay healthy                                                                                                 • High Acuity (identified high cost
        • Health information                                                                                             disease)
        • Make informed choices                                     Total Health                                       • Low Acuity (identified lower cost
                                                                                                                         disease; lifestyle behavior focus)
                                                                         &
   Health Risk Assessment
                                                                    Productivity
   • Assess and track health behaviors
   • Maintain health
                                                                    Management                                              Case Management
   • Address health risks




                                                                                                                    Absence Management
               Fitness Centers                                                                                      • STD, LTD
               • Low risk maintenance
                                                                                                                    • Workers’ Compensation
               • High risk reduction
                                                                                                                    • Scattered Absence




Long Term                                Wellness Programs                                On-site Medical
                                         • Active expansion                               • Diabetes education pilot
Strategy—                                • Retiree communications/awareness               • Injury and medical management
                                           program
Short Term
Solutions                                                                                             University of Michigan Health Management Research Center
Health Management as a Serious
       Business Strategy
               Worksite Environment
                     Values and Beliefs
                     Workplace Policies
                      Benefit Design
  Population                                        Individual
                                              (Stratification by
Website                                                 Individual)
                  Health Risk Appraisals
Health Policies
Special Promotions                     Coaching Sessions
Employee Assistance                      Low-Risk Maintenance
Risk Reduction Activities                Disease Management
Low-Risk Maintenance      Incentives     High-Risk Reduction
  Know Your Numbers                     Health Advocate
  Physical Activity                      Triage to Resources
  Nutrition Awareness
 Medical Facility
                          Measurement
                                          University of Michigan Health Management Research Center
      Environment Interventions
            (Physical, Psycho/Socio)
 Management and Leadership of the Company
 and Unions

 Mission and Values Aligned with a Healthy and
 Productive Culture

 Policies and Procedures Aligned with Healthy
 and Productive Culture
     Vending Machines    Job Design
     Cafeteria           Flexible Working Hours
     Stairwells          Smoking Policies
     Other

                                University of Michigan Health Management Research Center
  Next Generation Benefit Design to
       Promote Consumerism
• Values, Mission,… “What’s the Point
• Move from Entitlement to Consumer
  •Incentives follow Actionable Behaviors

• Provide Transparency
  •Appropriate Physicians
  •Appropriate Health Systems
  •Appropriate Pharmaceutical Solutions

• Promote Maintenance of Health Status
                                   University of Michigan Health Management Research Center
   Next Generation of
Individual Based Programs




                University of Michigan Health Management Research Center
        Individual Stratification and
                  Coaching
   Trend Management System
       Prioritized Risks
       Probability of being High-Cost
   Cluster Technology
   Coaching for all People: Low-Risk, High-Risk
    and Conditions
   Develop Self-Leaders; Intrinsic Coaching
   Health Advocate with triage to other resources
         (Behavioral Health, EAP, Family Physician,…)
                                     University of Michigan Health Management Research Center
            Coaching Strategy for Individual
                      Intervention
    Contact each individual
    Unlimited contacts (one-on-one, web, telephonic)
    By level of probability of being high cost
    Pay attention to cluster and prioritized risks
    Use variety of contacts (one on one, telephone and
    e-mail for sustainable engagement
    Use situational and whole person approach
    Engage individual in positive actions. Ask but don’t tell.
    Use triage, health advocate strategies, develop self-
    leaders and available resources

* Frequent evaluation of coach/client participation and
   satisfaction                     University of Michigan Health Management Research Center
   Next Generation of
Population Based Programs




                University of Michigan Health Management Research Center
   Population-Based Programs
Population Programs Orientation
 Pedometers, know your numbers, no weight gain

Human Resource Orientation
 People skills/Communications

Health Communications
 Written materials, Online portal, etc

Environmental Orientation
 Stairwells/Vending, Food Services, Other
                                University of Michigan Health Management Research Center
Incentives




         University of Michigan Health Management Research Center
                Incentives

Hats and T-Shirts

Cash, debit cards
($25 to $200)

Premium Reductions/Premium Plan
  ($600 to $2000)

Benefit Options (Co-pays, Deductibles, HSA
 contributions, …)


                              University of Michigan Health Management Research Center
   Measurement: Proof of Concept
              (Necessary and Sufficient)


1. Improve Health Status Transitions
2. Decrease Healthcare Cost Trend
3. Decrease Productivity Loss
4. Improve Overall Trends for all Outcomes


Business Case is pretty good but not yet perfect. We need
Champion Companies!!!!
                                     University of Michigan Health Management Research Center
Measurement, Evaluation
 and Decision Support
1. Participation and Employee Satisfaction

2. Reduction in Health Risks

3. Return on Investment

4. Decisions Based upon Program Results

5. Total Value of Health
   (Health Care Cost/Productivity Measures)
6. Proof of Concept
   (Beat Natural Flow/Bend the Trend Lines)
7. Shareholder Value
                               University of Michigan Health Management Research Center
Summary




      University of Michigan Health Management Research Center
Health Management: Next Generation
Programs, A Serious Business Strategy
Total Population
 Management
                                                   Risk & Disease
Environmental –                                     Identification
 Policies, Procedures,                            Know Target Population
 Benefits Aligned
                                Key
Individual –
                                             Success Scorecard
 Low-Risk Maintenance,
 Risk Reduction, Referral,
                             Strategies     Participation: 80%-95%%
 Follow-up                                  Low Risk Population: 75+%

Population -
 Engagement
                                            Outcome Measures
                                               Effective Programs Equal
Other –                                                 Benefits
 Incentives, Measurement

        Manage the Person, Not the Risk or the Disease
                                          University of Michigan Health Management Research Center
Thank you for your attention.
 Please contact us if you have any questions.

Phone: (734) 763 – 2462
Fax:   (734) 763 – 2206

Email:      dwe@umich.edu

Website: www.hmrc.umich.edu
Dee W. Edington, Ph.D. , Director
Health Management Research Center
University of Michigan
1027 E. Huron St.
Ann Arbor MI 48104-1688

                                University of Michigan Health Management Research Center
 25 Years of Key Learnings
           from the

   University of Michigan
Health Management Research
          Center
      (1980 to 2006)

                      University of Michigan Health Management Research Center
  Key Research Learnings from HMRC
1980   HRA -Implement and disseminate HRA from CDC/Carter Center
to
       Outcomes measure -Move from mortality outcomes to medical,
       pharmacy and time away from work as our primary outcome measures

1990   Consult and implement -Wellness Programs in 20+ companies

1991   High risk persons are high cost –(prospective data)
         a.) Individual risks
         b.) Cumulative risks (0-2, 3-4, 5 or more)

1993   Absenteeism -shows the same relationships to risks as medical costs

1993   Excess costs are related to excess risks

1994   Cost changes follow risk changes (medical and pharmacy)

1995   Risk combinations - the most dangerous predictors of cost

1996   Low risk maintenance -an important program strategy
                                                  University of Michigan Health Management Research Center
           Key Research Learnings
                (Continued)`
1996   Resource optimization -Changes in risk drive changes in cost when
       targeted according to specific risk combinations:
1997   Benchmarking -By wellness score and company health score

1998   Participation –Relates to risk and cost moderation

1998   Program opportunities -In preventive services, low-risk
       maintenance, high-risk intervention and disease management
1999   Presenteeism -Introduced as a measure of productivity and influenced
       by risks and disease

2000   Total value of health -Define to the organization

2001   Natural flow –Established for risks and costs

2002   Focus on the person – Primary and not the risk or the disease

                                                University of Michigan Health Management Research Center
           Key Research Learnings
                (Continued)
2002   Cost changes follow risk changes -Time away from work

2003   Improved population health status -Result from Employer
       sponsored programs
2004   Proof of Concept -Must bend the cost trends

2004   Percent participation and percent low-risk -Proposed as the
       important elements of a Health Management Scorecard

2005   Pre-retirement participation -Influences post-retirement
       participation
2005   Presenteeism -Changes in costs follow changes in risks
2005   Interventions -Susceptible to severe “step down” participation
2006 and beyond
  ~Health Management -A Key Component in Health Consumerism~
                                                University of Michigan Health Management Research Center

								
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