Iowa Bankers Benefit Plan

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					                              Iowa       Wellmark       Iowa
Disease Management          Bankers        BoB        Bankers     W BoB Paid
Program                    Prevalence   Prevalence   Paid PMPM      PMPM
Oncology                     1.16%        1.04%          $2,654       $2,910

Diabetes Management          3.26%        3.84%            $915         $813

Heart Failure (HF)           0.22%        0.30%          $2,212       $2,109

Coronary Artery Disease      0.99%        1.03%          $1,175       $1,298
(CAD)

Chronic Obstructive          0.21%        0.43%            $820       $1,054
Pulmonary Disease (COPD)


Asthma                       2.95%        3.06%            $380         $389

Impact Conditions           10.40%       11.45%            $558         $460
                                                                         1
                Disease Management
Comparing Iowa Bankers’ members diagnosed with conditions
applicable to disease management programs (prevalence)
and the amount of claims paid for those members per month,
with the Wellmark book of business prevalence and costs:
 – The Iowa Bankers’ prevalence rate was greater than the
   Wellmark book of business for oncology conditions only.

 – Claims paid per diseased member per month exceeded
   the Wellmark book of business for members with diabetes,
   heart failure, and impact conditions.



                                                          2
3
                                  Medical Risk                                                                                        Lifestyle Risk




                                                                                              Sedentary Lifestyle




                                                                                                                                                                                                                 Members Impacted




                                                                                                                                                                                                                                                       Diseased Member
                                                                                                                                  Dietary Fat Intake

                                                                                                                                                       Fruits/Vegetable




                                                                                                                                                                                                                                                        Claims Paid per
                                   Blood Pressure




                                                                              Blood Glucose
 Your costs and the




                                                                                                                                                                                                 Seat belt Use
                                                              Triglycerides




                                                                                                                    Tobacco Use




                                                                                                                                                                          Alcohol Use




                                                                                                                                                                                                                                         Claims Paid
  impact of different




                                                    TDL/HDL
                         Weight




                                                                                                                                                                                        Stress
                                                                                                                                                            Intake
 medical and lifestyle
        risks



Bones/Muscles/
Ligaments                  X                                                                      X                                                                                      X                       6,711              $7,777,889         $1,159
Benign/Cancerous
Tumors                     X                                                                      X                 X                  X               X                    X                                    2,631              $5,887,662         $2,238

Heart/Vessels              X       X                  X        X                    X             X                 X                  X               X                    X            X                       3,559              $4,859,427         $1,365

Digestive                  X                          X        X                                  X                                    X               X                    X            X                       2,653              $4,125,863         $1,555

Genital/Urinary            X       X                           X                    X             X                 X                  X                                    X            X                       4,262              $3,201,396              $751
Injuries/
Poisonings                 X                                                                      X                                                                         X                    X               4,120              $3,297,028              $800
Nose/Throat/
Lungs                      X                                                                      X                 X                                                                    X                       9,421              $2,848,091              $302

Nerves/Eyes/Ears                                                                    X                                                                  X                                                         6,859              $3,463,784              $505
Glands/
Metabolism/
Immune System              X                                                        X             X                 X                  X               X                    X            X                       4,884              $1,892,943              $388
                                                                                                                                                                                                                                                            4
Employee Benefit Workshop 2009
      • National Trends

      • IBBP Information

      • Analysis of the Plan

      • Wellness




                                 5
          The Case for Disease Management
» Chronic illness accounts for more than 75 percent of all
  health care costs.*

» An estimated one in three Americans has some form of
 cardiovascular disease, which is responsible for direct
 and indirect costs of $431.8 billion dollars annually.**

» Participants who better manage chronic diseases have a
 lower number of emergency room visits, hospitalizations and
  additional complications.

* National Centers for Disease Control and Prevention
** American Heart Association, Heart Disease and Stroke Statistics, 2007
                                                                           6
 Managing a Chronic Disease is Complex
             Test and Exams                   Insulin Using       Non-Insulin
                                                                    Using
            Hemoglobin A1c                   Four times a year   Two times a year
                                                                                    » 95% of what a
 (Measures average blood sugar for past 3
                  mo.)
                                                (Quarterly)       (once control
                                                                   established)       person with
    Foot inspection by Doctor or Nurse        One time a year    One time a year      diabetes should do
              Blood Pressure                    Each visit          Each visit

             Dilated Eye Exam                 One time a year    One time a year
                                                                                      to maintain good
                Lipid Profile                 One time a year    One time a year      health is self-
   (Cholesterol; HDL; LDL; Triglycerides)

         Kidney Function Exam                 One time a year    One time a year
                                                                                      directed
 (Serum Creatinine Tests – Microalbumin)

            Flu Shot – Vaccine                One time a year    One time a year
        Pneumonia Shot – Vaccine                  Initial             Initial
                                                                                    » Only 1 in 5 are
                            Talk To Your Doctor About
Pre-pregnancy – Family Planning Counseling      As needed          As needed
                                                                                      doing everything
              Aspirin Therapy                  Over 40 years      Over 40 years       they should
            Stopping Smoking                    Each Visit          Each Visit

          Your Health Care Goals                Each Visit          Each Visit
                                                                                                    7
Disease Management Programs
» Diabetes

» Congestive Heart Failure

» Coronary Artery Disease

» Asthma (high risk)

» Chronic Obstructive Pulmonary
  Disease                         8
Program Design

        Identification   Stratification




         Assessment      Intervention




                                          9
Risk Stratification
» 4 stratification levels
   • Level 1: Participants who are stable and at lowest risk for
      utilization, or aggravating their condition
   • Level 2: Participants who are at some risk for utilization, or
      aggravating their condition
   • Level 3: Participants who represent moderate risk for
      utilization or aggravating their condition, however, still
      preventable
   • Level 4: Participants at highest risk for utilization, or
      aggravating their condition, and timely action is required to
      lessen the risks
                                                                      10
Welcome Process
» Welcome kit
   • Personalized welcome letter
   • Health workbook

» Quiet period

» Welcome call
   • Care coordinators engage participants in
     the program after they are identified

» Opt-out engagement model
   • Participant must choose not to participate
                                                  11
Address the “Whole Person”
» It’s about people….not their disease
   • Depression
   • Co-morbidity                            All co-morbidities
   • Working                                 and behaviors should
   • Family                                  be managed
   • Denial                                  simultaneously by
                                             the same trusted
» Trust channels are essential               relationship.
  for outcomes improvement
  and successful behavior modification
» Must establish unconditional credibility
  and positive intent to create change
                                                               12
Personalized Interventions
» Interventions, support, and
  stratifications are dynamic and based
  on current health status and
  behaviors of participant

» Prochaska readiness to change

» Set obtainable goals with member


                                          13
 Member Interventions
                                                 Care Support Activities                                      Frequency
 • Welcome Packet/Letter                                                                       Initially
 • Welcome Call*

 • Care Calls from Program Nurse                                                               Varies per disease condition and
                                                                                               stratification level (2-39 times/year for
                                                                                               Core and 1-28 times/year for Impact)
 • Newsletter                                                                                  Quarterly**

 • Good Health Guidelines Reminders                                                            2-3 times/year and flu, varies by
                                                                                               disease condition
 • Depression Screening and Quality of Life Questionnaire                                      Annually
 • Program Satisfaction Survey

 •    Access to Dedicated Toll-Free Number (24/7)                                              As needed
 •    Self Care Goals and Education Materials
 •    Home Monitoring for Select Heart Failure Participants
*•    Home Pulmonary Education Program for Select COPD Participants
 •    Graduation Notification (Impact Conditions only)
*Asthma member interventions vary slightly.
**Disease specific newsletters are sent quarterly for all programs except Impact conditions.                                        14
            Improving the Patient-Physician
                     Relationship
                  Physician Activities                 Frequency
» Introductory Letter                               Once
» Welcome Kit
» Face-to-face Discussions with Registered Nurses   Ongoing
  (Clinical Integration Managers)
» Local Physician Advisory Council                  Quarterly
» Newsletter
» Evidence-Based Treatment Guidelines               Annually
» Standards of Care Flowsheet
» Program Satisfaction Survey (Core 5 only)
» Access to Dedicated Toll-Free Number              As needed


                                                                   15
    Programs are Designed to Achieve Results
• Clear need for program
• Supported by evidence-based medicine
• Measurable outcomes




                                               16
    Member Satisfaction Above
         Benchmark
8.26     Overall program satisfaction




85%      Improvement in taking medications as prescribed




92% Have more information on their overall health          17

				
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posted:10/15/2012
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