The Future of Health Care Focus on Health Management by rraul

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									              The Future of Health Care:
              Focus on Health Management



Health Management Research Center, Corporate Consortium
Camille Haltom, MS, Vice President, Consultant Relations
December 13, 2006
2006: Limited Value from U.S. Health Care
Expenditures
  America’s Health Rankings Report
  •   Lack of significant progress
  •   Smoking cessation rates
  •   Obesity impact on health
  •   Wide variation in cost and quality
  •   Address Health disparities
  •   Address the uninsured
  •   Mental Health Days: integration
                                                                       Health Rankings: A Call to Action for People and Their Communities, 2006.
                                                                       United Health Foundation, American Public Health Association, and Partnership
                                                                       for Prevention
  Consumerism Challenges
  •   CDHPs help consumers who have discretionary choices
  •   Consumers lack tools, resources for engagement/activation
  •   Few incentives for consumers to behave differently
  •   Few options for early retirees (age 50-64), low wage workers
  •   Fragmented care coordination approach
         2   Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
Preview of 2010
                                Percent Change in Population1 (2000–2010)                                               Expected Cost of Health Care Benefits
                     40%
                                                                                       33%                        $18,000
                     30%
                                                                                                                  $16,000
 Percentage Change




                     20%                                                                                          $14,000
                                                                          8%                                      $12,000
                     10%
                                 2%




                                                                                                           Cost
                                                                                                                  $10,000
                      0%
                                                                                                                   $8,000
                     -10%                      -5%                                                                 $6,000

                     -20%                                                                                          $4,000
                                                            -19%
                                                                                                                   $2,000
                     -30%
                                 <25        25–34         35–44           45–54        >55                            $0
                                                        Age Group                                                              25           35   45    55             65
                            Percent of Employees with a Work Disability                                                                          Age        Hewitt 2005 HHVI Data




                       • Baby boomers: Increased age-based utilization, greater intensity of care
                       • Those aged 35-44: Not yet highly engaged in their health care
                       • Younger generations: Will expect technology-based solutions and new
                         funding vehicles (HSAs)
                       • In all categories:
                            • Low cost will repopulate the high cost population segment
                            • Consumers need preparation and education in making better decisions
                                  U.S. Census Bureau, Populations Projection Bureau

                            3          Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
Employer Perspective: Cost Sharing is Playing Out
For Many
                                                            Health Care Costs
 $8,000
                                                                                                                      +57%
 $7,000                                                                                                                      Cost of Health Care Benefit

 $6,000
                                                                                                                     +53%    Employer Subsidy
 $5,000

 $4,000                                                                                                                      Employee Payroll Contribution
 $3,000
 $2,000                                                                                                             +74%     Empoyee Benefit Cost Sharing
                                                                                                                             Source: Hewitt HHVI
 $1,000                                                                                                              +210%

    $0
              2001                   2002                    2003                     2004                    2005



          – Employers continue to pay the vast majority of the cost.
          – A cost shifting strategy is shifting to “Consumer” models that offer
            employees options and palatable trade-offs



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A Fragmented System Drives Inefficiencies and
Consumer Disengagement
                                                                                                                     Rx
                                          Lifestyle                                                  – What is this medication?
                                    – What can I eat?                                                – Covered? Generic?
                                    – Is exercise OK?                                                – How do I take it?
                                    – Should I lose weight?                                          – How will I feel?
                                                                                                     – Take instead of other
     Wellness                                                                                          medication?
  Health Counselor                                                                                                                    Physician
  – Should I still participate?                                                                                                    – How often?
  – How will I earn incentives?                                                                                                    –Tests? What do they mean?
  – Continue with counselor?                                                                                                       – Specialist versus my doctor?
                                                                                                                                   – Will it be covered?



                   EAP
                                                                                                                               Disease
             Behavioral Health                                                                                               Management
                                                                         Disability
                – Who do I call?                                    – Who do I call?                                      – Who is calling me?
                – Another medication?                               – When?                                               – Why should I participate?
                – Is this covered?                                  – Coverage?                                           – Coordinate with my MD?

                                                                    – Who is calling me?


         5      Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
Clinical Behavior Requires Change– One Size Does
Not Fit All
  Clinical support programs target reduced variability in clinical decision-
              making - the source of most cost and quality issues


          Pre-ACN Group CSP                                                                                    Post-ACN Group CSP




      6   Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
Future Direction/Potential Solutions

   • Population management: Coordination of care vs. program management
      – Understand risk and behavior of entire population
      – Longer term, more holistic focus
      – Reach out to those whose behaviors put them at risk for high utilization
      – Active identification/integration of behavioral health – case finding and referral
      – Communication across providers and programs is required
   • Data sharing:
      – Evidence-based best practices
      – Longitudinal (medical) record shared across providers
      – Personal health record – claims based and self-reported information
      – Electronic health record – interoperable, secure, portable
   • Measurement focus includes engagement and action, broader measures of
     success, and earlier (upstream) identification

“With health information technology and the electronic health record, we have the
prospect of much more patient-centered health care…we know that the very
foundations of our health care system need to be strengthened, especially to make
better use of the information that is the heart of successful care”
Michael O. Leavitt, Secretary of Health and Human Services
          7     Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
Future Direction/Potential Solutions

 • Meet consumers where they are:
     – Needs of older population vs. younger (telephonic versus advanced technology)
     – Individuals – new approaches and plans
     – Arm consumers with tools to determine quality, cost, options, and value
 • Vest consumers in their health care decisions
     – Rewards, penalties – Evolution of incentives for health awareness and move
       toward rewarding action, compliance
     – Education and information – cost, quality, implications of poor care
 • Start consumer education in our schools and educational system
     – Integrate health management into basic curriculum and life skills
     – Focus on health management, health care financial management, focus on
       preventive care

“If we are to accelerate our progress toward better health, as well as to improve cost
effectiveness, we need informed consumers and providers who have the ability to
choose good quality, high-value health services”
Michael O. Leavitt, Secretary of Health and Human Services

          8     Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
Simplified Consumer Experience: Deliver the
Right Care, Right Time, Right Place


                                       • Wellness support                                                       • Improved health & well-being
                                       • Lifestyle coaching                                                       outcomes
                                       • Health care decision support                                           • Improved productivity at
    Consumers’                         • Physician selection
                                                                                                                  home and work
   points of entry                     • Centers of Excellence network program
                                         selection                                                              • Improved cost of care for
                                       • Disease management support                                               customers and consumers
                                       • Behavioral health support

          Customer service

             Web portals

               EAP line
                                                                                                                              Stay Well

              NurseLine
                                                                                                                              Get Well
             Health Risk
            Assessments
                                                                                                                           Live with Life’s
             Health Care                                                                                                     Challenges
              Provider
             Notification

                Claims

           Predictive Model

              Outreach


      9    Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
   Clinical Behavior Change – Share Data that
   Improves Access, Affordability, and Quality

      Straightforward, Commonplace
                                                                                                             Complex, Rare Conditions
                Conditions
# Cases




                                                                                                  # Cases
             Outliers                                              Outliers




                                          Quality                                                                                  Quality


           Change Clinical Behavior                                                                                          Shift Patient Flow
              Close Gaps in Care by                                                                            Reward and Inspire Exceptional
          Sharing Physician Practice Data                                                                           Clinical Performance
                                                                                                              “Centers of Excellence networks”

            10          Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
   Physician Engagement: Critical to Effective
   Care Management

On-Line Health Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Patient Data
     Provider                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Sharing
 Decision Support
       Tools


                                                                    On-Site Clinical Resources
                                                                    On-Site Clinical Resources



On-Site and Telephonic
 Health Care Provider
  Decision Support
 and preparation for
         visits             Consumer Health Advocacy
                            Consumer Health Advocacy                                                      Peer-to-Peer Consultations
                                                                                                          Peer-to-Peer Consultations

                                                                               Provider
                                                                               Provider
                                                                                                                                                                                                                                                                                                                               Heart Failure Program - Alert Report                                                                                                                                                                                          STAT

                                                                                                                                         595 Double Eagle Crt #1000 Reno, NV 89521                                                                                                                                            Phone: 866-766-8280                                                                                                        Fax: 888-922-5373
                                                                                                                          Patient:                                                                                                                                                                                            Health Plan:
                                                                                                                          DOB:                                                                                                                                                                                                Nurse Contact:
                                                                                                                          ID:                                                                                                                                                                                                 Date:
                                                                                                                          PCP:                                                                                                                                                                                                Health Plan:
                                                                                                                          SCP:                                                                                                                                                                                                Facility:
                                                                                                                          CM:                                                                                                                                                                                                 Med Group:
                                                                                                                          Other:




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Clinical Alerts
                                                                                                                          Comments:




 Physician and                                                                                                                 WEIGHT (lbs.) OVER LAST 30 DAYS
                                                                                                                                                           210



                                                                                                                                                           205




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Status Reports




                                                                                                                                                  Weight
    Facility
                                                                                                                                                           200



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 Data Sharing                                                                                                              Patient Reported SYMPTOMS to daily questions
                                                                                                                                     Wake up SOB

                                                                                                                                     Extra Pillow

                                                                                                                                     Missed Exercise

                                                                                                                                     Missed Medication

                                                                                                                                     Breathlessness

                                                                                                                                     Pedal Edema
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Summary Reports
                                                                                                                                     More Tired

                                                                                                                                     Coughing More

                                                                                                                                     Stomach Bloated

                                                                                                                                     Feeling Worse

                                                                                                                                     Feeling Dizzy
                                                                                                                                                                    1             2             3             4             5             6              7            8              9           10            11            12            13            14            15            16            17            18            19            20             21           22             23            24           25             26           27            28               1            2


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                                                           Physician and Facility Data Analytics
                                                           Physician and Facility Data Analytics
                                                                                                                                                                                                  ALERT Report - STAT




           11    Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.
Employers Will Manage and Measure the Total Value
of a Healthy Workforce
                                                                                                                                           Productivity Opportunity

                                                                                                                                    $150
                          Health Care Savings
                           Health Care Savings
                                                                                                                                    $125
                                       Health Care Costs
       $300,000,000
                                                                                                                                    $100
       $275,000,000




                                                                                                                  ($ in Millions)
       $250,000,000
                                                                                                                                    $75
       $225,000,000
       $200,000,000
                                                                                                                                    $50
       $175,000,000
       $150,000,000
                             2005     2006      2007         2008    2009       2010                                                $25


                                 Projected Costs            Estimated Cost Impact
                                                                                                                                     $0
                                                                                                                                           Incidental     Short Term     Long Term         Worker's
                        2005          2006           2007           2008          2009          2010                                                       Disability    Disability      Compensation

  Trend                  —            10%            9.5%           9.5%          9%             9%                                                     Direct Costs    Indirect Costs
  Projected Costs
                        $184          $202           $221           $242          $264          $288
  ($ Million)
  Annual Savings
                         —             $3            $10            $18           $30            $43
  ($Million)

 Potential opportunity will vary based on current                                                                                           Productivity Savings
                                                                                                                                             Productivity Savings
 initiatives, population profile, investment, etc.

          12        Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.

								
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