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 4 Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. 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 200 195 190 01/01 00:00 01/02 00:00 01/03 00:00 01/04 00:00 01/05 00:00 01/06 00:00 01/07 00:00 01/08 00:00 01/09 00:00 01/10 00:00 01/11 00:00 01/12 00:00 01/13 00:00 01/14 00:00 01/15 00:00 01/16 00:00 01/17 00:00 01/18 00:00 01/19 00:00 01/20 00:00 01/21 00:00 01/22 00:00 01/23 00:00 01/24 00:00 01/25 00:00 01/26 00:00 01/27 00:00 01/28 00:00 02/01 00:00 02/02 00:00 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 CONFIDENTIALITY NOTICE: This fax transmission is intended only for the use of the individual or entity to which it is addressed. It may contain information that is privileged, confidential or otherwise protected from disclosure. If you are not the intended recipient, you are here by notified that any dissemination or copying of the contents of this information is prohibited. If you have received this transmission in error, please notify UnitedHealthcare immediately by telephone, and mail the original back to UnitedHealthcare. If there is a transmission problem, please call 866-766-8280. 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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