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					Sutter Health Partners

  THE HERO Forum
 “Develop Corporate
   Responsibility and
Personal Accountability”
  September 18-19, 2006

     Margaret Sabin, CEO
    Sutter Health Partners
            Today’s Agenda


   Sutter Health Partners Overview
   SHP Lifestyle Management Program Model
   Train the Trainer for Healthcare Systems
   Summary
   Your Questions
   Next Steps
Sutter Health – Our Vital Statistics


                      Serving more than 100 cities
                      and towns in Northern CA
                     26 acute care hospitals
                     3,400 physicians (7 physician
                      medical foundations)
                     Approximately 43,000
                      employees
                     Home health & hospice, and
                      long-term care services
                     Medical research and medical
                      education/training
         Sutter Health’s Self Funded
              Migration Timeline

     2007                  2008                  2009
    SHSS (LM)         Sutter Solano            CPMC
Sac Sierra Region      Sutter Delta             PAMF
                                                               New to Self-
  Sutter – VNA       Sutter Regional         Santa Cruz
 Sutter Connect     Medical Foundation        Camino             Funded
Sutter Santa Rosa        (1,094)               (5,372)
w/ SMF North Bay
      (8,748)
                                  SutterSelect



Currently Self-      Marin General (LM)        ABSMC            Sutter Coast
   Funded            Novato Community            Eden             Modesto
                            (LM)           Mills Peninsula   Sutter Tracy/Gould
                    Sutter Amador (LM)        St.Luke’s             SNMF
                    Sutter Lakeside (LM)        (7,618)            (3,891)
                           (1,855)
                           2008                  2009             Future
     Health Insurance Landscape


   Employees/patients have become uninformed
    users of the healthcare system as they receive
    little information about the costs insurance
    companies pay when an employee or their
    dependents access the healthcare system
    – Symptom of the HMO Era
   As a result of sky-rocketing costs and increased
    utilization, companies are experiencing 30%
    increases in rates for the 2007 budget cycle
             What is SHP ?



   SHP is an administrator that manages self-
    funded, ERISA-compliant healthcare
    benefits programs
   SHP has developed and provides a unique
    lifestyle management program
   SHP integrates lifestyle, disease, medical,
    pharmacy, and behavioral health
    management into a single product
This is Accomplished Through…


 –   Excellent customer service
 –   Accurate and timely claims administration
 –   Proactive risk identification (health risk appraisal)
 –   Lifestyle management – “high touch” coaching
 –   Use of member empowerment tools (24/7 NAL, Audio
     Library)
 –   Disease management programs
 –   Pharmacy Management
 –   Behavioral Health Management
 –   Linkage to community resources
 –   Employee/member Incentives (financial)
What SHP Brings to the Table…


            What we can do for your
             organization:
             – help control/moderate
               escalating health care costs
             – take single source accountability
               for management and
               administration to provide
               excellent customer service
             – Work with you to maximize
               participation and results in your
               Lifestyle Management Program
    What Can We Provide?


– Matched/Enhanced benefits (e.g., LM)
  depending upon your goals
– A robust LM Program with focused
  incentives to maximize participation
  levels and achieve results (clinical and
  financial)
   Optimal Intervention Time
   for Greatest Cost Savings
Lifestyle Management                        Disease Management



                                                               Intervention
                                       Intervention
 SHP Identification
 and Intervention

                       Intervention                           Potential
                                                              Relapse


                                                 Severe
                                              Complications

   Emerging               Early
  Risk Factors         Complications
Flexibility of the SHP Model :
Putting the Pieces Together…



                          Reinsurance
              Actuarial                     BH
LM, DM,       Analysis                  Management
  FMM




Eligibility               Pharmacy
              Vision &                     Network
/ Claims                   Benefits
              Dental      Manager



 Key: One Stop Shopping
    Why Is Lifestyle Management (LM)
             Important?… (I)


72% of all disease is preventable
   Smoking results in $3391(per smoker) of
    additional claim costs annually
    – Smoking increases the risk of CVD by 30%
   Obese patients expend 77% more than non-
    obese patients on medications
   Diabetics costs per patient exceed $13K
    compared with $2500 for non-diabetics (14%
    of total US healthcare costs - $132B annually)
What’s Wrong With This Picture?



   We spend 97% of available
    healthcare dollars for
    restoration/illness, but…
   We spend only 3% of the
    available healthcare dollars on
    prevention
           Costs Follow Risks…



   19 year study of 10,245 men at Cooper
    Clinic*: average cost of “fit” men was
    53% less than “unfit” men
   Average cost of an overweight female is
    22.6% more than a healthy weight
    woman**

                *Med. & Science in Sports & Exercise; Sept., 2005
                **JAMA, September, 2005
Healthy Lifestyle Characteristics Among
           US Adults – 2000*


   Healthy lifestyle defined as combination of 4
    healthy lifestyle characteristics (HLCs)
    –   Non-smoking
    –   Healthy Weight (BMI<25)
    –   5 fruits and vegetables/day
    –   Regular physical activity
   Overall prevalence of adult US population who
    met above criteria: 3%

                              *Arch Intern Med.2005;165:854-857
 In Contrast: SHP Fosters Partnerships
               with MD’s
Active Patient                           Education &
Involvement                             Empowerment




                          Physician
                           Patient
                        “Partnership”

          Shared Decision
              Making              Lifestyle and DM
                                     Framework


                            “Collaborative Care”
The Role of Lifestyle Management (LM)


     LM is either the first intervention or a major
      component of the management of:
      –   Abnormal lipid profile
      –   Coronary artery disease
      –   Hypertension
      –   Diabetes
      –   Asthma
      –   Obesity/metabolic syndrome
     These diseases account for >75% of
      healthcare expenditures
The SHP Lifestyle Management Program
                                        –LM Coaches “close
                                            the loop” using PWP’s
                                            to modify identified risk
                                            factors
                                        –Reports sent to
                                            individual’s physician
                          “Back End” LM     for joint treatment
                              Coaches       planning and goal-
                                            setting
                                        –Professional clinical
 –Statistically valid &                     oversight & ongoing
     confidential health risk               education of LM
     appraisal                              Coaches
 –Completed via hard copy
     or on-line             “Front End”
 –Personal risk factor        Personal
     identification         Wellness Profile
                                 (PWP)
           LM Coaches Explained…

   Healthcare professionals with variety of
    training/degrees/expertise credentialed in
    related fields e.g.) ACE Certified (fitness
    trainers); RN, Master Level Kinesiology,
    Certified Coach
   Do not practice medicine
   Do not interrupt/interfere with MD’s workflow
    – “physician-extenders”
   Do help members set and achieve realistic
    lifestyle-related goals including stress, work-life
    balance – Behavior Modification
     LM Coaching Explained…


LM Coaching helps members:
  – Recognize/understand impact of lifestyle
    choices related to their health status
  – Understand benefits of change
  – Identify barriers to change
  – Build skills and provide tools for behavioral
    change (self-efficacy)
  – Increase motivation
    LM Coaches – Member “Load”



   Based on risk stratification (HRA,
    predictive modeling)
   Current ratios:
    – 1:100 (for high risk members)
    – 1:200 –250 (for moderate risk members)
    – 1:300 or > (for low risk members)
         Actual Case Summary
          Self Reported Data


   61 year old male hospital worker
   On no medications
   Reports health status as “good”
   Has not seen his physician for 7 years
   Family history of diabetes
   Walks daily for at least 30 minutes
   Reports 6-8 alcoholic beverages/week
          Actual Case Summary
            Coach Validated


   Smokes 1 PPD for 30 years
   Biometrics:
    – BP 203/113 initial reading; 192/110 second reading
   BMI – 25.5 (Ht. 70”; Wt. 170#)
   Lipids, Glucose – pending
   Patient “oblivious” to current health status
             Actual Case Summary
               Corrective Action


   Advised to make appointment with a physician
    immediately; risk factors of smoking and alcohol
    discussed with Lifestyle Coach
   Patient heeded advice; saw physician and was
    started on anti-hypertensive medication
   BP within 5 days was 157/78
   Started smoking cessation program, purchased
    BP machine and is monitoring BP 2X/day
   Initiated exercise program with physician’s
    clearance
Actual Examples of High End Claims
   Largely Impacted by Lifestyle


     Morbid Obesity – Average $75,000
       – High $116,000
       – Low $52,000


     Alcoholic Cirrhosis of the Liver
       – One case $295,500

Based on 2006 Sutter Health actual claims data
              Picture in Picture:
     Predictive Modeling-Based Focused
                  Outreach*

                                                              Percent
                                                  Dollars                         Disease/Case
Prevalent Disease Categories    # of Claimants                 of $$     PMPM
                                                  Spent                           Management
                                                               Spent

Circulatory                          925          $3.2 M
- Hyperlipidemia
                                     544          $1.2 M
- Hypertension                                                 30%       $290         Yes
- CHF                                300         $928,000
                                      22         $290,000
Diabetes                             265         $1.25 M      11.5%      $394         Yes
Neoplasms
- Breast
- Bone, CT,Skin
- Male GU
- Colo-Rectal                         97         $1.25 M      11.5%      $1,073       CM
- Respiratory
- Lip/Oral Cavity




                               * Based on paid claims 7/1/04 – 6/30/05
             Picture in Picture:
    Predictive Modeling-Based Focused
                 Outreach*

                                                            Percent
                                                 Dollars                          FH DM
Prevalent Disease Categories   # of Claimants                of $$       PMPM
                                                 Spent                          Program/CD
                                                             Spent
Mental Disorders
- Depressive Disorders              157
                                                $700,000     6.4%        $368      UBH
                                    151

Musculo-Skeletal
- Joint/CT
- Musculo-Skeletal Symptoms
                                    138         $750,000     6.8%        $449      Yes
- Sprains/Strains/Back



Respiratory
- Asthma
- COPD                              115         $480,000     4.4%        $348      Yes




                                  *Based on paid claims 7/1/04-6/30/05
Actual Examples of High End Claims
   Largely Impacted by Lifestyle


     Morbid Obesity – Average $75,000
       – High $116,000
       – Low $52,000


     Alcoholic Cirrhosis of the Liver
       – One case $295,500

Based on 2006 Sutter Health actual claims data
Active Patient Involvement – The PWP
         Individual Report (I)


                         John Q. Health
      John Q. Health
Active Patient Involvement: The PWP
        Individual Report (II)

             John Q Health
Non-Intrusive MD Actionable Data:
 The Physician Summary Report
For Affiliates: Executive Level Reporting
    For Affiliates
Group Level Reporting




                    % of people
                 interested in each
                        topic
Driving LM Participation: Pay Members
       to Get and Stay Healthy…

      LM Program Participation Rates


                           Due to application
                              of incentives
Current Incentive Program Structure

   Goal: Drive participation in Lifestyle Management Program

      $200                                                          $300 Max
                                  $500


 PARTICIPATION
 HRA completion
                                     $                 COMPLETION
                                                               All criteria is met
 LM Coach meeting                                             At least one goal
                                     And/Or                     has been attained
 Joint goal-setting
                        Maintain normal clinical parameters    Attendance at
 Basic Screening                                               programs/activities
                       For 12 months+Activity Class/Program
  Progressive Sequential Incentives:
    An Example (Starting in ’06)…

   Goal: Drive participation in Lifestyle Management Program
                  Through Ongoing Incentives
      $200                                                     $100 Max/Q
                                $500
       Q1                                                           Q 2-4

  PARTICIPATION
 HRA completion
                                    $                   COMPLETION
                                                               All criteria is met
 LM Coach meeting                                             At least one goal
                                     Or                         has been attained
 Joint goal-setting
                        Maintain normal clinical parameters  Attendance at
 Basic Screening                                             quarterly
                       For 12 months+Activity Class/Program   programs/activities
     Momentum Builds Over Time…

Sutter Health Partners Lifestyle Management Program
                 Participation Levels –
                       Affiliate A
     60%                                                     53%
                                                   48%
     50%                                 44%
                                42%
     40%             35%
     30%

     20%
           10%
     10%

      0%
           1st Qtr   2nd Qtr   3rd Qtr   4th Qtr   1st Qtr   1st Qtr

                               2004                 2005      2006
                        Participation Level
Sutter Health Affiliate Results:
    Affiliate “A” 9/05-12/05
              Picture in Picture:
     Predictive Modeling-Based Focused
                  Outreach*

                                                              Percent
                                                  Dollars                         Disease/Case
Prevalent Disease Categories    # of Claimants                 of $$     PMPM
                                                  Spent                           Management
                                                               Spent

Circulatory                          925          $3.2 M
- Hyperlipidemia
                                     544          $1.2 M
- Hypertension                                                 30%       $290         Yes
- CHF                                300         $928,000
                                      22         $290,000
Diabetes                             265         $1.25 M      11.5%      $394         Yes
Neoplasms
- Breast
- Bone, CT,Skin
- Male GU
- Colo-Rectal                         97         $1.25 M      11.5%      $1,073       CM
- Respiratory
- Lip/Oral Cavity




                               * Based on paid claims 7/1/04 – 6/30/05
             Picture in Picture:
    Predictive Modeling-Based Focused
                 Outreach*

                                                            Percent
                                                 Dollars                          FH DM
Prevalent Disease Categories   # of Claimants                of $$       PMPM
                                                 Spent                          Program/CD
                                                             Spent
Mental Disorders
- Depressive Disorders              157
                                                $700,000     6.4%        $368      UBH
                                    151

Musculo-Skeletal
- Joint/CT
- Musculo-Skeletal Symptoms
                                    138         $750,000     6.8%        $449      Yes
- Sprains/Strains/Back



Respiratory
- Asthma
- COPD                              115         $480,000     4.4%        $348      Yes




                                  *Based on paid claims 7/1/04-6/30/05
 What Have Been our Results: Financial
             MGH/NCH

        Premium Increase Moderation**


MGH/NCH       2002-2003 2003-2004 Aggregate
NBHP*           11.7%          12.1%            24%
PacifiCare*     28.9%           22%             51%

 Note: $2.15 M added to WC reserves

                        * Includes Medical and Pharmacy
                        ** Additional BH benefits added
       What Have Been Our Results?
       Member Satisfaction Survey*

   Overall Satisfaction:
    – 89% rated their experience good to excellent
    – 92% indicated they would recommend to a family
      member or friend
    – 96% would re-enroll

   Lifestyle Management Program
    – 93% rated their experience as good to excellent
    – 93% reported that they had reached their goals as a
      result of the LM program
    – 96% rated advice about remaining healthy/avoiding
      illness as good-excellent
    What Do the Economic Return Studies
                  Show?

      Meta-Evaluation of Worksite Health Promotion
                      2005 Update
               By Larry S. Chapman, MPH


“The summary evidence is very strong for average
  reductions in sick leave, health plan costs and
   workers’ compensation and disability costs of
             slightly more than 25%.”

        Source: The Art of Health Promotion, July/August 2005
    Health System Employer Strategy


   Internal initiative builds platform,
    establishes credibility and competence
   Hospitals must become trusted partner
    for health and disease prevention
   If health plans fill this niche (demand):
     – The Role of the Hospital is further
       diminished
     – Opportunities for Commercial Growth
       decrease significantly
 Sutter Health 2005-07 Strategic Plan:
Build New Relationships with Employers

 Sutter Health Partners will:
 Develop employer relationships

 Provide data

    – health risk
    – competitive
   Increase commercial business
   Increase consumer brand loyalty
   Creates foundation for partnerships
SHP’s “Living In Balance” Program
   Targets External Employers

        Flexible Product Offerings

   Comprehensive* LM Program
     – Target: Employers in Northern CA through
       local SH affiliates

   Consultative/Train the Trainer Program
     – Target: Healthcare systems outside the SH
       Northern CA marketplace


*Other Models Available
     Marketplace Price Points

               Charges        Charges
             Per Employee   Per Employee
              Per Month       Per Year
Low-range     $   5          $   60

Mid-range     $   15         $   180

High-range    $   25         $   300

Super High    $ 280          $ 3,360
           In Summary: Why do this?


   Provides effective tools to control cost escalation over
    time
   “Win-win” proposition for organization and employees
   Improves recruitment, retention
   Reduces workers comp costs, absenteeism,
    presenteeism
   Improves productivity
   Flexible platform for future expansion
   Aligns incentives with the employer community
Your questions please…



    Q&A

				
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