Transcript Slide 1
Are you ready for the future of wellness?
Gaston Regional Chamber Healthcare Summit
Leading edge wellness strategies for your organization
1 00.25.910.1 (4/08)
Wellness matters
70 – 90 percent
of health care costs are due to unhealthy choices and preventable risks 1 In 2008, employers are projected to spend
46% more
than in 2003, an average of $9,312 per employee 2 for health care costs Chronic diseases cost businesses
more than $1 trillion
in lost productivity 3 U.S. companies lose nearly
$63 billion
in lost work and productivity each year due to employee injuries and illnesses 4 1 2 3 4 Health Care Statistics, Prevent Disease.com, 2006 2008 Towers Perrin Health Care Cost Survey “An Unhealthy America: The Economic Burden of Chronic Disease,” The Milken Institute, October 2007 Journal of Occupational and Environmental Medicine, July 2007
Wellness works
Wellness programs may save organizations
$900/person/year
in direct medical costs 1 Most employers can expect a
$3 to $1 return on investment
and health promotion 2 for preventive services Employers can
save $1.65
in health care expenses
for every dollar
comprehensive health care program 3 spent on a Wellness programs
save money
through: Lower health care costs Greater productivity Reduced absenteeism 4 1 2 3 4 Wellness Councils of America (WELCOA) Absolute Advantage: ROI Bullseye; Building a First ClassWorkforce by David R. Anderson, 2003 Healthcare Cost Trends for 2008, PricewaterhouseCoopers, 2008 Journal of Occupational and Environmental Medicine, February 2008 Purdue University, February 2007
The plan sponsor’s journey to wellness…
embracing change and developing a supportive culture
Gather information to understand needs and develop strategies Solutions that drive meaningful change and make your vision a reality Celebrate your successes and refine your strategies for the future
The plan sponsor’s journey to wellness…
Five steps to creating an effective wellness strategy
Gather and analyze information Define goals and objectives Design wellness strategy Assess your workplace culture, environment, business and benefit strategies Review claim information to understand utilization and health risks Understand your employees, preferences, health status and behaviors Identify the behaviors you want to change Determine how wellness programs will contribute to your benefit strategy Define how you will measure and determine success Review current plan designs; align with defined goals and objectives Choose wellness programs and incentives that will meet your needs Identify other workplace changes, cafeteria food, smoke-free environment Develop implementation plan Ensure leadership commitment and support Create a detailed implementation plan and timeline Develop a comprehensive communications plan Evaluate outcomes and refine strategy Measure outcomes against goals and objectives Gather feedback about how well your strategy is working Celebrate successes and refine your strategy
Supporting members with wellness solutions that span the continuum of care
Health/low risk
Stay well (mind and body)
At risk for disease/injury Managing a chronic disease Major health events
Identify and manage health risks to prevent disease and disability Reduce absenteeism and on-the-job productivity loss Manage/mitigate disease impact Identify and manage those most at risk for disability Provide structured programs to support return to health and productivity Manage medical care Manage disability
Access to Quality Care
Aetna Health Connections SM
The suite of programs & services that enables wellness solutions
Staying Healthy Changing Lifestyles Managing Conditions Major Health Events Integrated Solutions Disease Management Lifestyle Coaching * Advocacy Programs * Worksite Clinic Services * Personal Health Record MedQuery Health Fairs and On-site Screenings * Informed Health Line Simple Steps To A Healthier Life ® Health Assessment Discount Programs, Natural Products and Services Well Visits & Screenings Communications Campaigns and Toolkits Tools and Informational Resources Case Management Aetna Healthy Actions SM Incentives Capabilities
* Availability may vary by location, product, group size
A plan sponsor’s multi-year wellness strategy
(Illustrative only)
More health assessments Lower absenteeism Incentives Simple Steps To A Healthier Life
®
Disease Management YEAR 1 Increase in physical activity Reduction in medical costs Fitness and weight management programs Incentives Simple Steps To A Healthier Life
®
Disease Management YEAR 2 Increase in productivity Reduction in medical costs Lifestyle coaching or wellness counseling Incentives Simple Steps To A Healthier Life
®
Disease Management YEAR 3
The Aetna Experience
Overall trends in Aetna employee population
Medical Trend Engagement (chronically ill) Results of Simple Steps Healthy Lifestyles Program Participation Illness Burden (chronically ill) 2007 trend is 3.3% compared to 5.9% as of 11/06 and 15.9% as of 11/05 A Engaged and Engageable population increased from 64.3% in 2005 to 72.7% in 2006 Participation in Healthy Living Programs climbed 111% from 2005 to 2007 Participation increased from 10,939 in 2006 to 17.085 employees in 2007, a 56% increase Retrospective Risk Score shows chronically ill population became less sick over last 2-1/2 years Please note: Trend is the result of plan design, medical management and wellness interventions. Today we are talking about wellness interventions, but all interventions should be used to get the trend in line. Illness burden measures the breadth and intensity of diseases in a population. A Dec 2007 12 month rolling trend
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We’re creating a future where…
Your employees and their families are fully
engaged
health and take responsibility for health care decisions in their The benefits experience they receive is
personalized
to meet their needs, based on experienced clinical knowledge and analysis All benefits seamlessly
work together
line and the well-being of your employees to enhance your bottom 10
We’re creating a future where…
Your employees and their families are fully
engaged
health and take responsibility for health care decisions in their The benefits experience they receive is
personalized
to meet their needs, based on experienced clinical knowledge and analysis All benefits seamlessly
work together
line and the well-being of your employees to enhance your bottom
Seamless Linking HRA to PHR to Wellness Programs
11
The journey to optimal health starts with the health assessment…
Know your:
Numbers Health status Modifiable risks Wellness resources Simple Steps to a Healthier Life
Staying Healthy Lifestyle Changes Managing Conditions Major Health Events
Preventive Screenings Well Visits Improve Nutrition Increase Physical Activity Medical Adherence Care Plan Care Management Managed Disability
… and continues with the right programs and services
Aetna Personal Health Record goes well beyond a static claim history
Our industry-leading PHR is really like a personal health assistant
All patient information in one place A dynamic system for interactivity based on our patented CareEngine ® technology Integrated patient and health care information to support higher quality, cost effective care A unique decision aid for health care providers, providing up-to-the-minute information on the patient
We’re creating a future where…
Your employees and their families are fully
engaged
health and take responsibility for health care decisions in their The benefits experience they receive is
personalized
to meet their needs, based on experienced clinical knowledge and analysis
Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes
All benefits seamlessly
work together
to enhance your bottom line and the well-being of your employees
Seamless Linking HRA to PHR to Wellness Programs
14
Evidence Based Care
Effective application of evidence-based care is key to improving outcomes
Improving care for members at all
stages of health
Evidence-based care relies on research evidence to enhance patient care
Evidence-based strategies are built into our:
Strategies for collaborating with members and physicians to improve health Clinical coverage decisions Strategies to identify care improvement opportunities Overall medical care management approach
Aetna Pharmacy Management
Medication adherence
22% of U.S. patients take less of the medication than is prescribed
American Heart Association: Statistics you need to know. http://www.americanheart.org/presenter.jhtml?identifier=107 Accessed November 21, 2007.
Aetna Pharmacy Management
Why adherence matters
“Of all medication-related hospital admissions in the United States, 33 to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion a year.”
Results of failure to adhere to prescribed medications: Increased hospitalization Poor health outcomes Increased costs Decreased quality of life Patient death Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:455-461
The Logical Next Step
Several sources of data: 1.
Surveys of self-reported underuse and pill-splitting 2.
3.
Comparisons of people with less and more generous drug insurance Longitudinal studies of the introduction of payment caps Reducing or eliminating cost sharing (at least for some conditions or for some levels of risk) may increase adherence to efficacious medications In fact, the cost of paying for increased drug costs may be (more than) offset by the cost-savings from averted clinical events
Aetna Pharmacy Management
Overcoming barriers to adherence
Health plan pays member copay Reduces member out-of pocket costs Emphasizes the importance of continuing therapy Education and outreach Explains the need for medication therapy Breaks down complex therapies into manageable parts Offers strategies for coping with side effects Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:455-461
Aetna Pharmacy Management
Investment in medication adherence can lead to dramatic reductions in overall cost of care
$10,000 $55 $8,000 $165 $285 $404
Rx $ Medical $
$6,000 $763 $8,812 $4,000 $6,959 $6,237 $5,887 $2,000 $3,808 $0 1-19% 20-39% 40-59% 60-79% 80-100%
Diabetes Medication Level of Adherence (% days supply/year)
Outcome is significantly higher than outcome for 80 100% adherence group (
P
<0.05). Differences were tested for medical cost and hospitalization risk.
Sokol M et al. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Medical Care. Volume 43, Number 6, June 2005
Sensitivity Analysis: Time Horizon
Health Affairs 2007; 26: 186
Benefit Design Research Study
Aetna / Harvard Proposal • Aetna to participate with Harvard in a study to formally test the hypothesis that by removing financial barriers (co-pay, co insurance and deductibles) for certain conditions we would:
– Increase medication adherence – Improve clinical quality – Decrease medical costs
We’re creating a future where…
Your employees and their families are fully
engaged
health and take responsibility for health care decisions in their
Work Site Clinics: Brings wellness to the worksite
The benefits experience they receive is
personalized
to meet their needs, based on experienced clinical knowledge and analysis
Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes
All benefits seamlessly
work together
line and the well-being of your employees to enhance your bottom
Seamless Linking HRA to PHR to Wellness Programs
23
What is engagement?
Engagement
is an individual’s
ownership
of and
active participation
in his or her journey to optimal health and wellness
JOIN US
Engagement matters
• • • •
Up to 50%
of health care costs are due to unhealthy choices and preventable risks 1 In 2008, employers are projected to spend
46% more
for health care costs than in 2003, an average of $9,312 per employee 2 Chronic diseases cost businesses
more than $1 trillion
in lost productivity 3 U.S. companies lose nearly
$63 billion
in lost work and productivity each year due to employee injuries and illnesses 4 1 NAHU’s Healthy Access Briefing Report: Constraining Medical Costs, 2006, https://www.nahu.org/legislative/healthyaccess/Report-ConstrainingMedicalCosts.pdf
2 2008 Towers Perrin Health Care Cost Survey 3 “An Unhealthy America: The Economic Burden of Chronic Disease,” The Milken Institute, October 2007 4 Journal of Occupational and Environmental Medicine, July 2007
Your organization may already be paying
Lost productivity and a lack of focus on wellness can cost your organization We know…
Increased productivity
has been noted as a key reason plan sponsors adopt an onsite health center* Onsite programs using face-to-face coaching and motivational interviewing techniques result in
higher engagement levels
than telephonic only delivery of programs Worksite health services create and support an effective wellness strategy by helping to
create and maintain a culture of wellness
* Watson Wyatt “
Realizing the Potential of Onsite Health Centers” 2008
Study © 2007 Aetna Inc.
Our worksite health solution:
Aetna Health Connections Direct2you
• Expands and extends our Aetna Health Connections overall health and wellness solutions portfolio • Initial offering includes onsite delivery of: –
Selected Aetna Health Connections programs already delivered telephonically
–
Biometric screenings Our future vision of Direct2you solutions:
Part-time clinical staff Community-based centers Remote outreach and engagement .
Direct2you
Aetna Health Connections
Available beginning 1/1/2009
The program includes face-to-face delivery of any combination of these programs: Disease Management Wellness Counseling Behavioral Health (BH) Assessment and Counseling Employee Assistance Program (EAP) Assessment and Counseling Biometric Screenings available through Summit Health or Quest Diagnostics
We’re creating a future where…
Your employees and their families are fully
engaged
health and take responsibility for health care decisions in their
Work Site Clinics: Brings wellness to the worksite
The benefits experience they receive is
personalized
to meet their needs, based on experienced clinical knowledge and analysis
Value Based Benefits - Rx/DM incentive: Copay relief for medication adherence for specific drug classes
All benefits seamlessly
work together
line and the well-being of your employees to enhance your bottom
Seamless Linking HRA to PHR to Wellness Programs
29