Transcript P5117 - Kansas City Collaborative Template

A Data Driven, Employer Focused
Value Based Health Strategy
Initiative
November 16, 2010
National Business Coalition on Health
Presentation Sponsored by Pfizer
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Empowering the Employer
William L. Bruning
 President & CEO,
 Mid-America Coalition on Health Care
Douglas Tapp
 Vice President, Total Rewards
 H&R Block
 Chairman - Board of Directors, Mid-America
Coalition on Health Care
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Presentation Focus
 Background on the Kansas City Collaborative (KC2)
initiative and its key partners
 Introduce the American Health Strategy Project
 Identify some of the VBB interventions that several
employers are currently implementing
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Mid-America Coalition on Health Care
Over 30 years of collaboration toward incremental,
sustainable, and replicable change in health care
Mission:
 Improve the health of employees and their families
 Promote employee and community wellness
 Develop strategies for containing health care costs
 Serve as a community resource in generating and
communicating health care information
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Mid-America Coalition on Health Care
Founded: 1978 Established as a 501(c)(3)
 Fourth oldest employer Coalition in the nation
Who We Are:
 Bi-State
 60 members – 500,000 lives
 Board of employers and all regional stakeholders
 Budget $500,000 – split between dues and donations
 4 employees
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Value-Based Benefit Design:
Restructuring Health Benefits
 VBBD is a strategy that minimizes or eliminates out-of-pocket
costs for high-value services in defined patient populations
 High-value services are identified through scientific evidence
 The more clinically beneficial and cost-effective the therapy is
for a patient group, the lower the out-of-pocket costs
 Lowering out-of-pocket costs for high-value services has
been found to improve access to and use of those services
 More effective use of high-value services may positively
impact the health of the targeted population
 Preventable adverse health consequences reduced
 Related high-cost health care services avoided
Chernew ME et al. Health Aff (Millwood). 2008;27:103-112; Fendrick AM et al. Am J Manag Care. 2001;7:861867;Fendrick AM, Chernew ME. Am J Manag Care. 2006;12 (special issue):SP5-SP10.
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How KC2 Defines Value Based Benefits
In operationalizing “Value Based Benefits,” Kansas
City employers have broadly defined it to mean:
 Taking a comprehensive approach to investing in health benefit
and wellness program offerings;
 Ensuring that beneficiaries receive high quality, evidencebased, and cost effective care;
 Aligning incentives and removing barriers to getting the best
care;
 Using data to drive both decision-making and evaluation of
health benefit and wellness programming.
Source: KC2 Project Team
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KC2: A Unique Collaboration
 Proven track record
testing and implementing
national models
 Bringing together 17
diverse employers and
all regional health care
stakeholders
 Flexible program content
designed to address
dynamic employer needs
 Project management
 Evidence-based
grounding
 Analytics and
technical strategies
 Funding assistance
 Participation in
national replication
Tom Parry, PhD
Jack Mahoney, MD
Bruce Bagley, MD
Marcia Wright, PharmD
Intellectual Director
Quality Director
Medical Director
Pharmacy Director
 The “Coalition of Coalitions”
 Nearly 60 member coalitions
representing over 10,000 employers
 Support national dissemination of
learnings and replication of KC2 model
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Creating Employer Collaboratives in New
Markets
Oregon Coalition
of Health Care
Purchasers
Midwest Business
Group on Health
Pittsburgh Business
Group on Health
Virginia Business
Coalition on Health
Dallas-Ft Worth
Business Group on
Health
Spreading the Collaborative Model
2008–2011
2010–2011
 Engage and activate
employers
 Test the approach with other
coalitions
 Empower them to leverage
existing data to support
their health strategy
 Refine and expand the tools and
materials
 Facilitate implementation
of VBB initiatives that
promote prevention, lessen
barriers and use evidenced
based guidelines
 Evaluate and publicize
process learnings and
outcomes
 Add to the Learnings
2011 and Beyond
Employer Guide
 Package up materials
and learnings for
a la carte use with
employers and
coalitions
The Kansas City
Collaborative:
The predecessor to
American Health Strategy
Project
16 Employers, 63,000 KC Employees;
460,000 Lives Firm Wide
Median Size Employer = 4009
Firm Wide
Small to Mid-Size
Mid-Size to Large
Jumbo
#EEs
375–3,000
3,000–10,000
10,000+
Trademarks on this page are the property of their respective owners.
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Process of Applying Value-Based Benefits
Start
Here
Measure and
evaluate outcomes
ROI
Establish goals,
design and conduct
worksite interventions
that remove barriers to
healthy choices
Identify and
collect data
Sustainable
Change
Integrate data
Use data to
classify risks
e.g., Chronic disease,
lifestyle, high dollar
claims
© 2007 Mid America Coalition on Health Care
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Baseline Assessment Tools and Reports
Initial
Employer
Surveys
Structured
Employer
Interviews
Community Report
Data
Mapping
&
Tracking
Structured
Employer
Workshops
Individual Report
Source: KC2 Project Team
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Implementing Interventions
Community Report
Individual Report
KC2 Business Health Implementation Strategy
KC2 Population Health Intervention Strategy
Source: KC2 Project Team
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Identifying VBB Interventions
Definition:
Intervention Types
 Health Management Team
 Employer-specific
 Actionable Data
 Measurable
 Environment or Policy
 Evidence-based
 Insurance Benefit Design
 Optimizes outcomes
 Employee Engagement
 Vendor and Provider Value
Source: KC2 Project Team
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KC2 Business Health Implementation Strategy
Reflects Employers Business Related Health Implementation Plans
Focus of
implementations
Types of Measures
Leadership/Culture
Health
Management Team
HMT Structure
Health a Core
Business Strategy
Use of Data
Actionable Data
Baseline
Findings
Business
Health Goals
Access to Data
Coordinated
Messaging
Building a Healthier
Community
Employer
Collaboration
Participation in
Message Campaigns
Participation in
Collaboration
Community
Involvement
Community Capacity
Building
Participation in
Community Events
Evaluation
Source: KC2 Project Team
Expenses/Cost Trend
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KC2 Population Health Intervention Strategy
Reflects Employers Population Health Intervention Plans
Focus of interventions
Types of Measures
Participation Rates
Diet and Nutrition
Self-Reported
Behavior Change
Physical Activity
Biometrics
Quit Rates
Risk Status Change
Med Adherence
Utilization Change
Receipt of
Preventive Care
Overweight/Obesity
High Blood Pressure
Baseline
Findings
Population
Health Goals
High Blood Sugar
High Cholesterol
Smoking
Evaluation
Expenses/Cost Trend
Source:
KC2
Project Team
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Implementation Support Tools
 Glossary of types of Interventions
 Intervention Models
 Guide to Business and Population Health Objectives
 Intervention Grids
 Cardiometabolic Road Map
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Guide to Business and Population Health
Objectives
A workbook to help
work through
Planning and
Implementation
Stepwise process
 Set Goals
 Choose Objectives
 Plan and Implement
Interventions
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Evidence Based Resources
Intervention Grids
 Business Goals
– Health as a Core Strategy
– Building a Healthier Community
 Population Health Goals (Cardiometabolic Risk
Focused)
– Overweight/Obesity
– High Blood Sugar
– High Blood Pressure
– High Blood Cholesterol
– Smoking
Cardiometabolic Roadmap
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KC2® Intervention Grid
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Employer Applications
of Value Based
Benefits
November 16, 2010
Douglas Tapp
Vice President, Total Rewards
Employer Case Studies
Sprint - Nation’s largest independent local telephone provider and a
leader in telecommunications innovation
 Population Health Goal: Smoking
City of Kansas City, Missouri – Self-insured municipal
government with unionized labor force and constantly changing and
Council management structure as opposed to a traditional C-Suite
 Business Health Goal: Strengthen Health Management
Team
JE Dunn – 11th largest general building company in the U.S. with
18 office locations coast-to-coast
 Population Health Goals: Weight, High Blood Pressure,
Smoking
H&R Block - One of world’s largest tax services providers …
H&R Block: The Company
H&R is one of the world's largest tax services
providers
 More than 12,000 locations; retail office, on-line at
home or both!
 Utilizing more than 100,000 highly trained “tax
professionals”
 Prepared more than 550 million tax returns – still going
 Brand “icon” – 99%+ brand recognition
 Today, H&R Block:
EDUCATION
EDUCATION
– Prepares 1 in every 7 U.S. tax returns
– Customized tax advice on more than 400 occupations
– Files 1 in every 5 Earned Income Tax Credits
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H&R Block: The Company
Leading providers of business services
through McGladrey and traditional banking
solutions through H&R Block Bank
H&R Block success factors:
 Superior customer service
 A pledge to stand behind our work
 A commitment to serving clients where they
prefer to be reached — in a retail office, online,
using software or a combination of methods.
EDUCATION
EDUCATION
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H&R Block: Total Rewards Philosophy
Our Total Rewards Philosophy allows us to attract, motivate, develop and
retain high-performing associates with the knowledge, skills, and abilities
that will help H&R Block meet its long-term business objectives, while
providing a rewarding work environment for our associates.
• Compensation that provides rewards
based on individual and company
performance
• Benefits to help associates manage
their health, well being and financial
planning for retirement
• Development that help associates grow
their professional careers while
balancing work and personal
responsibilities.
Employee Assistance
Strength in Numbers
Tuition Assistance
Performance Excellence
Health
Life
Retirement
Paid Time Off
Perks Plus/Well Power
Benefits
Development
Compensation
Salary
Short Term Incentives
Long Term Incentives
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H&R Block: “Vision of Health”
Open Your
Eyes!!
Prevention
Treatment
Management
“Create a Culture of Wellness where
associates take responsibility for their health.”
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H&R Block: “Vision of Health”
Prevention
Open Your
Eyes!!
Treatment
Management
RESPONSIBILITY
ENGAGEMENT
RESULTS
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H&R Block: “Vision of Health…MYTHS”
“I’m too busy”
“I’m young”
“That’s nice
for the staff
but…”
“PUSH”
Prevention
“I have a
strong family
history”
“It’s not
convenient…
I’m in the
field”
“Isn’t that
too private”
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H&R Block: Health Intervention Strategy
Reflects Employers Population Health Intervention Plans
PHASE 1
Wellness
Focus of interventions
Participation Rates
Neoplasm
Weight/Obesity
Baseline
Population
Findings
Health Goals
Types of Measures
Stress
Self-Reported
Behavior Change
Diet and Nutrition
Physical Activity
Biometrics
Quit Rates
Risk Status Change
Med Adherence
Utilization Change
Receipt of
Preventive Care
High Cholesterol
High Blood Sugar
Evaluation
Expenses/Cost Trend
Source: KC2 Project Team
31
H&R Block: Value-Based Benefits Design
Process
Start
Here
Measure and
evaluate outcomes
ROI
Establish goals,
design and conduct
worksite interventions
that remove barriers to
healthy choices
Identify and
collect data
Sustainable
Change
Integrate data
Use data to
classify risks
e.g., Chronic disease,
lifestyle, high dollar
claims
© 2007 Mid America Coalition on Health Care
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Why Wellness?
 Why did we decide to focus on Wellness?
 It starts at the beginning; the root cause of illness and the need
for treatment may stem from not having healthy habits or the
education, i.e. what you eat, lack of exercise, family history.
 Many times, you don’t know you aren’t healthy or you choose to
ignore the signs.
 At Block, we believe a partnership is the key. With education,
our associates were ready.
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Why Wellness?
 Neoplasms were the number one driver of cost?
 Prevention is key; warning signs abound
 Early detection is important
– whose responsibility?
 But…associates need to know the signs
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Why Wellness?
 “Early signs”
 In all indications, we were catching it late
 Increased inpatient admissions and average length of stay
 People entering the hospital were sicker
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Why Wellness?
 Our population was aging and a disproportionate
amount of claims were attributable to ages 45+
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Why Wellness?
 We also started to think about other contributing factors
 We knew our business was going through big changes
 Change in leadership, reductions in force, tough economic
environment
 STRESS, weight, eating became real concerns as evidenced
through claims, screenings and discussions with employees
80%
69%
70%
60%
58%
61%
67%
60%
56%
51%
49%
47%
50%
58%
57%
56%
54%
50% 51%
40%
30%
20%
10%
0%
Stress
Exams
Weight
HRB
RSM
Eating
BoB
Cholesterol
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H&R Block - So what did we do?
 Environment, policy, business core values
 Implement a robust Wellness program
 “Building a Healthy You”
 Insurance Benefit Design





Free health risk assessment
Free biometric screening – “Know Your Numbers” campaign
Free preventative physicals
Free maintenance meds (pilot)
Incentives – “carrots and sticks” approach
 Employee Engagement and Responsibility
 Messaging regarding a healthy lifestyle (flu shots, stress)
 CARROTS – Point$ bank, premium credits, HSA company match
 STICK – Tobacco premium, limit plan choices, timing
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H&R Block … and RESULTS?
90%
HRA participation
70%
13%
15%
16%
9%
64%
53%
54%
80%
63%
60%
50%
100%
80%
77%
80%
“high” health risks
57%
55%
60%
50%
47%
40%
35%
30%
40%
20%
20%
63%
21%
31%
24%
37%
Baseline
Current
0%
10%
0%
Year 1
Year 2
HRB
Year 3
Year 4 (thus
far)
High: 6+ Risks
Current
Moderate: 3-5 Risks
Low: 0-2 Risks
RSM
Screening participation
18%
Past
50%
Current
Trend
5.2%
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H&R Block: What’s Next?
Focus of interventions
PHASE 2
Neoplasm
Weight/Obesity
Baseline
Population
Findings
Health Goals
Stress
Types of Measures
Participation Rates
Self-Reported
Behavior Change
Diet and Nutrition
Physical Activity
Biometrics
Quit Rates
Risk Status Change
Med Adherence
Utilization Change
Receipt of
Preventive Care
High Cholesterol
High Blood Sugar
Evaluation
Expenses/Cost Trend
Source: KC2 Project Team
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H&R Block – The Healthcare Program

Focus on Consumerism and Wellness



Consumerism = actively engaged in decision making
Exceptional use of on-line tools and plan cost estimator
Over 70% generic utilization in RX plan

Continue to offer medical plan choice but… highly incentivize our high
deductible health plans

Enrollment trend toward full HDHP/HSA plans; 18-64% over 3 years

Reward wellness activities with incentives – non-tobacco use discount,
premium credit and cash incentives for participation in wellness (health
assessment participation to qualify)



Total Wellness screenings are above normative ranges; little difference in wellness
activity rates between plan
For 2011, moving to outcomes-based incentive design with health assessment and
biometric screenings required to earn incentives and receive company HSA
contribution
Focus on network utilization

Approximately 95% in all plan types
Discussion
www.machc.org
Bill Bruning
[email protected]
Doug Tapp
© 2010 Kansas City Collaborative
All Rights Reserved.
PG286306