Evidence-Based Population Health Management through Analytics

Transcription

1 Evidence-Based Population Health Management through Analytics Presented to: Human Factor Analytics, Inc. Slide 1

2 What can a geological principle teach us about risk management? Human Factor Analytics, Inc. Slide 2

3 What can a geological principle teach us about risk management? Human Factor Analytics, Inc. Slide 3

4 Data Driven Decision Making Health Utilization Data Biometric Data Pharmacy Data Human Risk Health Risk Appraisal Data Workers Comp Data Human Factor Analytics, Inc. Slide 4

5 Raw Data From Insurer & Employer Health Care Utilization Data Pharmacy Data Health Risk Appraisal Data Biometric Data Occupational Risk / Workers Comp Control Panel - Query Data to Identify Cost Drivers Statistical Engine ( HF ) Output Risk-Specific Money-Saving Solutions Human Factor Analytics, Inc. Slide 5

6 Relational Database with Infinite Query Capability and Solution Mining Example Query Variables Age, Gender, Ethnicity, Amount Paid, Date of Service, Provider Type, Location, Biometric Data, Drug, Procedure Code, Type Of Service, Dependent, Spouse, Employee, Diabetes, Heart Disease, Asthma, Hypertension, Dyslipidemia, Depression, Diagnosis Code Example Query Variables How many individuals have Type 2 Diabetes? How many females have Heart Disease? What are the Top 1 most costly uses of the ER? In-patient? How many individuals over 5 have a diagnosis of Hypertension? Ability to add unlimited queries for the purpose of identifying cost drivers and deriving risk mitigation solutions Human Factor Analytics, Inc. Slide 6

7 Sample Data Analysis Human Factor Analytics, Inc. Slide 7

8 Total Amount Paid Employee/Spouse/Dependent Combined N = 675 N = 678 Total Amount Paid Mean Amount Paid $3,, $2,786,84 $4,5 $4,128 $4, $2,5, $3,5 $2,117,669 $3,123 $2,, $3, $2,5 $1,5, $2, $1,, $1,5 $1, $5, $5 $ $ Human Factor Analytics, Inc. Slide 8

9 Diagnosis Category Employee/Spouse/Dependent $19,8 Amount Paid 211 E Codes $ V Codes Injury and Poisoning Symptoms, Signs and Ill-Defined Conditions Conditions in the Perinatal Period Congenital Anomalies Musculoskeletal and Connective Tissue Skin and Subcutaneous Tissue Complication of Pregnancy, Childbirth, and the Genitourinary System Digestive System Respiratory System Circulatory System Nervous System and Sense Organs Mental Disorders Blood and Blood-Forming Organs Endocrine, nutritional, Metabolic Immunity Neoplasms Infectious and Parasitic Diseases $79 $97 $29,179 $3,561 $32,67 $22,31 $11,798 $13,755 $124,24 $11,183 $217,136 $257,487 $231,317 $294,448 $33,227 $368,344 $416,638 $ 212 $219 $13,36 $26,573 $3,874 $5,887 $58,11 $86,823 $91,556 $7,8 $11,195 $91,992 $157,631 $135,71 $142,892 $2,529 $23,384 $369,741 $326,15 Human Factor Analytics, Inc. Slide 9

10 Severe Chronic Liver Disease $ 211 Renal Failure Peripheral Vascular Disease $76 $1,674 Total Amount Paid Employee/Spouse/Dependent Chronic by Category $ $ (3) $93,82 Obesity $753 $729 Hypertension (4) $28,47 (5) $22,839 Heart Disease (2) $27,251 (1) $233,354 Diabetes w/end Organ Damage $ $ Diabetes (3) $38,913 (4) $29,88 Dementia $ $ Congestive Heart Failure $ $ Chronic Pulmonary Disease $14,58 (5) $4,395 Cancer (1) $415,58 (2) $129,414 Asthma $7,293 $13,287 Top 5 categories ranked (rank) Human Factor Analytics, Inc. Slide 1

11 Severe Chronic Liver Disease 1 Number of Individuals Employee/Spouse/Dependents Chronic by Category Renal Failure 5 4 Peripheral Vascular Disease 3 Obesity 5 4 Hypertension (1) 115 (1) 122 Heart Disease (4) 6 (4) 58 Diabetes w/end Organ Damage Diabetes (2) 62 (3) 63 Dementia Congestive Heart Failure Chronic Pulmonary Disease 12 7 Cancer (3) 78 (2) 7 Asthma (5) 18 (5) 16 Top 5 categories ranked (rank) Human Factor Analytics, Inc. Slide 11

12 $83 $ $ $ $4 $ $1,674 $2,153 $2,258 3 $2, $3, $8,277 Total Amount Paid by Complication $9, Complications of Diabetes Employee/Spouse/Dependent DCSI Score Number of Individuals by Complication 12 $8, Cardiovascular 1 $7, Cerebrovascular $6, 8 $5, Nephropathy 6 $4, Neuropathy $3, 4 $2, Peripheral vascular disease 2 $1, Retinopathy $ Human Factor Analytics, Inc. Slide 12

13 $7,246 $174 $1,66 $2,856 $325,248 $372, Complications of Diabetes Employee/Spouse/Dependent Total Score 28 DCSI Score $4, $35, Total Amount Paid by Score $3, 2 $25, 15 $2, $15, 1 $1, 5 $5, $ Human Factor Analytics, Inc. Slide 13

14 Diabetes Complications Severity Index (=no complications, 1=some abnormality, 2=severe abnormality) Cardiovascular DCSI Atherosclerosis 1 Angina Pectoris 1 Atrial fibrillation 2 Metabolic Ketoacidosis 2 Hyperosmolar 2 Other Coma 2 Cerebrovascular TIA 1 Stroke 2 Retinopathy DCSI Retinal edema 1 Retinal detachment 2 Blindness 2 Nephropathy Chronic renal failure 2 Nephrotic syndrome 1 Renal failure NOS 2 Neuropathy Cranial nerve palsy 1 Mononeuropathy 1 Charcot s arthropathy 1 Human Factor Analytics, Inc. Slide 14

15 Distribution of Co-morbid Patterns Employee/Spouse/Dependent Type I Diabetes Number of People in Each Category to 1 2 to 3 4 or more Heart Disease to 1 2 to 3 4 or more 35 Type II Diabetes 26 to 1 2 to 3 4 or more Human Factor Analytics, Inc. Slide 15

16 Preventative Screening Compliance Breast Cancer Screening Rate National Norm is 8% in the 95 th Percentile and 69% in the 25 th Percentile Total Eligible Actual Screening Screening Rate Cervical Cancer Screening Rate National Norm is 82% in the 95 th Percentile and 73% in the 25 th Percentile Total Eligible Actual Screening Screening Rate 1,4 1,2 1, ,156 1, % 43.7% % 46.% 45.5% 45.% 44.5% 44.% 43.5% 43.% 42.5% Colorectal Cancer Screening Rat National Norm is 68% in the 95 th Percentile and 5% in the 25 th Percentile 2,5 2, 1,5 1, % 2,124 2, % % 44.% 43.% 42.% 41.% 4.% 39.% 38.% 37.% 36.% 35.% Total Eligible Actual Screening Screening Rate 1,4 1,2 1, % 1,99 1, % % 14.% 12.% 1.% 8.% 6.% 4.% 2.%.% Human Factor Analytics, Inc. Slide 16

17 N = 66 N = 6 $1,2, $1,, Total Amount Paid $95,416 Pharmaceutical Employee/Spouse/Dependent Total Paid $1,7,712 $2, $1,8 $1,6 Mean Amount Paid $1,568 $1,785 $8, $1,4 $1,2 $6, $1, $8 $4, $6 $2, $4 $2 $ $ Human Factor Analytics, Inc. Slide 17

18 N = 48 N = 54 N = 73 N = 482 N = 54 N = 64 Pharmaceutical Employee/Spouse/Dependent $1,, $9, $8, $7, Total Amount Paid Employee Spouse Dependent $92,682 $822,316 $2,5 $2, Mean Amount Paid Employee Spouse Dependent $1,91 $1,839 $1,713 $1,682 $6, $1,5 $5, $4, $1, $793 $3, $2, $5 $511 $1, $9,814 $99,281 $37,286 $5,749 $ $ Human Factor Analytics, Inc. Slide 18

19 Diabetes Employee/Spouse/Dependent Pharmaceutical Use No ACE Inhibitor No ARB No DRI No Statin No Diabetes/Taking Byetta or Victoza Human Factor Analytics, Inc. Slide 19

20 Other Employee/Spouse/Dependent Pharmaceutical Use Opioids w/cancer Singular/No Asthma Diag 3 2 Antipsychotic/No Metabolic Diabetes/No Foot Exam 1 Diabetes/No Eye Exam Diabetes/No HbA1c Taking Oral Steriods/No Bone Density Test Allergic Rhinitis/Singular Human Factor Analytics, Inc. Slide 2

21 N = 1,563 N = 1,611 Medication Possession Ratio Average 1% 9% 84.5% 84.2% 8% 7% 6% 5% 4% 3% 2% 1% % Medication Possession Ratio Calculation Beginning Date of Prescription End Date of Prescription Days of Prescription - Sum of Days Supply for Prescription Days of Prescription Medication Possession Ratio Medication Possession Ratio measures the average compliance to prescriptions for those individuals who received a prescription and refilled it at least once. Human Factor Analytics, Inc. Slide 21

22 N = 89 N = 116 1% 9% Medication Possession Ratio Hypertension Drugs Average 89.9% 1.% 8% 7% 6% 5% 4% 3% 2% 1% % Medication Possession Ratio Calculation Beginning Date of Prescription End Date of Prescription Days of Prescription - Sum of Days Supply for Prescription Days of Prescription Medication Possession Ratio Medication Possession Ratio measures the average compliance to prescriptions for those individuals who received a prescription and refilled it at least once. Human Factor Analytics, Inc. Slide 22

23 $18,74,48 $18,877,28 Lost Time and Cost due to Health Disparities Total Lost Days and Amount Lost due to Health Disparities Amount Lost Total Lost Days $2,, $18,, 234, ,966 25, $16,, 2, $14,, $12,, 15, $1,, $8,, 1, $6,, $4,, 5, $2,, $ 211 N = 2, N = 2,79 Human Factor Analytics, Inc. Slide 23

24 Human Factor Analytics, Inc. Slide 24

25 $556,353 $1,548,956 $1,498,316 $75,587 $2,878,444 $1,73,348 $6,73,138 $7,933,924 $13,5,559 $13,342,36 Disease Group Stratification Total Amount Paid - Disease Group Risk Stratification - Total Population Group Description 1 No Chronic disease and less than $1,5 Utilization expenditures per 12 months $16,, $14,, No Chronic disease and $1,5 or more Utilization expenditures per 12 months 3 Chronic disease with no comorbidities $12,, $1,, $8,, 4 Chronic disease with comorbidities $6,, 5 Chronic disease with comorbidities and complications $4,, $2,, $ 211 Group 1 N = 1,523 Group 2 N = 33 Group 3 N = 2,141 Group 4 N = 434 Group 5 N = Group 1 N = 1,431 Group 2 N = 335 Group 3 N = 2,177 Group 4 N = 439 Group 5 N = 26 Human Factor Analytics, Inc. Slide 25

26 Spending, Disease frequency & Chronic disease increases from Groups 1-5 Human Factor Analytics, Inc. Slide 26

27 Human Factor Analytics, Inc. Slide 27

28 High Turnover rate employer: How healthy are our new hires? Physical Ability must equate with the essential functions of the job Human Factor Analytics, Inc. Slide 28

29 Human Factor Analytics, Inc. Slide 29

30 Musculoskeletal System & Connective Tissue Claims constituted 6% of the frequency of claims for new hires in 212 (ICD-9 Codes ) Diagnosis Code Description Amount Paid Swelling of limb $ Pain in limb $ Specific bursitides often of occupational origin $ JOINT PAIN-ANKLE $ Lumbosacral spondylosis without myelopathy $ Myelopathy $ Lumbar region $4, Postlaminectomy syndrome $21, Lumbar region $3, Lumbago $6, Thoracic or lumbosacral neuritis or radiculitis, unspecified $3, Backache, unspecified $ MUSCLE WEAKNESS (Begin 23) $4, Derangement of posterior horn of medial meniscus $11, Other and unspecified derangement of medial meniscus $1, Pain in joint; Arthralgia $ Brachia neuritis or radiculitis NOS $1, Achilles bursitis or tendinitis $2, Rotator cuff syndrome of shoulder and allied disorders $2, Other specified disorders $21, Other affections of shoulder region, not elsewhere classified $ Other $3, Lumbar or lumbosacral intervertebral disc $ Lumbago $ Backache, unspecified $ Pain in joint; Arthralgia $ Human Factor Analytics, Inc. Slide 3

31 Pre-employment Physical ability test was re-designed Human Factor Analytics, Inc. Slide 31

32 How can analytics be used to enhance worksite clinical outreach? Human Factor Analytics, Inc. Slide 32

33 Analytic-Driven Clinical Outreach ID Class Code Gender Asthma Diabetes Heart Disease Hypertension Ace Inhibiter ARB Statin Drugs Metabolic Panel Foot Exam Eye Exam HbA1c Hypertension Meds Disease Group Amount Paid M FALSE TRUE FALSE FALSE FALSE FALSE TRUE TRUE FALSE TRUE TRUE TRUE 4 $11, M FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE TRUE FALSE FALSE 3 $ M FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 2 $1, M FALSE FALSE TRUE FALSE FALSE FALSE TRUE TRUE FALSE TRUE FALSE FALSE 4 $1, M FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 1 $ M FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 1 $ M FALSE TRUE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE FALSE 4 $ F FALSE FALSE TRUE TRUE FALSE FALSE FALSE TRUE FALSE TRUE FALSE TRUE 5 $11, M FALSE FALSE FALSE TRUE TRUE TRUE TRUE TRUE FALSE TRUE FALSE TRUE 4 $2, M FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE FALSE 3 $ F FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 1 $ F FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE TRUE FALSE FALSE 2 $8, M FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE 1 $ M FALSE FALSE FALSE TRUE TRUE FALSE FALSE TRUE FALSE TRUE FALSE TRUE 3 $79.75 Human Factor Analytics, Inc. Slide 33

34 Ability to monitor the effectiveness of Evidence-based Medicine Human Factor Analytics, Inc. Slide 34

35 Risk & Cost Reduction associated with ACE Inhibitor use for persons with a diagnosis of Diabetes Human Factor Analytics, Inc. Slide 35

36 Is our wellness program reducing risk or reducing costs? Human Factor Analytics, Inc. Slide 36

37 Employer-Sponsored Results-Based Wellness Program XYZ company wellness program consisted of participants completing a health risk appraisal and various biometrics In 211, XYZ company decided to create 3 distinct programs based on the level of criteria completed Premium differentials were applied on an individual and per family basis Non-Participants (Bronze) For employees and spouses who chose not to participate. Maximum premium differentials were levied to this group. Intermediary Participants (Silver) Required covered employees and spouses to complete an online health risk appraisal and a specific set of biometrics. Meeting this requirement gave participants a reduction in their premium contributions. Total Compliance (Gold) Required covered employees and spouses to complete an online health risk appraisal, biometrics, and meet at least 4 of 5 health indicators. Human Factor Analytics, Inc. Slide 37

38 Gold level participants spent more money??? Mean amount paid for participants passing 4 out of 5 goals were higher than nonparticipants and low performing participants Human Factor Analytics, Inc. Slide 38

39 Key Findings (cont.) 3. Biometric variables used within the gold group criteria only explained 1% of an individual s overall spending (i.e., Glucose, Triglycerides, HDL Cholesterol, Waistline, Blood Pressure, Tobacco Use). (See Attachment 1) Amount of future spending variance explained by risk factor criteria Human Factor Analytics, Inc. Slide 39

40 Increased explanation of future spending when contributing variables are included in analysis Human Factor Analytics, Inc. Slide 4

41 Results-Based Wellness Program risk stratification Plausible explanation of higher spending was due to the high level of risk contained within the gold group Human Factor Analytics, Inc. Slide 41

42 Combination diagnosis relates to increased risk and spending Human Factor Analytics, Inc. Slide 42