Joint Labor-Management Benefits Committee (JLMBC) COMMITTEE REPORT JLMBC MEMBERS Employee Organizations David Sanders, Chairperson

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1 Joint Labor-Management Benefits Committee (JLMBC) COMMITTEE REPORT JLMBC MEMBERS Employee Organizations David Sanders, Chairperson Date: April 4, 2019 To: From: Subject: JLMBC Staff LAwell Program Benefit Service Provider Goals, Metrics, and Data Reporting Paul Bechely Chris Hannan Steve Koffroth William Violante Management Wendy G. Macy, Vice-Chairperson Neil Guglielmo Rich Llewellyn Tony Royster Matthew Rudnick RECOMMENDATION That the JLMBC receive and file report regarding LAwell Program benefit service provider goals, metrics, and data reporting. DISCUSSION A. BACKGROUND On January 4, 2018, staff initiated a series of ongoing LAwell Program Benefit Service Provider summits in response to recommendations provided by the JLMBC s consultants at Keenan. The goal for these summits was to create a group structure for developing a goals-driven approach to coordinating benefit service provider resources, improving member outcomes, and evolving LAwell Program services to members. Targeted areas include preventive services, condition management, wellness services, communications, and data management. On March 30, 2018, Keenan convened the first benefit service provider summit. Subsequent summits were held on July 10, 2018, and September 9, Progress updates were provided to the JLMBC at meetings held on August 2, 2018, and November 1, At its February 7, 2019 meeting, the JLMBC approved staff s and Keenan s proposal for providing quarterly activity updates and supplementary data reports to the JLMBC. B. ACTIVITIES UPDATE AND ONGOING QUARTERLY REPORTS An additional update from Keenan is provided as Attachment A to this report. As that report indicates, Keenan has developed initial data sets to collect from LAwell Program service providers for the purpose of creating a data dashboard that will be presented to the JLMBC on a quarterly basis. The first such data dashboard report will be presented at the JLMBC s May 30, 2019 meeting (or early July meeting if the May 30 meeting is canceled). Keenan will review the data sets and contemplated reporting structure at the JLMBC s April 4, 2019 meeting. Submitted by: Steven Montagna JOINT LABOR-MANAGEMENT BENEFITS COMMITTEE

2 ATTACHMENT A Overview City of Los Angeles Health Management Metrics, Goals, and Strategies Update April 4, 2019 On February 26, 2019, a City of LA Benefit Service Provider Summit attended by representatives from Personnel Staff, Keenan, Anthem Blue Cross, Kaiser Permanente, Delta Dental, EyeMed, Optum, the Standard, Limeade, and Segal was held to review current reporting available from the service providers on metrics that could used for a) identifying the primary health issues and cost drivers among the City s workforce, b) tracking employees use of the health management resources available to them, and c) guiding the development of health management strategies for optimizing the health of City employees. The group also reviewed initial drafts of potential goals for positively impacting those metrics, including participation, engagement, health risk prevalence, chronic and cost, and condition management. During the meeting, several issues were identified that need to be addressed in collecting and reporting the health management metrics, setting appropriate goals, and developing strategies for achieving those goals: Identifying the eligible populations Determining frequency and timing for data reports Setting realistic short-term versus long-term goals as appropriate to the metric to be impacted Developing strategies that will be effective in assuring that the goals are met Determining the most appropriate comparison groups for metrics ing As a next step in the development of this health management project, Keenan consultants drafted templates for use in collecting the relevant data identified at the meeting, tracking those data points over time, and setting short- and long-term goals and strategies. These template drafts, along with simulated examples of how the metrics and goals can be tracked on quarterly and yearly bases, are provided below. The templates and the associated dashboard reporting will be revised as additional or more relevant metrics become available, and goals will be adjusted as appropriate. The metrics and goals will be used as the basis for determining appropriate health management strategies, and will be tracked and evaluated to measure the progress and success of the City s health management initiatives. Progress has been made on establishing specific goals, but the goal-setting process is still underway. Updates on this project, along with dashboard reports, will be provided to the JLMBC on a quarterly basis. The first quarterly dashboard with real data and specific goals for several of the metrics will be provided at the May 30 th 2019 JLMBC meeting. Please note: Templates for Standard, Limeade, WageWorks, and LIVEwell are currently under development. 1

3 Template General Layout A draft of the general layout of the health management metrics, goals, and strategies templates is presented in slides 2-3. s of the templates for Anthem Blue Cross, Kaiser Permanente, Optum, Delta Dental, and EyeMed are presented in slides Examples of what the health management data dashboard will look like, using simulated data, are presented in slides Report Population* Metrics Category Metric Source of Metric Freq Report Elements Member Participation & Engagement Preventive Care # Ees # Members Anthem Website Anthem Website/Mobile App Member Activity Report registration, utilization Registration LiveHealth Online LiveHealth Online Report medical activity: registration, utilization Registration behavioral health activity: registration, utilization Mobile Health App Mobile Health App Report registration, utilization Registration Preventive Screening/ Immunization Compliance Maternity Preventive Care Services Report Future Moms Progam Activity Report preventive screening/immunization compliance, well adult visits, registration, participation, symptoms, recommendation, delivery outcomes, Participation in prevalence care screening/ immunization compliance Registration for Future Moms Program Participation in Fujture Moms Program Normal birthweight for Future Moms Program participants Full-term birth for Future Moms Program participants Chronic Conditions Diabetes (Type 2) Lifestyle Condition Report condition the chronic condition, Hypertension Lifestyle Condition Report condition the chronic condition, Hyperlipidemia Clinical Dashboard Report condition the chronic condition, Coronary Artery Disease Lifestyle Condition Report condition the chronic condition, Asthma Clinical Dashboard Report condition the chronic condition, Overweight/Obesity Lifestyle Condition Report condition the chronic condition, Low Back Pain Lifestyle Condition Report condition the chronic condition, Depression Lifestyle Condition Report condition the chronic condition, Cancer Skin Lifestyle Condition Report condition the chronic condition, Cancer - Breast Lifestyle Condition Report condition the chronic condition, Cancer - Colorectal Lifestyle Condition Report condition the chronic condition, Metric To Be Tracked 2

4 Template General Layout (continued) Metric To Be Tracked Registration Registration Registration Participation in preventive care screening/ immunization compliance Registration for Future Moms Program Participation in Fujture Moms Program Normal birthweight for Future Moms Program participants FY 2017/18 FY 2019/20 FY 2024/25 FY 2018/19 Strategy for Attaining Baseline Goal Goal 2019/20 Goal Q4 Benchmark Q1 Q2 Q3 Q4 Benchmark Goal % Change Goal % Change Strategy for Attaining 2024/25 Goal Full-term birth for Future Moms Program participants of, % of total $ of all incurred claims paid of, % of total $ of all incurred claims paid of, % of total $ of all incurred claims paid of, % of total $ of all incurred claims paid 3

5 Template - Anthem Blue Cross Metrics Category Metric Source of Metric Report Population* # Ees # Members Freq Report Elements Member Participation & Anthem Website Anthem Website/Mobile App Member Activity Report registration, utilization Engagement LiveHealth Online LiveHealth Online Report medical activity: registration, utilization behavioral health activity: Mobile Health App Mobile Health App Report registration, utilization Preventive Care Preventive Screening/ Immunization Compliance Maternity Preventive Care Services Report preventive screening/immuni zation compliance, well adult visits, Future Moms Progam Activity Report registration, participation, symptoms, recommendation, delivery outcomes, Metric To Be Tracked Registration Registration Registration Participation in preventive care screening/ immunization compliance Registration for Future Moms Program Participation in Fujture Moms Program Normal birthweight for Future Moms Program participants Full-term birth for Future Moms Program participants *Indicate what populations are displayed in the report: employees, dependents, all members. 4

6 Template - Anthem Blue Cross (continued) Chronic Conditions Diabetes (Type 2) Lifestyle Condition Report condition Hypertension Lifestyle Condition Report condition Hyperlipidemia Clinical Dashboard Report condition Coronary Artery Disease Lifestyle Condition Report condition Asthma Clinical Dashboard Report condition Overweight/Obesity Lifestyle Condition Report condition, % of total $ of all, % of total $ of all, % of total $ of all, % of total $ of all, % of total $ of all, % of total $ of all 5

7 Template - Anthem Blue Cross (continued) Condition Management Low Back Pain Lifestyle Condition Report condition Depression Lifestyle Condition Report condition Cancer Skin Lifestyle Condition Report condition Cancer - Breast Lifestyle Condition Report condition Cancer - Colorectal Lifestyle Condition Report condition ConditionCare Engagement Rate ConditionCare Program Activity Report condition risk stratification, enrollment,, % of total $ of all, % of total $ of all, % of total $ of all, % of total $ of all, % of total $ of all Enrolled of those contacted Engaged of those enrolled 6

8 Template - Anthem Blue Cross (continued) Health Risk Prediabetes Risk factor prevalence, Health Behaviors Gaps in Care Mobile Health App Report gaps in care (GIC), App user responses to member gaps in care responses to gaps App user gaps in care Utilization Emergency Room Visits Clinical Dashboard Report ER visits, avoidable ER ER visits Avoidable ER visits 7

9 Template - Kaiser Permanente Metrics Category Metric Source of Metric Report Population* # Ees # Members Freq Report Elements Metric To Be Tracked Member KP.org KP.org Member Activity registration, utilization; Registrations Participation & Report Sign-ins Engagement Healthy Lifestyle Programs participation in healthy Participation lifestyle programs; Preventive Care Telephonic Wellness Coaching Preventive Screening/ Immunization Maternity Chronic Conditions Diabetes (Type 2) Hypertension Customer Composite Customer Composite Prevention and Lifestyle Risks Report participation in telephonic wellness coaching; preventive screening/immunizatio n compliance, maternity incidence, prenatal/postpartum care participation, health status, % of maternity costs related to moms with chronic rates, individuals condition, rates, individuals condition, Participation In compliance with recommended preventive screening/immunization Participation by all moms who are healthiest Participation by all moms who have major chronic conditions, % of total $ of all, % of total $ of all *Indicate what populations are displayed in the report: employees, dependents, all members. 8

10 Template - Kaiser Permanente (continued) Chronic Conditions Hyperlipidemia Coronary Artery Disease Asthma Obesity Low Back Pain rates, individuals condition, rates, individuals condition, rates, individuals condition, rates, individuals condition, rates, individuals condition,, % of total $ of all, % of total $ of all, % of total $ of all, % of total $ of all, % of total $ of all 9

11 Template - Kaiser Permanente (continued) Condition Management Depression Cancer Skin Cancer - Breast Cancer - Colorectal Diabetes (Type 2) Hypertension rates, individuals condition, rates, individuals condition, rates, individuals condition, rates, individuals condition, rates, metrics on condition control, eye exam, rates, metrics on condition control,, % of total $ of all, % of total $ of all, % of total $ of all, % of total $ of all Enrolled in condition management Blood sugar good control - HbA1c <8% Eye exam completion Enrolled in condition management BP control <140/90 10

12 Template - Kaiser Permanente (continued) Condition Management Health Risk Hyperlipidemia Health Risk Awareness Prediabetes Obesity Coronary Artery Disease Asthma Depression rates, metrics on condition control, rates, medication adherence, metrics on rates, metrics on condition control, rates, metrics on condition control, Awareness of BMI, BP, exercise status;,, Enrolled in condition management Total chol < 200 LDL <= 129 HDL >=40 (male) or >=50 (female) Trig <150 Enrolled in condition management Beta blocker use Enrolled in condition management Asthma med ratio Enrolled in condition management Effective acute phase treatment Effective continuation phase treatment Aware of BMI, BP, exercise status 11

13 Template - Kaiser Permanente (continued) Health Risk Health Behaviors Utilization Hypertension High Total Cholesterol Low HDL High Triglycerides High Blood Glucose Low Physical Activity Poor Nutrition High Alcohol Use Tobacco Use High Stress Low Skin Protection Depression Gaps in Care Emergency Room Visits Total Health Assessment (THA) Report Total Health Assessment (THA) Report Total Health Assessment (THA) Report Total Health Assessment (THA) Report rate, rate, rate, rate, rate, rate, rate, rate, rate, rate, rate, rate, ER visits, ER visits Avoidable ER visits 12

14 Template - Optum Report Population* Freq Metric To Be Tracked Metrics Category Metric Source of Metric # Ees # Members Report Elements Member Participation & Engagement EAP Core Services EAP Activity Report core services participation, EAP Core Services EAP Activity Report core services engagement, EAP WorkLife Services EAP Activity Report WorkLife utilization, Participation in core services Engaged in core services Participation in WorkLife services Template - Delta Dental Metrics Category Metric Source of Metric Report Population* # Ees # Members Freq Report Elements Metric To Be Tracked Deltal Dental Website Utilization Report website registration, Registration Member Participation & Engagement Preventive Care Dental Services Utilization Dental Services Utilization Plan Performance Report Plan Performance Report utilization (by procedure preventive, diagnostic, etc.), utilization (by procedure preventive, diagnostic, etc.), No dental visits Completion of dental cleaning *Indicate what populations are displayed in the report: employees, dependents, all members. 13

15 Template - Eye Med Metrics Category Metric Source of Metric Report Population* # Ees # Members Freq Report Elements Member Participation & Engagement Utilization Utilization Report vision exams as percent of total members Chronic Conditions High Risk for Chronic Conditions Wellness Report Semi- Annl high-risk diagnosis rates for conditions (including diabetes, diabetic retinopathy, hypercholesterol, hypertension) Metric To Be Tracked Completion of annual vision exam High-risk diagnosis for diabetes High-risk diagnosis for diabetic retinopathy High-risk diagnosis for hypertension High-risk diagnosis for hypercholesterol *Indicate what populations are displayed in the report: employees, dependents, all members. Templates for Standard, Limeade, WageWorks, and LIVEwell Under Development 14

16 Data Dashboard Examples Diabetes (Type 2) Prevalence Rate Quarterly: 2017/ /20 20% 15% 10% 5% 0% 13.5% 13.3% 13.2% 13.2% 13.8% 14.2% 14.6% 14.8% 15.1% 2017/18 Q4 Baseline 10.8% 11.0% 11.4% 11.4% 11.2% 11.5% 11.7% 11.8% [VALUE] 2018/19 Q1 2018/19 Q2 2018/19 Q3 2018/19 Q4 2019/20 Q1 2019/20 Q2 % Prevalence Benchmark 2019/ /20 Q3 Q4 Simulated Data for Demo Purposes Only Diabetes (Type 2) Prevalence Rate Yearly: 2017/ /25 20% 15% 10% 5% 0% 13.5% 13.8% 15.1% 15.3% 14.7% 13.1% 12.7% 12.3% 12.8% 10.8% 11.2% 11.6% 11.4% 11.3% 11.7% 11.9% 11.8% [VALUE] 2017/18 Baseline 2018/ / / / / / / /25 Goal (-5%) % Prevalence Benchmark 15

17 Data Dashboard Examples 30% 20% 10% 0% Diabetes (Type 2) % of Total Medical/Rx Claims Cost Quarterly: 2017/ / % 19.5% 19.9% 20.1% 20.3% 20.5% 21.2% 21.6% 22.0% 2017/18 Q4 Baseline 15.3% 15.4% 15.6% 15.4% 15.1% 15.0% 15.4% 15.7% [VALUE] 2018/19 Q1 2018/19 Q2 2018/19 Q3 2018/19 Q4 2019/20 Q1 2019/20 Q2 % of Total Medical/Rx Claims Benchmark 2019/ /20 Q3 Q4 Simulated Data for Demo Purposes Only 30% 20% 10% Diabetes (Type 2) % of Total Medical/Rx Claims Cost Yearly: 2017/ / % 20.3% 22.0% 22.3% 21.0% 19.4% 18.6% 17.0% 17.4% 15.3% 15.1% 16.4% 16.5% 16.7% 17.3% 17.2% 17.8% 0% 2017/18 Baseline 2018/ / / / / / / /25 Goal (-15%) % of Total Medical/Rx Claims Benchmark 16

18 Data Dashboard Examples 80% 60% 40% 20% 0% Dental Care % Employees With Dental Visits Quarterly: 2017/ / % 54.2% 58.2% 63.0% 55.2% 59.9% 65.2% 65.6% 65.2% 61.5% 65.8% [VALUE] 56.1% 57.8% 60.3% 31.1% 31.8% 34.3% 32.7% 2017/182018/192018/192018/192018/192019/202019/202019/202019/202019/20 Q4 Baseline Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Goal (+5%) % With Visits Benchmark Simulated Data for Demo Purposes Only 80% 60% 40% 20% 0% 62.5% 63.0% 65.2% 67.5% 69.6% 70.7% 71.3% 73.7% 72.0% 65.2% 65.8% 65.9% 66.1% 67.4% 68.7% 68.9% 69.0% 2017/18 Baseline Dental Care % Employees With Dental Visits Yearly: 2017/ / / / / / / / / /25 Goal (+15%) % With Visits Benchmark 17

19 Data Dashboard Examples Simulated Data for Demo Purposes Only Engagements 30,000 25,000 20,000 15,000 10,000 5, ,429 1,731 4,215 7,058 LIVEwell Program Engagements Quarterly: 2017/ /20 12,708 6,000 10,010 15,688 16, /182018/192018/192018/192018/192018/192019/202019/202019/202019/202019/202020/212020/212020/212020/212020/21 Q4 Baseline Q1 Q2 Q3 Q4 Goal (+75%) Q1 Q2 Q3 Q4 Goal (+45%) Q1 Q2 Q3 Q4 Goal (+25%) 21,873 18,000 12,861 18,345 25,672 27,000 18