County of Sacramento Review of Population Health through Kaiser Permanente Data Dr. Diane Dailey, M.D., Chief of Business Health Engagement Eileen Peterson, MPH, RD, TPMG Business Health Consultant, Public Affairs Patricia Purvis, Executive Account Manager, Strategic Accounts 0 1/18/2017
Meeting Topic Guide The people enrolled The health status How health status influences chronic conditions The overall impact of population health on claims 1
Explore the Ionic History of Kaiser Permanente. A talented young surgeon and a Vision Tunnel rescue squad serving the Colorado River Aqueduct Project workers, circa 1933 Patient at Contractors General Hospital, circa 1934 Dr. Garfield in front of his hospital, Mojave Desert, 1935 KP s Oakland Medical Center started with rebuilding of the burned out shell of a former hospital, Dr. Garfield on right, 1942 Sidney R. Garfield, MD 1906-1984 2 2
Your group at a glance Member demographics County of Sacramento Kaiser Permanente adjusted regional average* Comparison Subscribers 7,727 - - Members 18,750 - - Average age 33.2 33.9.7 yrs younger Gender (% female) 52.7% 50.6% 2.1% pts higher Average family size 2.4 1.8 0.6 higher Enrollment Stability Index 95.1% - - * The Kaiser Permanente regionally adjusted benchmark values are based on the weighted average of the purchaser s distribution of members across the Kaiser Permanente regions for the time period being measured. 3 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: lifestyle risks overview Measure Adult weight (BMI) Childhood weight Exercise+ Prediabetes+ Diabetes+ Cholesterol Blood pressure Smoking rates Description % of adult members who are overweight or obese % of child members who are overweight or obese % of adult members who are not meeting the minimum exercise recommendation % of adult members who had a prediabetic test result % of adult members who had a diabetic test result % of adult members with borderline high or high total cholesterol % of adult members with blood pressure >=140/90 % of adult members who smoke Your results, 2014 Q3^ Your results, 2016 Q3^ Kaiser Permanente adjusted regional average National comparative data 74.2% 75.1% 68.2% 68.7%* 31.4% 31.0% 31.5% 31.7%* 67.2% 66.4% 65.9% N/A 27.0% 29.2% 31.1% 37.0%** 12.7% 13.1% 11.8% 12.3%** 35.0% 35.9% 35.9% N/A 8.6% 9.7% 7.9% 33.3%*** 10.6% 9.7% 10.0% 19.0%**** ^ ISS (Insufficient Sample Size) will be displayed if eligible member population for the prevention measure is less than 30. + As a newly reported measure, data is available beginning Q2 2013. For prediabetes and diabetes, not all members with an elevated fasting glucose test result > 126 or hemoglobin A1c > 6.5 will develop a diabetes diagnosis based on a single test result. An actual diabetic diagnosis is based on a number of clinical criteria. * Trust for America s Health and the Robert Wood Johnson Foundation, 2013. ** CDC, 2014. *** American Heart Association, accessed September 9, 2013. **** CDC, accessed September 6, 2013. 4 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: preventive services overview Measure* Description Your results, 2014 Q2^ Your results, 2016 Q2^ Kaiser Permanente adjusted regional average National comparative data+ Breast cancer screenings Cervical cancer screenings Colorectal cancer screenings Childhood immunization rates** % of eligible population screened % of eligible population screened % of eligible population screened % of eligible population screened 86.4% 82.1% 86.9% 82.4% 92.9% 90.8% 91.6% 83.6% 72.1% 76.5% 77.5% 75.7% 88.4% 91.7% 90.4% 87.1% 5 The data measurement period for preventive services lags a quarter behind lifestyle risks. It takes more time to collect and validate the data because each measure has a different eligible population. * Continuously enrolled members during measurement period. ^ ISS (Insufficient Sample Size) will be displayed if eligible member population for the prevention measure is less than 30. + 2014 HEDIS scores (90th percentile). ** CIS Combo 3. County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: adult weight of your member population was measured in the last 12 months Underweight BMI < 18.5 Normal BMI 18.5 24.9 Overweight BMI 25.0 29.9 Obese BMI 30.0 or higher 75.1% of your 2016 Q3 adult member population is overweight or obese Ages 21 to 74. Excludes members who utilized maternity services. The customer values will be displayed as 0% if the eligible member population for the metric is less than 30. 6 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: adult weight On average, an overweight or obese employee costs an employer $2,295 more a year in direct and indirect medical expenses than an employee at a healthy weight. * Your results in 2016 Q3 Direct and indirect costs related to weight ISS Overweight or obese adult members x 6,440 members are overweight or obese $2,295 additional medical costs $14,779,800 estimated additional annual direct and indirect costs * Van Nuys et al., American Journal of Health Promotion, May/June 2014. 7 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: glucose of your member population was measured for glucose in the last 3 years Normal test result Fasting glucose < 100 or hemoglobin A1c < 5.7 Prediabetic test result Fasting glucose 100 125 or hemoglobin A1c 5.7 6.4 Diabetic test result * Fasting glucose > 126 or hemoglobin A1c > 6.5 8 42.3% of your 2016 Q3 member population had a prediabetic or diabetic test result * Not all members with an elevated fasting glucose test result > 126 or hemoglobin A1c > 6.5 will develop a diabetes diagnosis based on a single test result. An actual diabetic diagnosis is based on a number of clinical criteria. Total percentage of members ages 18 and older. The customer values will be displayed as 0% if the eligible member population for the metric is less than 30. Data isn t available for any region prior to Q2 2013. County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: glucose Employees with diabetes can cost their employers $4,413 more a year on average than nondiabetic employees. * Your results in 2016 Q3 Medical costs related to diabetes ISS Adult members with diabetic test results x 905 members have diabetes $4,413 additional medical costs $3,993,765 estimated additional annual medical costs * National Business Coalition on Health, February 2012. Not all members with an elevated fasting glucose test result > 126 or hemoglobin A1c > 6.5 will develop a diabetes diagnosis based on a single test result. An actual diabetic diagnosis is based on a number of clinical criteria. 9 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: cholesterol of your member population was measured for cholesterol in the last 5 years Desirable Total cholesterol < 200 Borderline Total cholesterol 200 239 High Total cholesterol > 240 35.9% of your 2013 Q3 member population has borderline to high total cholesterol Total percentage of members ages 18 to 75. Components of total cholesterol include LDL, HDL, and triglycerides. The customer values will be displayed as 0% if the eligible member population for the metric is less than 30. 10 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: cholesterol Annual medical expenses for employees with high total cholesterol are about $92 more than expenses for employees with lower cholesterol. * Your results in 2016 Q3 Medical costs related to high cholesterol ISS Employees with high cholesterol x 701 members have high cholesterol $92 additional medical costs $64,492 estimated additional annual medical costs * Goetzel et al., Health Affairs, 2012. 11 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: blood pressure of your member population was measured in the last 12 months Desirable BP systolic/diastolic <140/90 Undesirable BP systolic/diastolic 140/90 The percentage of members ages 18 to 85 who came to a doctor during the measurement period and had a blood pressure reading. The customer values will be displayed as 0% if the eligible member population for the metric is less than 30. 12 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: blood pressure Medical expenses for an employee with high blood pressure are $1,378 more than for an employee without high blood pressure. * Your results in 2016 Q3 Medical costs related to high blood pressure ISS Employees with undesirable blood pressure x 917 members have undesirable blood pressure $1,378 additional medical costs $1,263,626 estimated additional annual medical costs * Goetzel et al., Health Affairs, November 2012. 13 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: smoking of your member population age 18+ with a recorded result for smoking status Percentage that smokes The customer values will be displayed as 0% if the eligible member population for the metric is less than 30. 14 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
Your results: smoking Just one smoking employee can cost an employer $5,816 more per year compared to nonsmoking workers. * Your results in 2016 Q3 Direct and indirect costs related to smoking ISS Percentage that smokes x 1,254 members smoke $5,816 additional medical costs $7,293,264 estimated additional annual direct and indirect costs * Berman et al., tobaccocontrol.bmj.com, June 2, 2013. 15 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016
The impact of chronic conditions Chronic conditions can have a significant impact on your employees quality of life. They re also a primary driver of health care costs. Our integrated system of care and focus on member engagement help you improve your employees health and well-being while combating those costs. People with chronic conditions account for up to 80% of health care costs. They also account for: * Hospital admissions Prescriptions Doctor s office visits Workers compensation claims cost about twice as much for employees with chronic conditions. ** And these claims also result in more time away from work. Diabetes increased the average price of a claim by $3,169 Hypertension increased the average price of a claim by $2,687 Chronic obstructive pulmonary disease increased the average price of a claim by $2,501 * California Department of Public Health, 2013. ** Laws and Colon, NCCI Research Brief, October 2012. 16 County of Sacramento Measurement period: Jul-1-2015 through Jun-30-2016
The importance of engagement When people with chronic conditions are more engaged in their health, they are more likely to: adhere to treatment monitor their condition at home get regular chronic care Higher engagement is also linked to better health outcomes and lower costs. * At Kaiser Permanente, our integrated care delivery makes it easier for members to actively participate in and manage their care, wherever they are: * Hibbard and Greene, Health Affairs, February 2013. At home At work At our facilities Online and on the go 17 County of Sacramento Measurement period: Jul-1-2015 through Jun-30-2016
Percentage of your costs driven by chronic conditions 63% of your costs are driven by 22% of your members 1 86% 22.3% Percentage of members with chronic conditions 77.9% 63.0% Percentage of costs from members with chronic conditions 37.0% Percentage of U.S. employees who have at least one chronic condition or are overweight and many of them have multiple chronic conditions. 2 People with multiple chronic conditions are more likely to end up in the hospital. 3 1 Continuously enrolled members during measurement period. The calculations for this graph use DxCG methodology. 2 Witters and Agrawal, Gallup-Healthways Well- Being Index, January 2 October 2, 2011, gallup.com. 3 Brownlee, Center for Advancing Health, April 18, 2012. 18 County of Sacramento Measurement period: Jul-1-2015 through Jun-30-2016
Percentage of your costs driven by conditions segmented Percentage of members compared to percentage of cost by condition * 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Members Costs 2 or more major chronic conditions 3.4% 21.3% 1 major chronic condition 14.6% 28.7% Additional chronic conditions 4.3% 13.0% Cancer 0.7% 1.9% Back pain 7.1% 7.0% Arthritis 1.4% 2.1% Injuries (other than back pain) 7.7% 4.4% Maternity without other conditions 1.5% 5.0% All other 59.5% 16.6% 63% of your costs are driven by 22% of your members* * Continuously enrolled members during measurement period. Note: Major chronic conditions = diabetes, asthma, coronary artery disease, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and depression. Calculations for this graph use DxCG methodology. 19 County of Sacramento Measurement period: Jul-1-2015 through Jun-30-2016
Inpatient - $ PMPM and $ / Day 20
Inpatient Days /1000 and ALOS 21
Inpatient Claims Top 10 - DRG 22
Outpatient $ PMPM and $/Visit 23
Pharmacy Detail: Drug Category by Dollars in Claims, Drug Category by Medication Type 2015 - % of Total Rx $ 2016 - % of Total Rx $ Specialty 29% Generic 37% Specialty 30% Generic 36% Brand 34% Brand 34% 24
Top 25 Drugs by Total Scripts sorted by Therapeutic Class 25
Top 25 Drugs by Net Claims sorted by Therapeutic Class 26
Build your workforce health strategy 27 County of Sacramento Measurement period: OCT-01-2015 through SEP-30-2016