Using Risk Based Incentives and Wellness Programs to Foster Healthier Behavior By Jeff Wu Regional Head of Accident and Health Insurance, Generali Asia November 16-17, 2015, Singapore Generali
An Healthcare interesting cost study increases with age US Commercial aging curve US Medicare aging curve 3 2.5 2 1.5 1 0.5 0 2 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 Male Female Male Female Source: Data for 2010 Health Care Costs From Birth to Death Dale H. Yamamoto. Australian Government health spending by program based on age Health cost weights, by age group New Zealand 5 4 3 2 1 0 16000 14000 12000 10000 8000 6000 4000 2000 0 Medicare Benefits Schedule Pharmaceutical Benefits Scheme Public hospitals Source: Department of Health, Australia Generali 3 Male Female Currency: NZD Source: 2010 Data, Ministry of Health, New Zealand
An 3 States interesting - Health, study Sub-health and Disease Sub-healthy individuals are at high risk of developing diseases if not treated in time, but their sub-health status can be eliminated simply by psychological interventions and/or lifestyle modifications, e.g. increasing physical activity and following an healthy diet. Age-specific prevalence of health, subhealth and disease among 1473 Chinese adults 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 20-39 40-59 60 Health Subhealth Disease Source: 2013 Sub-health: definition, criteria for diagnosis and potential prevalence in the Central region of China Generali 4
An Prevalence interesting of Selected study Chronic Diseases The conditions of concern among the elderly are primarily those associated with chronic disease. USA - Rate per 1,000 persons Arthritis 48 253 443 Heart Disease 38 129 274 Diabetes 9 58 80 Hypertension 59 214 385 Visual Impairment 29 58 119 Hearing Impairment 45 119 282 0 50 100 150 200 250 300 350 400 450 17-44 years 45-64 years 64+ years Source: Chartbook on Aging in America by Allan C. and H. Brotman Generali 5
Prevention of Chronic Diseases Many chronic diseases have been associated with personal habits and, conversely, each of these habits may be associated with several diseases. Smoking Diet Stress and Isolation Physical activity Chronic obstructive pulmonary disease Lung cancer Coronary heart disease, stroke and lower respiratory tract infections Dementia Cataracts Blindness and visual loss Cancer of the colon, pancreas and prostate. Cardiovascular and cerebrovascular disease Diabetes Osteoporosis Increases blood pressure, abnormal stress response, heart disease and poor sleep Strong correlated with Depression Increases chances of developing dementia and Alzheimer s disease Reduces the risk of falling and fracturing bones Reduces the risk of coronary heart disease Reduces the risk of high blood pressure, colon cancer, and diabetes Reduces anxiety and depression Helps to maintain healthy bones, muscles and joints Fosters improvements in mood and feelings of wellbeing Source: Prevention and the Elderly: Risk Factors Generali 6
Falls and healthcare costs Falls are a significant problem for the elderly. It is estimated that one out of three older adults (those aged 65 or older) falls each year but less than half talk to their healthcare providers about it. 140 120 Rate per 1000 Population of Fallrelated Hospital Admissions of Older Adults Western Australia 16 14 12 Average length of Hospital Stay (in days) Canada 100 10 80 8 60 6 40 4 20 2 0 65-69 70-74 75-79 80-84 85 + 0 65-74 75-84 85 + Males Females All causes Falls Source: Injury in Western Australia: The Health System Cost of Falls in Older Adults in Western Australia Source: British Colombia, Canada 2004/2005 The evolution of senior s falls prevention in British Colombia Generali 7
How personal habits influences medical costs Some researches have highlighted how an active and healthy lifestyle influences the healthcare costs, especially for older adults. 3500 3000 2500 Medical costs of active and inactive people without physical limitations both sexes - USA 7000 6000 5000 Healthcare cost per person per year (Canada) 2000 4000 1500 3000 1000 2000 500 1000 0 15-24 25-34 35-44 45-54 55-64 65-74 75 + 0 40 45 50 55 60 65 70 75 80 85 + Active Inactive Non - Smokers Smokers Currency: 1987 USD Source: Higher Direct Medical Costs Associated with Physical Inactivity by Pratt, Macera, Wang Currency: 1988 USD Source: JJ Barendreght et al. New Engl J Med 1997 Generali 8
An Risk interesting factors related study to healthcare cost Risk factor Illness Days Existing Medical Conditions Alcohol Life Satisfaction Physical Activity Perceived Health Medical/Drug for Relaxation Diastolic Blood Pressure Systolic Blood Pressure Smoking Stress Body Weight Cholesterol Job Satisfaction High risk criterion More than 5 days in the past year Self-reported heart problems, cancer, diabetes, past stroke, chronic bronchitis/emphysema Male: More than 14 drinks per week. Female: More than 7 drinks per week. Partly or not satisfied Less than one time per week Fair or Poor Use almost every day or sometimes Greater than 89 mmhg Greater than 139 mmhg Current cigarette smoker Greater than 20 (based on a composite score from questions related to personal life and hours of sleep) Body Mass Index (BMI) equal to or greater than 27.5 kg/m2 Greater than 239 mg/dl Disagree or strongly disagree Medical claims costs for people who indicate a low risk in category Medical claims costs for people who indicate a high risk in category Absence of illness Medical Problems Alcohol Life satisfaction Physical activity Perceived health fair/poor Medical /drug use Diastolic blood pressure Systolic blood pressure Smoking Stress Body weight Cholesterol Job satisfaction 0 200 400 600 800 1000 1200 1400 Source: The University of Michigan Health Management Research Center Generali 9 Currency: USD
An Some interesting risk factors study are modifiable, some are not We can group the risk factors in two main categories: modifiable and non-modifiable. Non modifiable Conditions that increase the risk but cannot be changed Examples: age, gender, family medical history Modifiable Risk factors that can be changed or treated Examples: smoking, physical activity, body weight From the study analyzed in the previous slide, we can group the risk factors that are correlated with each other: Non Modifiable risk factors: Medical claims costs for people who indicate a low risk in category Medical claims costs for people who indicate a high risk in category Non Modifiable factors Absence of illness, medical problems Modifiable risk factors: Physical Activity correlated: physical activity, diastolic and systolic blood pressure, body weight, cholesterol Physical Activity correlated Bad habits Bad habits: alcohol, smoking, drug abuse Personal Perception Personal perception: perceived health, life satisfaction, stress, job satisfaction 0 1000 2000 3000 4000 Currency: USD Generali 10
Focus of Wellness Programs Quit bad habits Health Education Physical Activity Early detection Generali 11
Examples of Wellness Programs Prevention Check-up, healthy nutrition, stop-smoking, fitness & exercise coaching, stress management, etc. Tele assistance / Telemedicine Measuring and monitoring of vital signs through dedicated tele medical devices in order to react in case of medical emergency and guarantee autonomy and peace of mind for care givers Rehabilitation management Coordination of medical, social and professional rehabilitation programs after a heavy injury in order to bring the injured back to normal life Chronic Disease Management Information provision, coaching, compliance monitoring, tele care and healthcare services for specific populations suffering chronic diseases Medical advice hot line Medical advice for persons with acute health problems based on evidence Generali 12
Key success factors for any wellness programs A successful wellness program should be result-oriented. Modifiable Is the program targeting risk factors that people can change? Enforceable Can the program enforce people to take the corrective measures? Verifiable Can the program track and verify the result? Generali 13
Wearable devices can be helpful Physical Activity tracker Monitoring and access the data generated by today s fitness trackers allow insurers to design enforceable fitness programs and verify the results. Diet tracker The sensor allow people to keep a track of their diet. Possibility to monitor diet of elderly and suggest the right diet advices. Tele assistance For elderly, a prompt medical treatment is very important. This device allow people to react in case of medical emergency and guarantee autonomy. Generali 14 Chronic Disease Management This device helps to monitor chronic illnesses with multiple data captures. For example, for patients with cardiac illness, monitoring of blood pressure, cortisol levels and cholesterol.
An The interesting Effectiveness study of Wellness Programs Wellness Program Modifiable Enforceable Verifiable Prevention Tele assistance / Telemedicine Rehabilitation management Chronic Disease Management Medical advise hot line Generali 15
An Discovery interesting Vitality study Program It is the world's largest scientific, incentive-based wellness solution for individuals and corporates: by rewarding healthy behavior it is aimed to give members and their family knowledge and motivation to make healthy living. Education activities Fitness activities Prevention Healthy Living Health Assessment First aid certification Monthly medical Visit Kids Health Assessment Verified workout (partner health club, device, mobile app) Sports league Athletic events Kids sport league and events Health screenings Flu shot Nicotine test Dental exam Vision exam Kids prevention (exams and immunizations) Blood donation Double points if you are healthy (based on BMI, blood pressure systolic, blood glucose, total cholesterol) Electronics Fitness devices Hotel stays Movie tickets Amazon.com gift cards Source: Humana Vitality Program www.humana.com/vitality/ Generali 16
An Practical interesting tips for study wellness programs Wellness programs based on prevention Incentives for engagement Wearable devices Foster healthier behavior Decrease medical cost Design personal goals Reward healthy behavior Can make more verifiable the wellness programs Medical advice hot line Tele assistance Chronic Disease Management Program Rehabilitation Management 24h medical hot line Avoid unnecessary medical visit Can guarantee autonomy to elderly Offered as added service Aim to educate the patient Identify health and care patient s need Very important after a fall Offered as added service Generali 17
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