Engage and Empower Pa.ents with Interac.ve Technology Northeast NAHAM Regional Conference Pa.ent Access: GeBng It Right Upfront October 22-23, 2012
NAHAM - Pa.ent Access Services 2 Pa%ent Access Services Scheduling Call Centers Registra.on Admissions Pa.ent Finance Guest Rela.ons Other Related Services Common themes for the op.mal pa.ent experience and gebng it right upfront: q Access to informa.on is cri.cal q Right informa-on at the right -me in the right way q Personal q Delivered the way pa.ent wants q Timely q Relevant
Healthcare System Challenges 3 Chronic Disease: Some Unfortunate Truths q q 107 million Americans almost 1 out of every 2 adults age 18 or older had at least 1 chronic illness (Centers for Disease Control) Among the working popula.on that have a chronic condi.on: 32% have 0 53% have 1 3 14% have 4 or more
Cost Implica.ons of Chronic Illness 4 q Corpora.ons are seeing declines in produc.vity and an unsustainable increase in insurance premium costs (U.S. Chamber of Commerce) q Chronic diseases account for nearly 75% of the na.ons annual $2 trillion health expenditures (Kaiser Family Founda.on) q Chronic diseases account for: q 81% of hospital admissions q 91% of all prescrip.ons filled q 76% of all physician visits (Centers for Disease Control) Consumer engagement in health is low Consumers are not taking an ac.ve role in their health 75 percent of pa.ents and 50 percent of chronics fail to comply with prescribed treatment plans and medica.ons in the US** **. http://www.cvscaremarkfyi.com/sites/all/themes/cvs_theme/11-cvs_346-state-of-adherence%20brochure_fnl_web.pdf, 2012
Gaps in Care: Lack of Diagnosis, Treatment and Goal Aeainment Drives Risk 5 Closing gaps in care is cri.cal to gebng individuals engaged with the diagnosis, appropriate treatment and goal aeainment of chronic condi.ons Age: 40-64 High Cholesterol High Blood Pressure Diabetes Prevalence 41.2% 29.9% 10.6% Awareness (Diagnosed) 53.7% 71.2% 69.6% Treated 26.1% 59.5% 45.9% At Goal 61.3% 64.4% 47.2% Par.cipant Popula.on (Age: 40-64) with condi.on, treated, and treated to goal (26.1% Treated x 61.3% "At Goal") The Problem! 16.0% 38.3% 21.7% Prevalence percentage: Persons with the disease or condi.on (diagnosed plus undiagnosed) as a percentage of a popula.on. Awareness percentage: Persons diagnosed with the disease or condi.on as a percentage of prevalent cases. Treatment percentage: Persons being treated for the disease or condi.on (ie, taking prescrip.on medicine), as a percentage of prevalent cases. Control among treated percentage: Persons with the disease or condi.on who are controlled at or below the appropriate treatment goal, as a percentage of treated cases. NHANES 1999-2000.
Gaps in Care: Rx Non- adherence Drives Hospitaliza.on Risk P<.05* Medica%on adherence level (%) * P<.05 for all adherence levels and all diseases, compared with reference group, with 80%- 100% adherence level for respec%ve disease. Retrospec%ve cohort study of popula%on- based sample in the US. N=137,277 pa%ents <65 years. Adherence: % days with supply of 1 maintenance Rx. 12- month follow- up. Hospitaliza%on risk: probability of having 1 hospitaliza%ons or ER treatment. Sokol MC, et al. Med Care. 2005;43:521-530.
Gaps in Care: Rx Non- adherence Drives Costs All- cause health care costs per pa%ent, per year* Adjusted total all- cause health care costs (medical and drugs) ($) *In the 12- month period following the index claim, the first of 2 dates of outpa%ent service for target condi%on or the first of 1 dates of inpa%ent or ER service. Retrospec%ve cohort study of popula%on- based sample in the US. N=137,277 pa%ents <65 years. Adherence: % days with supply of 1 maintenance Rx. 12- month follow- up. Sokol MC, et al. Med Care. 2005;43:521-530.
Gaps in Care: A1C Control Drives Medical Costs Appropriate Rx U-liza-on Drives A1C Control Gilmer TP et. al Diabetes Care 1997;20:1847-1853.
Pa.ent Engagement Obstacles 9 Overall, Individuals q q q q Lack accurate meaningful health educa.on Lack the belief that recommended treatment or ac.ons will make a significant difference Lack understanding on how to incorporate changes into their personal life Lack the support necessary to adopt and sustain changes
Engaging Pa.ents 10 ü ü ü ü ü Our Opportunity Focus on health risks, preven.on and gaps in care Convert data into informa.on Develop personalized content for pa.ents Deliver through mul.ple channels (text messages, e- mail, phone, mail) Pa-ents want to be transformed, not just informed Providing text messages as a behavior change tool generates posi.ve short- term effects in regard to disease preven.on and management * Increased Engagement Health Behavior Change Improved Health Lower Costs *Lewis & Kershaw, 2010
Leverage Data 11 Pa.ent Portal HRA EMR/Medical Claims Library of Content and Video Customized Pa.ent Content Pharmacy Claims Biometrics Lab Values Alerts Personaliza6on Engine Risk Stra-fica-on Predic-ve modeling Customized content based on Alert Op6onal Connec6ons or Referrals Disease management program Primary care physician Case management Health coach Hospital Care Team Alerts: Gaps- in- Care Medica-on adherence Personalized literature Email Text Msg Internet HIPAA Compliant Alert Message: you have an important Health & wellness Alert. Please log in and check your Health Alerts at your earliest convenience.
Types of Alerts Category Descrip%on Example Wellness Preven%on and Screening Risk Factors Gaps In Care Primarily based on an individual s demographics Based on industry standard protocols from the U.S. Preven.ve Services Task Force sponsored by the Agency for Healthcare Research and Quality Based on self- reported data, primarily through an HRA Risks are iden.fied, priori.zed, and sent based on the highest risk to the lowest risk Uses clinical data from medical and pharmacy claims, lab values, or other clinical data to evaluate whether an individual is mee.ng evidence based medicine standards of care Alerts are sent to the individual and may also be sent to the a care management nurse, health coach, or health care provider High Blood Pressure screening Aspirin for preven.on of CVD Colorectal cancer screening Mammograms Smoking Obesity Depression ASTHMA Standard of Care: An individual with asthma should use controller medica.on Iden.fica.on & Alert: One dispensed inhaled cor.costeroid within 30 days of iden.fica.on Users receive alerts that are clinically validated and highly focused around their specific healthcare needs in a manner in which they want to receive it
Engagement Results in Improved Healthcare When a member is engaged in their healthcare, they are more likely to adhere to their treatment and have beher health outcomes Providing employees with personalized health- related informa.on resulted in a decrease in sedentary behavior, unhealthy stress and smoking and an increase in quality food choices (Levi et al., 2008) Providing pa.ents with appropriate educa.onal resources increases medica.on adherence by 12-25% (Cutler, 2010) Bi- weekly automated assessment calls to pa.ents with Diabetes increased adherence by 21% (Cutler, 2010) Par.cipa.on in a cardiac disease management program improved cholesterol control by 36% in the first year (Coberley et al., 2008) The more personalized the program, the greater risk reduc.on and health improvement (Heinin, 2005)
Higher Engagement - Improves Health and Lowers Costs With higher engagement resul%ng in improved healthcare, studies show that overall cost are reduced When a gap- in- care was iden.fied, sending informa.on packets resulted in a 20% increase in the gap being closed which is es.mated to save $1.49 PMPM. (Oswald et al., 2009) BAE Systems Inc combined risk assessments for chronic disease with online and telephonic health coaching leading to an annual 3.3% reduc.on in medical costs; represen.ng a 2 to 3:1 ROI (Klein, 2009) An online primary preven.on program targeted at pa.ents with Diabetes reduced the average annual medical costs for the interven.on group by 21% (Klein, 2009) Par.cipa.on in a health club benefit program decreased average annual healthcare expenditures by $1633 per enrolled member (Nguyen, 2008) Preven.ng 10% of upward risk transi.ons that would otherwise occur aqer entry into Medicare reduces average life.me costs per beneficiary by $4361 resul.ng in $163.5 billion in total savings (CHR, 2009)
Wellness Programs and ROI Wellness and Lifestyle programs indicate an ROI of 2:1 to 8:1 (Aldana, 2001; Chapman, 2003; Harkin, 2010; Oswald et al., 2009; Rula et al., 2009; Heinen, 2005, AHIP; Levi et al., 2008.) Extensive research analyzing 73 studies found that employers saved an average of $3.50 for every $1 spent on work- based wellness programs (Hewie Associates, LLC, 2008). 42 studies analyzing the benefit of wellness programs had an average of $5.93 savings for every dollar spent (Chapman, 2003) Investment in community- based disease preven.on programs would lead to an es.mated ROI of 5.6:1 within 5 years (Levi et al., 2008). Studies providing employees with specific health related informa.on had an average ROI of 1.5 to 2.1:1 (Levi et al., 2008). Companies conduc.ng evalua.on of their own employee risk reduc.on programs found an ROI between 4 and 5:1 (Heinen, 2005). A sustained commitment to chronic disease preven.on and management results in an es.mated savings of $47 billion in na.onal health expenditures by 2015 (AHIP).
16 Demonstra.on
17 Thoughts??
18 Thank you Gary Greinke gary@liivmd.com 707 292 6839