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Wellness Presentation


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Wellness Presentation

  1. 1. From Wellness to Disease Management: Covering the Health Care Continuum
  2. 2. Reality Check • The top three causes of death are heart disease, cancer and stroke; The leading cause of all three is. A.) High Blood Pressure B.) Fatigue C.) Obesity • The director of the Behavioral Medicine Research Center at Baylor College predicts what percentage of Americans will be overweight or obese by 2040. A.) 50% B.) 90% C.) 75% • What percentage of US adults do not engage in any leisure time physical activity. A.) 40% B.) 25% C.) 60% (Department of Health and Human Services) • An American Cancer Society report shows obesity and lack of physical activity causes how many cancer cases in the United States? A.) 1/5 B.)1/2 C.) 1/3
  3. 3. For Every 100 Employees…
  4. 4. 60 are Sedentary
  5. 5. 25 Smoke
  6. 6. 64 are Obese/Overweight
  7. 7. 27 Have Heart Disease
  8. 8. 10 Have Diabetes
  9. 9. 50 Have High Cholesterol
  10. 10. 24 Have High Blood Pressure
  11. 11. 50 Are Distressed or Depressed
  12. 12. Reducing one health risk can… •Reduce absenteeism by 2% •Improve productivity by 9% Reference: Pelletier B, Boles M, Lynch W. (2004). Change in health risks and work productivity over time. J Occup Environ Med. Small changes, Big Impact
  13. 13. Activation!  Our level of personal activation (“Take Chargedness”) determines our behavior, our risks, our likelihood to change, and our medical costs. • Diet • Exercise • Disease specific self-management • Consumeristic behaviors
  14. 14. 70% 46% 35% 21% 15% 12% 10% Depression Stress Blood Sugar Control Overw eight Smoking Blood Pressure Sedentary Lifestyle Increased health risk, increased cost Impact of Modifiable Risk Factors on Medical Expenses Adapted from Goetzel RZ, Anderson DR, Whitmer RW, et al, Journal of Occupational and Environmental Medicine (40) (10) October 1998, 1-12 Annualadjustedmedicalexpenses ie. Overweight individuals cost 21% more than those whose weight is in the healthy range
  15. 15. Care Management: Every Day Health CareEnhance Health Coach Special Beginnings Disease Management Case Management SUPPORT FOR EVERY DAY HEALTH WELLNESS COACHING SUPPORT MANAGEMENT  Integration between systems, people, programs  Lifelong support for members at any health stage  Simplification for member, employer, physician  Transformation of health care system
  16. 16. CareEnhance: Decision Support The difference between…wondering what to do and knowing.
  17. 17. CareEnhance: Decision Support  24/7 toll-free phone access to registered nurses • 5 call centers and support for more than 100 languages  Help knowing when, where (or whether) to seek care  Library of over 1,100 prerecorded health topics  Program reminders mailed to members quarterly  Administered by McKesson Health Solutions .
  18. 18. Health Coach: Lifestyle Change The difference between…inaction and taking charge.
  19. 19. Special Beginnings: Healthy Pregnancy The difference between…worry and peace of mind.
  20. 20. Special Beginnings: Healthy Pregnancy Nurses provide one-on-one member support • Assess each member’s risk to determine education and outreach • Member’s choice of pregnancy book or DVD (Spanish options) • What to expect during pregnancy and birth • Signs of premature labor and other complications • Tailored pregnancy information • 24/7 phone access (CareEnhance after hours) Engine rewards for completing program
  21. 21. Case Management: Advocate, Navigate The difference between… going it alone and having a trusted advisor help you through.
  22. 22. Case Management: Advocate, Navigate  Support for serious illness or injury  One-on-one nurse support based on conditions • Nurses advocate, navigate and coordinate care • Promote optimal quality • Match resources to needs  Avert unnecessary expenses ($20 million in 2005) • 1% of members drive 30% of health care costs Reminder: Case managers can help members understand their conditions, work with multiple providers and make the most of their benefits.
  23. 23. Disease Management: Change the Future The difference between… an existence controlled by your condition and taking control of your life.
  24. 24. Disease Management: Change the Future  Targets diabetes, cardiac, and respiratory conditions • AdviCare packages may cover additional conditions  Prevent or postpone complications  Nurses and clinicians offer one-on-one support • Interventions based on members’ risk level • Newsletters, care reminders, phone contact, other outreach • Support treatment plans and improve compliance • Improved clinical measures and outcomes • Help members understand and manage their condition(s)
  25. 25. Disease Management: Change the Future  Disease management is the difference between... BEFORE Uncontrolled Diabetic with Non-Healing Wound 3 Office Visits $ 375 Hospital Admission $25,000 Surgeon Fees $ 6,000 Prosthetic $12,000 Rehabilitation $24,000 Insulin $ 6,000 TOTAL $73,375 AFTER Controlled Diabetic 6 Office Visits $ 750 Foot Care $1,100 Dietician $ 300 Physical Therapy $ 500 Insulin $4,500 Pharmacy Services $ 110 TOTAL $7,260
  26. 26. Why Regence Disease Management Matters  45% of members with chronic conditions do not receive evidence-based care* • Medications, tests and exams, doctor visits • Improve diet and exercise • Reduce stress  Engaged members make better health care decisions  Improvements in quality of life may • Increase productivity • Reduce absenteeism and presenteeism • Slow cost trends over time • *Source: McGlynn, et al., New England Journal of Medicine, 2003.
  27. 27. Regence Disease Management Basics  Targeted conditions • Diabetes • Coronary artery disease (CAD) • Congestive heart failure (CHF) • Asthma • Chronic obstructive pulmonary disease (COPD) • Depression • Anxiety  Prevents or postpones complications  Supports treatment plans and improves compliance  Helps members understand and manage their condition
  28. 28. Health Care Advocacy for Members
  29. 29. Having A Chronic Illness Is Complicated Only about 20% of people with health conditions do what they should to maintain good health Take Medications Do Prescribed Tests Visit Doctor Regularly Reduce Stress ExerciseFollow Diet
  30. 30. Physicians Have Challenges, Too  Health care systems have driven physicians to “fix” patients, not maintain their health  Lack of time with patients  Increasing prevalence of chronic conditions  Shift to short term episodes rather than long term health status. Our goal is to support the physician with patient behaviors between office visits
  31. 31. We Stratify the Population  Stratification of Risk •Rules-based algorithms •Individually stratifies the population so we know where to start Low Risk High Risk
  32. 32. We Apply the Right Level of Intervention  4 levels of risk stratification  Program tailored to risk level  Fluid stratification algorithms (claims, prescriptions, updates, self report, physician and care calls)  Interventions based on member specific needs and best practice guidelines Level of intervention is based on individual stratification and risk status of the member
  33. 33. What do members participating in the program receive? AdviCare participants will be offered:  One-on-one nurse-based counseling  Support through telephone calls designed to help the member through coaching and education Members talk by phone with a knowledgeable RN who: One-on-one nurse-based counseling Understands the complexities of their conditions Can take the time to answer all of their questions Has access to a variety of educational materials
  34. 34. We Address the Whole Person  It’s about people, not the disease  Understand individual behaviors and help the participant modify them  In order to create change you must establish unconditional credibility and positive intent  Set goals with the patient that are achievable  Build on their successes All co-morbidities and behaviors must be managed simultaneously by the same trusted relationship
  35. 35. We Extend the Physician’s Reach  Expanded “interventions” between office visits  Comprehensive health condition protocols (evidence based standards of care)  Behavioral modification  In market nurses supporting practice patterns with tools and education A primary goal of our program is to support the physician with patient behaviors between office visits
  36. 36. Outcomes Reporting  Financial – semi-annual report reflects pre- versus post program results  Clinical Outcomes – semi-annual report on members’ overall compliance with selected standards of care  Utilization – semi-annual with % change in admissions, length of stay, ER visits and bed days  Member Satisfaction - annually  Activity – quarterly report showing members counts and type/frequency of member contact  Note: Client level reporting varies based on group size.
  37. 37. Health Care Cost for Diabetes Population Declined During Years 1 and 2 both in Real Terms and when Compared to Adjusted Base Period Costs Year 1 Trend is 7% Year 2 Trend is 12% Program Results
  38. 38. Diabetes Clinical Indicator Improvement
  39. 39. Results • 43,492 Program participants • 677,940 Educational mailings • 186,088 Telephonic interventions Office Visits ALOS (days) ER visits Admissions Bed Days Utilization Other Professional Pharmacy Outpatient Inpatient Overall Costs 6.56 6.0 263 157 938 $45 $97 $106 $58 $145 $431 Intervention 6.93 5.2 307 206 1,061 $47 $137 $118 $118 $147 $551 No Intervention -5% 13% -14% -24% -12% -4% -29% -10% -51% -2% -22% % Change
  40. 40. Member Satisfaction Percent of Members Rating the Program Good to Excellent Member satisfaction with healthcare increases steadily so you hear less noise. 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% Used AdviCare Suggestions & Guidelines Satisfied with Courtesy & Sensitivity of AdviCare Nurses Overall Satisfaction with AdviCare 78% 89% 78%
  41. 41. Success Story  Diagnosed with type 2 diabetes for over a decade.  During a Welcome Call, she told the AdviCare nurse that upon receiving her AdviCare diabetes workbook,she read it from "cover to cover." She stated more than once how pleased she was with it; in comparing it with others she had read, she found AdviCare's to be "more readable" and to contain "better dietary information" than others she had read. She reported that despite her long time diagnosis, she looked forward to participating in the AdviCare program.
  42. 42. Making a Difference in Someone’s Life  A member had a history of substance abuse and uncontrolled diabetes prior to her calls from the AdviCare program. For four years she had not been having regular laboratory testing or reviews of her medications. In 2005, the AdviCare nurses sent her workbooks and encouraged the member to review the standards of care. The member also set a goal to call member services and find a physician to help her manage her diabetes. Since then the member has had her medications reviewed, her annual exams, and A1C testing. She has continued to remain sober and stated she attributes her current health with diabetes to the information and support provided by the AdviCare nurses.
  43. 43. Thank you for attending… Jennifer Havlin, BA, BSN, RN Regence BlueShield (206) 332-5011

Notas del editor

  • Reality Check
    Break down of Health Care Premium $
    Shifting the dialogue and at the same time involving everyone in finding equitable solutions for both employers and employees seems to be the trend
  • …and less likely to:
    Engage in risky cost-saving behaviors
    Use ‘unproductive’ chronic care visits
    This translates into positive impacts for the employer. Members who feel better take fewer sick days and are more productive when they are at work. This coupled with a slowing claims trend can really add up.
  • We are pleased to offer our internally-administered disease management program to you. This program manages seven chronic conditions, including (national prevalence rates shown):
    Diabetes (7%)
    Asthma (7.5%)
    Chronic Obstructive Pulmonary Disease (3.1%)
    Congestive heart failure (CHF) (1-2%)
    Coronary artery disease (CAD) (6.9%)
    Depression (5.3% - 9.2%)
    Anxiety (17%)
    These programs are designed to postpone or even prevent future complications of these conditions and help our members take charge of their health and take an active role in managing their condition.
  • !