chronic disease prevalence key chronic conditions show overall higher exposure: 20% higher diabetes...

Chronic Disease Prevalence

•Key chronic conditions show overall higher exposure:

• 20% higher Diabetes

• 35% higher Chronic Renal Failure

• 2% higher Hypertension

• 32% higher Coronary Artery Disease

• 2% lower Back Pain

• 8% higher Asthma

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How does the City compare to other municipalities in the Central Region?

Value Levers Current Performance

Network Resources

• Access to Premium providers

• 57% of all eligible claim spend to premium physicians, 6% above UHC norm; Greater Milwaukee area at 59%

Clinical and Wellness Resources

• Personal Health Support• Disease Management• Healthy Pregnancy• HealtheNotes• HealtheNote Reminders

• 6.5% of all members were Actively Engaged with UHC nurses • 16% of members who qualified for high risk Disease

Management outreach engaged with a Nurse. All low and moderate risk Disease Management members received condition specific mailings.

• 37% of mothers who delivered in 2012 were enrolled in the Healthy Pregnancy Program

• 2,212 members received HealtheNotes representing 6,753 gaps in care; on average, 1.6 gaps in care per member were closed in the period

• 1,981 members received HealtheNote Reminders related to Women's Health and Childhood & Adolescent Immunizations


Current Solutions


2012 Healthy/Unknown Low-Medium Risk High Risk

% Population/Net Paid 62% / 14% 29% / 33% 9% / 53%

Primary Conditions (By Cost)

Preventive, Unknown, Infection/Inflammation,

Ear/Nose/Throat

Orthopedics/Rheumatology, Asthma, Diabetes

Diabetes, Coronary Artery Disease, Cancer

Claim Risk Score 0.29 (3.5% increase) 2.02 (No Change) 8.2 (3.8% decrease)

Net cost per member, per year

$1032 (21.2% decrease) $4,956 (28.5% decrease) $27,624 (7.1% decrease)

Premium Physician Utilization

47.0% 58.6% 61.6%

% Qualified / % Actively Engaged with Nurse

2.4% / 01.2% 203% / 8.1% 66% / 36.7%

Enrolled on Plan for 2+ years

78% 78% 76%

Members > Age 40 33% 64% 78%

Strategy Maintain Risk•Preventive care & age-appropriate screenings•PCP relationships•Lifestyle modifications (ex. Weight loss; increase activity, etc.)

Maintain Risk•Prior strategies PLUS•Healthcare Cost Estimator•Compliance with condition specific EBM guidelines•Wellness Engagement

Manage Risk•BOTH prior strategies PLUS•Engagement in condition specific programs

Population Health Risk Stratification

Diagnosis Group Current Active Retiree

Diabetes

Diabetes without complications 68.8 ▼ -5.8% ▲ 19.7% ▲ 57.0% 55.0 137.6

Diabetes with complications 23.3 ▼ -7.4% ▼ -8.0% ▲ 35.4% 18.4 46.2

Hypertension 107.7 -4.4% 1.8% ▲ 23.5% 83.6 222.6

Coronary Artery Disease (CAD)

Acute Myocardial Infarction 1.2 ▼ -8.2% ▼ -8.9% 4.5% 1.0 1.8

Coronary Atherosclerosis 19.4 3.6% ▲ 31.5% ▲ 28.3% 11.8 57.2

Congestive Heart Failure (CHF) 3.0 ▼ -23.5% 4.5% ▲ 29.1% 1.7 9.2

Chronic Renal Failure 5.9 ▼ -20.9% ▲ 35.1% ▲ 69.4% 4.5 11.6

COPD 15.1 ▲ 10.4% ▼ -17.1% 1.7% 12.7 25.1

Asthma 34.8 ▼ -5.3% 8.4% ▲ 16.0% 34.9 33.9

Intervertebral Disc Disorders 123.1 ▼ -5.3% -2.4% ▲ 23.7% 117.2 152.0

Normal Pregnancy/Delivery 20.1 ▼ -27.9% ▼ -7.8% 5.7% 23.2 5.2

Breast Cancer 6.8 ▲ 20.3% ▲ 10.6% 5.5% 5.2 15.3

Cervical Cancer 4.1 ▼ -41.3% ▼ -31.7% ▼ -28.4% 4.2 3.7

Colon Cancer 1.3 ▲ 76.0% -4.3% ▲ 14.0% 1.1 2.1

Prostate Cancer 4.3 ▲ 43.8% ▲ 37.2% ▲ 18.0% 2.1 16.2

Expected

Variance From

Claimants per 1,000

Variance From

Change Peer


Common/Chronic Diagnoses

• Prevalence of chronic illness above expected levels based on demographics

• Diabetes, heart disease, chronic renal failure, and back pain prevalence above peer


In 2012, the City of Milwaukee had 1,488 members (7.5% of total) with a diabetes diagnosis (150 more than in 2011) and total costs

of $16.3 million (25% of total); we expect another 150 new diabetics in 2013

Diabetic Members

$11,000cost per year+150 Individuals

To Convert

Non-Diabetic Adult Members

$4,400cost per year

Diabetic Prevention = Future Cost Prevention

This would add nearly

$1m to medical costs

annually

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

• 48% of City of Milwaukee’s members who qualified for outreach by UHC nurses became Actively Engaged – working with a nurse to reduce their risk, manage their illness and improve their healthcare experience

• 34% of members that qualified for Disease Management engaged with a nurse; once a nurse is able to reach the member, 91% agree to enroll in the program

Clinical Engagement

Why is UHC calling?

Please pick up the phone and find out. This is one call you don’t want to miss. In fact, it might change your life.

Your employer has asked UnitedHealthcare to contact you to offer valuable health services. If you receive a call, it’s because they’ve identified you as someone who could benefit from a telephone conversation with a nurse.

These are not sales calls; no one will try to sell you anything. These are also confidential calls. Our nurses will never share information with your employer

So, go ahead and answer the phone. You’ll be happy you did!

Here’s what you can expect from the calls:A nurse employed by UnitedHealthcare may call you and suggest you participate in a clinical management program. The nurse might

even call to simply check in and assist you with your healthcare needs.


Premium Designation Program

City of Milwaukee 2012 results:•57% of eligible costs went to Premium Providers•EBM compliance for Asthma, COPD and Heart Disease is better when a member is highly engaged with Premium docs•Utilization is better as well:

• 23% lower ER utilization• 5 point lower readmission rate• Net Paid PMPM is lower ($159 high

engagement vs $202 low engagement)

Quality and Efficiency = Better Care and Savings!

UnitedHealth Premium® designated surgeons have 59% lower complication

rates and 15% lower costs*

• 21 specialties are included, doctors are re-evaluated annually

• Criteria for evaluating are set by the specialty’s professional organization (i.e. American Academy of Pediatrics)

• Physicians must first achieve Quality designation before being evaluated for Efficiency


Solution Interventions Value Proposition

Chronic Conditions

• Promote engagement with UHC nurses• Wellness program expansion• Premium Designation

promotion/incentive

• Increased engagement in medical care and Disease Management maximizes the use of health resources to help manage risk and cost

Member Engagement

• Health4me, Treatment Cost Estimator and Premium Provider Education

• Provide employees and families with tools that allow them to maximize the benefits and resources available to them

Solution Opportunities

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Innovation that informs:Health Care Cost Estimator

Intuitive tool supports consumer decisions with consistently reliable cost estimates

• Helps each member make the best personal value choice – based on price, quality and convenience

• Methodology gives consumers consistently reliable estimates based on historic claims data, validated against actual fee schedules

• Links separate health events –appointments, procedures and follow-up – into an understandable care path

• Fully integrated within myuhc.com® – so members can speak with customer service professionals, get trusted data from care management nurses and make informed decisions with a single tool

Milwaukee, WI --- Knee MRIRange of Costs

$454 $2,888

City’s 90%

$409City’s 90%

$2,600

Cost and Quality Transparency Support Better Informed Decisions

Health4Me

Innovation Driving Engagement

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Key health care resources at your fingertips

• Find the nearest Urgent Care, Convenience Care or ER

• Search for a provider• View your ID card and fax or email to a

provider• Estimate healthcare costs• Connect with NurseLine

• View claims for all your family members

• Connect with customer service professionals

• View benefit amounts and account balances

• Access your Personal Health Record

chronic disease prevalence key chronic conditions show overall higher exposure: 20% higher diabetes...

Documents

higher asthma

higher coronary artery

members age

higher chronic renal

higher hypertension

higher diabetes

heart disease

higher exposure