identifying needs - insights in well-being improvement

8/8/2019 Identifying Needs - Insights in Well-Being Improvement

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INSIGHTS INWELL-BEING

IMPROVEMENT

Identifying Needs


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CREATE

SUSTAINED

ENGAGEMENTS

CHANGE

BEHAVIORS

DELIVER

OUTCOMES

Assesses well-being beyond

physical health.

Views each person within

a population from a

complete perspective.

Anticipates, prioritizes and

prevents costly health events

through predictive models.

Our Well-Being Improvement

Solution identifies needs

with deep foresight and

preventive impact.

IDENTIFY

NEEDS


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OPPORTUNITY FOR IMPROVEMENT

Despite a proliferation of health and wellness

programs, medical expenditures and chronic disease

continue to rise. Evidence indicates a large-scale failure

to contain the containable. Yet the potential for positive

change is significant and measurable. In a 2010 study,

Healthways Center for Health Research found nearly $1

trillion in healthcare costs could be saved over 10 years

by reducing risks in the U.S. commercially insured

population by 25%.

Critical to containing the containable are solutions

with sophisticated foresightsolutions that reduce

healthcare demand by anticipating and intervening to

improve well-being and stop or reduce preventable costs.

Identifying needs is the first step in the process for well-

being improvement.

Traditional health programs have often failed to prevent

costly disease by:

Identifying needs too latefor example, offeringdiabetes management support to individuals with a

diabetes diagnosis who are already complying with

standards of care, while in the broader population,

other individuals with risks for diabetes move

toward chronic disease.

Overlooking the interrelationships of risks,

demographics, and other factors that influence

well-being and ultimately impact medical costs

and human performancereaching out only to

address specific high risks, such as smoking or

hypertension.

Ignoring individuals without current indicators of

disease or high risks.

HEALTHWAYS APPROACH

Our Well-Being Improvement Solution uses

proprietary tools that work in concert to identify

improvement needs and determine appropriate support

across the population:

Guiding improvement for every personincluding

the healthiestwith a deep and comprehensive view

of the social, emotional, and physical factors that

influence well-being.

Directing proactive outreach to the highest

opportunities for well-being improvement

individuals who are predicted to incur high

health costs without intervention and who have

health risks and gaps in care that Healthways

interventions are designed to address.

MEASURING WELL-BEING

The Healthways Well-Being Assessment (WBA)

provides a uniquely full view of the factors that influence

healthcare costs, health risks, and human performance.

The WBA advances the traditional health risk

assessment (HRA):

Containing an assessment of health risks accredited

by the National Committee on Quality Assurance

and based on the research of Dee Edington, Director

of the University of Michigans Health Management

Research Center. For individuals and populations

where biometric screening data is available,objective data can replace self-reported measures

for BMI, blood pressure, cholesterol, etc.

Insights in WellBeing Improvement:

Identifying Needs

Healthways guides well-being improvement across populations with deeper foresight, and more

preventive impact, than other solution providers. We assess well-being beyond physical health

and use sophisticated models to predict and prioritize costly health events that our interventions

can prevent.


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Addressing the six scientifically defined areas of

well-being tracked in the Gallup-Healthways Well-

Being Index:

Life evaluation, or overall outlook

Emotional health

Physical health

Healthy behavior

Work environment and quality

Basic access to health and life resources

Providing a comprehensive view of public well-

being in the United States since January 2008,

the Gallup-Healthways Well-Being Index (WBI)

amasses new data each day and has surpassed one

million completed surveys. Because Well-Being

Assessment measures can be matched against

those in the WBI, Healthways can benchmark an

organizations WBA results with current national

data. The WBA includes the tested depression

screening tool PHQ-2.

Delivering additional insights on productivity and

organizational cultureinfluences on absenteeism

and presenteeism, based on the published research

of Ronald Kessler, a professor of healthcare policy

at Harvard Medical Center.

As part of our Well-Being Improvement Solution,

Healthways administers the WBA annually to customer

populations via the member web portal and on paper as

needed.

Adding Biometric Screening

A random sample of 12,000 people completing both

a health risk assessment and worksite biometric

screening found that:

74% did not know their levels of cholesterol, blood

pressure, or body fat

42% more participants tested positive for

nicotine than reported they smoked

33% reported good or excellent self-perception of

health but unknowingly had three or more clinical

risk factors

28% reported good eating habits but had

dangerous blood fat levels3

To increase the accuracy and understanding of health

risks and related improvement efforts, Healthways

recommends obtaining objective biometric data from

populations where feasible. Healthways can manage

biometric screening for customer populations through

established relationships with screening partners.

Screenings include an abbreviated physical exam

measuring height, weight, blood pressure, and BMI

and a blood sample.

Healthways follows a fourstep event management

process to ensure accurate and valuable results:

Preparation

Offering online scheduling to participants and

providing detailed administrative information for

customer contacts at the worksite

Training

Using trusted screening partners who train, certify,

and retain individual examiners

Fulfillment

Ensuring standardized equipment and supplies,

provided from a central source

Site management

Specifying pre-screening visits for lead examiners

and sufficient staffing for positive participant

experience

Our technology integrates screening results with

other health data from the Well-Being Assessment.

Healthways can also incorporate screening results

from customer-selected providers. Resulting individualreports and an aggregate customer report provide a

convenient and complete health picture.

Evaluating Risk

Healthways uses WBA and screening data to identify

the need for health coaching outreach within customer

populations. An identification algorithm selects

individuals for coaching interventions. Health risk,

cost, and behavior change research and Healthways

customer experience influence the rules used within

the algorithm, which looks for:

Single risks with particularly high potential for

future health complications and costs, such as

extreme obesity

Multiple moderate risks, such as a positive

depression screening and suboptimal exercise


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Insights in Well-Being Improvement: Identifying Needs

PREDICTING ADVERSE HEALTH EVENTS

AND AVOIDABLE COSTS

To augment the WBA with a focus on identifying

and applying resources to the most urgent needs,

Healthways uses multiple neural network and clinical

risk predictive models. We are consistently improving

those models based on research, trends, and client

data. With more than 30 years of customer experience,Healthways has one of the largest multi-terabyte

healthcare outcomes data warehouses in the world. As a

result, our predictive models are highly evolved.

Healthways uses a matrix of predictive models on a

quarterly basis within most customer populations. The

models help identify not only who within the population

is likely to experience high-cost health events within

the next 12 months but whose costs are preventable

who has risks or gaps in care that our solutions are

designed to address.

We integrate needs identification with the capabilities

of our interventions, making the wisest use of health

management resources. Models essentially find and

screen the best opportunities for cost savings through

health improvement, producing a prioritized ladder of

individuals for outreach.

The process gradually funnels opportunities by:

Analysis

Analyzing 12 months of customer claims data,

supplemented with age and gender information, and

weighing more than 180 factors that give insight into

utilization and clinical patterns to forecast high-

cost events. Indicators may include new outpatient

diagnoses; a lack of compliance with certain

standards of care; or prior-year inpatient stays.

Integration

Integrating predicted high-cost events with

actionable codesmore than 400 distinct

diagnosis codes indicating risks and conditions

that Healthways solutions effectively address.(For example, hospitalizations for cancer surgery

or childbirth can be anticipated but would not be

actionable codes.)

Screening for addressable risks and gaps in care.

For example, individuals with:

Previously diagnosed heart disease who are

not on a statin

No physician office visit in the last 12 months

Prescriptions for more than 15 drug classes in

the period

Chest pain-related emergency room visits

The absence of addressable risks and gaps indicate

that individuals are already receiving proper care and

taking necessary steps to minimize health problems

Outreach to these individuals is less likely to provide

care or cost benefits.

Finding Savingsand Helping People

Overlooked by Old Methods

Traditional disease management programs look fointervention opportunities within narrow diseas

corridors, but these condition-specific approache

overlook 20 to 30% of the people who most need help

Healthways predictive models break out of diseas

silos. We find needs among people without curren

disease diagnoses and people with existing diagnose

who may be headed for a different chronic condition o

event. The following four examples cut potential cost

by nearly $60,000:

Member A

Data show unspecified chest pain, palpitations, highcholesterol, hypertension, shortness of breath, and

carotid artery stenosis, treated in an inpatient stay.

Interventions could prevent or delay progression

to congestive heart failure and atrial fibrillation.

Preventable inpatient costs: $10,000.

Member B

Data show evidence of cerebrovascular disease,

peripheral artery disease, hypertension, back pain,

and multiple emergency room visits for headaches

and urinary tract infections. Interventions could

help prevent sudden collapse and coronary artery

disease. Preventable inpatient costs: $11,000.

Member C

Data show a diagnosis of chronic obstructive

pulmonary disorder, high cholesterol, and recent

outpatient visits for back pain and pneumonia.

Interventions could prevent coronary artery disease


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leading to a bypass graft. Preventable inpatient

costs: $15,000.

Member D

Data show asthma diagnosis and a recent blood

clot, with outpatient, inpatient, and emergency

room visits for coagulation disorders. Interventions

could prevent a coronary event (acute myocardial

infarction). Preventable inpatient costs: $23,000.

Reflecting Customer Populations

Healthways customizes predictive models for particular

populations. We have developed a predictive model

for Medicare Advantage populations based on the

interactions and impacts of risk factors on senior

members. Also for senior populations, our end-of-

life model can identify members at the highest risk of

death in the coming 12 months and connect them with a

unique intervention set that helps them think through

and express their wishes about heroic measures and

palliative care.

For large health plans and employers, we may

recommend customizing predictive models based on

unique population patterns.

Because our predictive models can be tuned to produce

a ranked array of outreach opportunities, Healthways

can work with each customer to determine strategies

to optimize business objectives: return-on-investment,

total savings, or other metrics.

We typically perform a tailored opportunity analysis

before solution implementation:

Applying Healthways predictive models to

customer data

Presenting alternatives for population outreach,

guided by model results

Recommending an approach based on customer

priorities and budget

Pinpointing Additional Needs

In addition to the high-priority needs identified through

our predictive models, the Healthways Embrace

technology platform supports real-time evaluation of

new incoming data and initiates needed action.

Hospitalization claims data may prompt outreach

by Healthways professionals to prevent potential

readmissions.

An algorithm using biometric screening and claims

data can identify the presence of chronic conditions and

initiate the delivery of standards-of-care information

via low-cost delivery channels. Customers can add

automated screening for additional clinical metrics,

such as missing preventive tests and procedures.

INITIATING ACTION

Needs identified through our proprietary toolsspark integrated preventive action at multiple levels:

by individuals, Healthways professionals, and customer

leadership.

Educating and Focusing Individuals

Every person who completes a Well-Being Assessment

receives a personalized results report providing a point-

in-time snapshot of health and well-being. Reports call

out areas that need attention using clear cues, colors,

and symbols.

Identifying scores in each of the six areas of well-

being as helping, hurting, or neutral to well-being

and offering improvement tips.

Displaying personal statistics and healthy targets

(based on age and gender) for measurable risks

and conditions including BMI, exercise, tobacco

use, stress, depression, cholesterol, blood pressure,

alcohol use, and medical conditions.

Recommending immediate steps to action, based

on healthy behaviors connected to an individuals

risks and conditions.

Reports link to and prompt use of the member web

portal, which guides each user to access and update

a Personal Well-Being Plan, complete daily actions

tailored to individual needs, and use relevant online

resources. Comprehensive chronic condition self-

management tools are among the resources reached

through the member portal.

Even individuals with healthy scores in all aspectsof the WBA will find personalized tips for well-being

improvement on their assessment report and be

encouraged to use a Personal Well-Being Plan to focus

on specific behaviors to maintain good health.


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Insights in Well-Being Improvement: Identifying Needs

Informing Healthways Professionals

Healthways predictive models and assessment

algorithms scientifically and cost-effectively

identify high-opportunity health needs across large

populations. Healthways health professionals take

needs identification to the next level, supported by our

technology platform and tools.

A portal for Healthways professionals highlights an

individuals identified areas of need and associated

behaviors and provides access to all the rich content

within each participants assessment and claims

history. Questions and prompts help the professional to

explore identified needs.

Based on a greater understanding of individual

situation and status, our health professionals may:

Focus interventions on new or related

improvement needs.

Move individuals out of proactive outreach

programs.

Extend a program of outreach for participants who

need continued support to close high-priority gaps

or reduce risks.

Providing Customer Organizations with

Actionable Insights

Customers receive an aggregate WBA report that

provides a clear sense of population well-being and its

impact across the organization.

Benchmarking

Benchmarking aggregate scores in each of the six

areas of well-being against national WBI data for

the same survey period. Comparative performance

better, worse, or the same as the benchmarkis

clearly noted.

Detailing Detailing aggregate responses to key questions

within each well-being areafor example, levels of

healthy eating and regular exercise within healthy

behavior and job satisfaction and supervisor

treatment within work environment.

Additional Factors

Reporting on additional factors that influence

productivity: caregiver responsibilities, job overload,

adequate training, technology issues, financial

stress, and depression or anxiety.

Organizational Risks

Identifying the prevalence of 11 organizational risks,

proven to increase healthcare costs and/or lostproductivity by the University of Michigans Health

Management Research Center.

Summarizing

Summarizing demographic data and the prevalence

of 21 health conditions compared to national

data. Where biometric screening data is available,

objective measures can replace self-reported

measures for BMI, blood pressure, cholesterol, etc.

By surveying people about the broader aspects of their

lives that are known to affect health but are seldom

taken into account, customers gain a more holistic,

relevant perspective on health and well-being, and

Healthways can recommend targeted measures to

support improvement efforts across the population.

Healthways can provide additional views of WBA data

that shed light on variations within and across an

organization, showing results by:

Division

Location

Job classification

Other criteria

These results can help reveal barriers to well-being

improvementleadership issues in a particular location,

cultural or environmental differences in healthy habits,

or disconnects between employee groups. Healthways

can work with organizations to address specialized

needs through program design and implementation.


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A BETTER WAY

For greater impact across populations, well-

being solutions must simply prevent more costs.

Identifying needs is the first step in the process.

Healthways proprietary toolspredictive models,

algorithms, and the WellBeing Assessment

support that process in the most effective

possible way:

Enabling every member of the population to

recognize, understand, and act on well-being

improvement needs: optimizing care for

those with health conditions; reducing and

eliminating lifestyle risks; and sustaining

good health.

Equipping individuals, Healthways

professionals, and customer organizations

with complete, integrated information andclear guidanceconsidering factors beyond

physical measures with significant influence

on health and well-being.

Accurately and efficiently forecasting high-

cost events.

Focusing resources on the best opportunities

to prevent those costsopportunities where

Healthways interventions produce results.

REFERENCES1An Unhealthy America: The Economic Burden of Chronic Disease, Charting a New

Course to Save Lives and Increase Productivity and Economic Growth, Milken Institute,

October 2007.2Savings Potential from Prevention & Risk Reduction for the Commercially Insured, A

Report from The Healthways Center for Health Research, May 2010.3Measuring the Success of the Healthways myHealthIQ Program, Healthways Center

for Health Research, 2006.

identifying needs - insights in well-being improvement

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