improving results and measuring roi of population health management initiatives
DESCRIPTION
In this presentation, CoreSource, a Trustmark company, discusses lessons learned and its use of data analytics to measure the effectiveness of population health management for smaller employer groups. Through the use of client examples, CoreSource will discuss: • Results from its YourCare program, a chronic disease and wellness management product • How its health system clients are using actionable analytics to directly manage population healthTRANSCRIPT
Improving Results and Measuring ROI of Population Health Management Initiatives
March 19, 20141
Presenter
Rob Corrigan is Vice President of Product Development and Strategy of CoreSource, currently leading their strategic planning and product development teams.
Since joining CoreSource in 2007, Rob has led the design and development solutions for YourCare population management, high risk insurance pools and integrated accountable care with health care organizations.
He is a regular speaker at national conferences and has authored several articles for Business Insurance. Rob earned a bachelor’s degree in Industrial Engineering and Business Administration, and a Master’s of Business Administration from the University of Illinois at Chicago.
2
About Verisk Health
Publicly-Traded
Focus on The Science of Risk
Financial Services
Property & Casualty
We drive performance in the business of healthcare. By combining clinical and analytics expertise with advanced technology and services, we help payers, employers and providers solve complex problems with measurable results.
$11.4 B Market Cap
Supply Chain
Healthcare
3
LESSONS LEARNED MANAGING A TOTAL POPULATION
TODAYS DISCUSSION• Background
CoreSource YourCare
• Evolution to Quantify Value In beginning….T1 / T2 Follow the Leaders to ROI Old fashion value—one person at a time Have it your way—D.I.Y. TPM Back to Future—DxCG flux capacitor?
• Questions
PERSONAL SERVICE FROM NATIONAL TPA
TPA Experience• 35+ Years in TPA industry
• 1,100 employees
• 1.3 Million Members*• 955,000 Medical benefits• 385,000 Dental benefits• 675,000 ancillary plans
• 785 self-funded clients• 49% under 500
employees• 100 over 1,000 employees• 17 over 5,000• Health Plans & Trusts
* * Note: includes members participating in multiple benefitsSAS70 Type II auditing standardwww.sas70.com
Superior Service Results• 10.9 Million claims processed a year
• $2.9 Billion benefits paid annually
• 2.1 Million member inquiries a year
Business Unit Target Markets Products
300 – 20,000+ EmployeesSchools, Hospitals, Manufacturing,
Municipalities, Services
Universal Life, Critical Illness Disability Income, Accident Consolidated/Payroll Billing
300 – 5,000+ Employees Claims Administration Care Management Other Benefit Administration
1,000+ EmployeesEmployer groups, disease
management companies, health plans
Health Coaching Biometric Screening Fitness Center Management 24/7 Nurse line Health & Member Advocacy Telephonic enrollment
2 – 500 Employees Level Self-Funding Medical Life, Dental & Disability Insurance
Employer Medical
TRUSTMARK GROUP
Trustmark Insurance is Rated A- (Excellent) by A.M. BestMutual Insurance Company—not subject to Wall Street
YOURCARE DEVELOPMENT—A TOTAL POPULATION MANAGEMENT PRODUCT YourCare launched (2008)
Gaps in Care Monitoring:• Chronic Conditions• Preventive Screenings
Health Coaching:• Chronic Conditions • Health Risks
HealthCenter (2009) Health Fitness (2011)
On-site HRA and screeningsHealth AdvisingExpand solutionsEnhanced Health Center
2008 2009 2010 2011 2012 20130
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000YourCare Membership
Client ProgramsTrustmarkCoreSource
CoreSource and Verisk HealthSupport for effective clinical integration
• Reporting• Tracking
Outcomes• Practice Profiling
Consumer Health RiskAssessments
Consumer Health RiskAssessments
Biometric Test ResultsBiometric Test Results
Eligibility & EnrollmentEligibility & Enrollment
Pharmacy ClaimsPharmacy Claims
Medical ClaimsMedical Claims
Data Consolidation
Centers of Excellence Utilization ManagementGaps in Care Outreach
Evidence-Based Analytics
Verisk IntelligentDatabases & Norms
Data Integration
Normalization
Identify Risk Factors
Stratify & Prioritize
Member Outreach &Program Enrollment
Member Registry
Care Navigation Chronic Condition Management
Lifestyle Behavior Coaching
Discharge Planning & Follow-up
Rules & Algorithms Risk/Care Gaps Risk Models (DcGX) Participation Status
Large Case ManagementAt-Risk Prevention
9
Electronic Medical RecordElectronic Medical Record
Reporting—Activity and Outcomes
Available Client Reports
Monitoring ReportsCondition Management & Prevention
Baseline
Mid-Year
Year-End
Health Advisor Enrollment Report
Coaching Progress Report
Coaching Outcomes Report
Coaching Satisfaction Report
HRA Impact Report (Verisk) HRA Aggregate Report
HRA T1/T2 Aggregate Report
Health Action Challenge Reports
- Great American Fitness Adventure
- Feel Like a Million
Screening Aggregate Report
Screening Satisfaction Report
Web Utilization Report
PARTICIPATION AND ENGAGEMENT
Care Gaps Monitoring Focus Coaching0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%YourCare Program Participation
YourCare Par-ticipant
Opt-Out / Declined
Could Not Contact
Chro
nica
lly Il
l Mem
bers
40%
60%
63%99%
Participation excludescurrent high cost members:
• Prior Year Costs > $25k• ARI > 20
or Cancer diagnosis or Case Management or Medicare eligible (65+) or COBRA participants or Enrolled < 24 months
Source: CoreSource YourCare 2013 participation, using Verisk Health Medical Intelligence Sightlines
Focus Coaching participation:– 79% < 3 months– 11% 3 to 6 months– 10% > 6 months
YOURCARE COMPLIANCE MONITORING
Cardiac Risk CAD/CHF Diabetes Respiratory Preventive0%
10%20%30%40%50%60%70%80%90%
100%T1 vs T2 Gaps in Care Compliance
BaselineYear EndVH Norm
Source: CoreSource YourCare client results October 2012 through November 2013
HEALTHCENTERIntegrated member experience: single sign-on from CoreSource portal
YOURCARE IMPACTS PARTICIPATION
Compliance is better for members usingPrimary physician or medical home (+16%)HealthCenter (+55%)
YourCare participants more likely to usePreventive Screenings (+15%)Annual Health Exam (+5%)Hospital Review and Case Management (+12%)
But has not influenced participation inHealth risk assessments (HRA)Health coaching
YourCare Solutions
INCENTIVE SOLUTIONS INCREASEPARTICIPATION AND RESULTS
0%
10%
20%
30%
40%
50%
60%
70%
80%
53%50%
41%
56%
30%
73%
39%
27%31%
54%
18%
70%
Reward Solutions EMPOWERED Coaching
*Source: Health Fitness clients (47) with over 400,000 Eligible Participants, 2012
16
FOLLOW THE MARKETRETURN ON INVESTMENT (ROI)
Natural experiment:• YourCare Clients—participants & opt-outs• Benchmark—other CoreSource groups not using TPM
DMAA ROI methodology• Member exclusion criteria• Hospital usage trends (T1 vs T2)• Quantify savings with average cost per service• ROI based on YourCare fees
YOURCARE ROI = $4.7 TO $1
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
CompliantMembers
Gaps in Care Medical Acuity Hospital Inpatient Emergency RoomVisits
Total Paid ClaimCosts
Your
Care
Hig
her(
Low
er) t
han
Benc
hmar
k
YourCare vs Non-YourCare (Benchmark) GroupsPrior YearCurrent Year
Source: CoreSource book-of-business analyzed using Verisk Health, April 2010Note: Outcomes compare the actual change for CoreSource groups using YourCare relative to other CoreSource groups NOT using any disease management program. Results are adjusted for differences in the risk and demographic mix of members across groups.
LESSONS LEARNED—BETTER COMPLIANCE LIMITS
ADDITIONAL CHRONIC ILLNESSES
People following the evidence-based guidelines for managing their chronic illness have fewer “gaps in care”….
. . . which limits developing other chronic conditions that escalate a person’s medical risk or acuity
Source: CoreSource Book-of-Business, January 2012 analyzed using Verisk Health Medical Intelligence SightlinesNote: Results includes all groups whether they use YourCare or not.
…RESULTING IN LOWER HOSPITAL UTILIZATION BETTER CONTROL OF HEALTH PLAN COSTS…compliant people have fewer
hospital admissions or emergency room visits for illness-related care...
. . . leading to lower health care costs & trends because their
chronic illness is under control
Source: CoreSource Clients experience, January 2012 analyzed using Verisk Health Medical Intelligence Sightlines.
DEFINING SUCCESS—ONE MEMBER AT A TIME Clients reaction—ROI is great, but what about my members? Compliance with evidence-based medicine guidelines is key:
• Define Compliance—using Care Gap Index (CGI)• Compliance trends by member
Impact on co-morbidities—no escalation of medical risk (RI) Defined Success controlling costs when:
• Low cost member remain low cost (below average)• Moderate cost members cost decline (as compared to prior year)• Higher cost members experience significant drop in costs (+25%)• Exclude High cost members (over $25,000 in prior year) to limit
regression to the mean affect
YOURCARE IMPROVES MEMBER COMPLIANCE
YourCare Participation Impacton Chronic Care Compliance
80%
65%
95%
47%40%
55%
81%
66%
87%
58%
33%
53%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
YourCareParticipants
Did NotParticipate
BenchmarkGroups
YourCareParticipants
Did NotParticipate
BenchmarkGroups
% o
f Mem
bers
with
Chr
onic
Illn
ess Prior Year
Current Year
Low Risk / Gaps in Care Monitoring Higher Risk / Focus RN Coaching
Source: CoreSource book-of-business analyzed using Verisk Health Medical Intelligence, April 2010
COMPLIANCE IMPACTS CLIENT’S RISK
Care Gaps Risk Index DxCG (M18) DxCG (M26) CoMorbidity0.75
0.8
0.85
0.9
0.95
1
1.05
1.1
1.15
1.2
1.25T1 vs T2 Risk Scores
BaselineYear End
Source: CoreSource YourCare client results October 2012 through November 2013
QUANTIFY SAVINGS BY MEMBER RISK LEVEL
YourCare Benchmark YourCare Benchmark YourCare Benchmark YourCare Benchmark$0
$1,000
$2,000
$3,000
$4,000
$5,000
YourCare vs Benchmark Group’s Change in Member’s Av-erage Annual Allowed Plan Costs by Medical Risk Level
Current Prior Year Current Prior Year
BaseYear
CurrentPeriod
Low Risk Members Average Risk (Median) At-Risk Members High Risk Members
Source: CoreSource YourCare Adult Members on Plan 2+ years, January 2012 analyzed using Verisk Health Medical Intelligence Sightlines
CLIENT PROGRAMS USING VERISK HEALTH
Clients using other:• Population Management products• Community-based health improvement initiatives
Health System clients• Pilot integrated care management on Employee plan• Proprietary population management product
Quarterly monitoring using Health Care Clients benchmark:• Overall cost and utilization trends• Chronic condition trends• Quality & utilization comparison trends
COMPLIANCE TRENDS AND BENCHMARKSBY CONDITION
Chronic Conditions by Physician Involvement in Managing Condition
# of Members w/Condition
Clients Members
CS BOB Average
VH NormCS BOB Average
VH NormChange in
ComplianceDec-12
Chronic Care Management ConditionsAsthma 997 86.2% 84.4% 83.2% 1.8% 3.0% (0.6%) 86.9%Chronic Obstructive Pulmonary Dx (COPD) 148 73.8% 74.0% 73.2% (0.2%) 0.6% (0.8%) 74.5%Congestive Heart Failure (CHF) 89 74.8% 74.2% 73.6% 0.5% 1.2% 0.1% 74.6%Coronary Artery Dx (CAD) 638 77.0% 76.3% 76.6% 0.7% 0.5% 0.7% 76.4%Diabetes 1,310 74.3% 76.9% 79.1% (2.6%) (4.8%) (0.6%) 74.9%Hypertension 3,043 73.9% 66.1% 69.4% 7.7% 4.4% 1.3% 72.6%
Medication Management ConditionsAtrial Fibrillation 154 45.8% 47.0% 62.1% (1.1%) (16.3%) (8.0%) 53.8%High Cholesterol 3,097 52.0% 60.5% 67.8% (8.5%) (15.8%) 4.6% 47.4%
Physician Monitored ConditionsArthritis 161 64.0% 68.8% 71.9% (4.8%) (7.9%) (5.7%) 69.7%Back/Neck Pain 2,068 92.8% 95.1% 95.4% (2.3%) (2.6%) (1.2%) 94.0%Depression 574 91.3% 92.4% 92.6% (1.1%) (1.3%) (1.1%) 92.4%End-Stage Renal Dx (ESRD) 126 65.0% 69.1% 69.0% (4.1%) (3.9%) (1.1%) 66.1%Inflammatory Bowel Dx (IBD) 117 87.5% 71.4% 71.6% 16.2% 15.9% 2.5% 85.0%Migraine 223 95.2% 90.5% 89.9% 4.6% 5.2% 1.4% 93.8%Pain Management 5,777 93.3% 93.5% 93.6% (0.2%) (0.3%) 2.6% 90.7%
Chronic Care Management based on compliance with physician office visits, medication and testing to monitor statusPhysician Management based on regular physician office visits and testing to monitor statusMedication Management based on medication compliance and regular physician visits to monitor status
Compliance with Evidence-Based Care Client Better (Worse) Compliance Trend
COMPLIANCE TRENDS AND BENCHMARKSBY MEMBER BEHAVIOR
Member Behaviors Contributing to Gaps in Care
Clients Members
CS BOB Average
VH NormCS BOB Average
VH NormChange in
ComplianceDec-12
Managing Chronic ConditionLong Office Visit with Doctor 9.2% 12.8% 11.2% 3.6% 2.0% (0.5%) 8.7%Medication Compliance 38.4% 40.3% 35.8% 1.9% (2.6%) 2.5% 40.9%Testing to Monitor Condition 49.4% 34.2% 29.0% (15.2%) (20.4%) (0.6%) 48.8%
Complications of Chronic IllnessAdmitted to Hospital 5.0% 4.4% 6.4% (0.6%) 1.4% (0.1%) 4.9%CoMorbid Chronic Condition 20.4% 19.2% 16.8% (1.2%) (3.6%) (0.3%) 20.2%Emergency Room Visit 11.0% 9.1% 11.7% (1.9%) 0.7% 0.2% 11.2%Hospital Re-Admission 6.7% 5.2% 6.2% (1.6%) (0.6%) (0.3%) 6.4%Illness-related Complication 4.0% 4.0% 4.3% 0.0% 0.3% (0.2%) 3.7%
Partnering with Primary PhysicianCondition Monitoring 55.5% 52.3% 48.8% (3.1%) (6.6%) (6.0%) 49.5%Follow-Up After Discharge 48.7% 48.5% 50.2% (0.2%) 1.5% (0.2%) 48.5%Follow-Up after ER Visit 24.5% 23.9% 26.1% (0.6%) 1.6% 1.2% 25.7%
Proactive Preventive HealthAnnual Physician Office Visit 19.5% 23.7% 28.4% 4.2% 8.9% 2.7% 22.2%Cancer Screening 49.1% 52.8% 58.3% 3.6% 9.2% (0.7%) 48.4%
Members with Gaps in Care Client Better (Worse) Compliance Trend
COMMUNITY-BASED DIABETIC HEALTH PROMOTION—CLIENT ASSESSMENT Participants are higher risk than other diabetics—
leading to more admissions, emergency room and physician visits
Yet, health care usage is under control:• Inpatient hospital patient days increased less• Emergency room visits declined
Benefit plan costs declined for participants:• Few high cost participants account for 24% of total costs• Other participants actual and risk-adjusted costs declined
ALLOWED CHARGES PER PERSON(EXCLUDING ALL HIGH COST MEMBERS)
Prior Year Current Year Prior Year Current Year$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
LPiHO ParticipantsAll Other Diabetics
Actual Medical Allowed Charges DxCG Normalized Charges
Impact of high-cost members::24% of LPiHO Members had annualcosts over $50,000 in prior/current yearas compared with 5% for other diabetics
Source: CoreSource Client’s Health Plan Experience from May 2010 through April 2012 analyzed using Verisk Health
RISK ADJUSTED COSTS AND TRENDS COMPARISON
Current Risk Adjusted Costs (Model #18)
Prior Year Projected Costs (Model #26)
Prior Year Projected Costs (Model #56)
0%
10%
20%
30%
40%
50%
60%
70%Actual vs Projected Member Costs
using DxCG Projected Costs
Compliant MembersStable NonCompliantDeclining Compliance
% o
f M
em
be
rs A
ctu
al <
Pro
jec
ted
Co
sts
Source: CoreSource Clients Health Plan Experience, 2011 to 2013 using Verisk Health Medical Intelligence Sightlines
CONCLUSIONS FROM LESSONS LEARNED
Participation leads to more participation Changing behavior better compliance
fewer hospital services lower total plan costs Tracking behavior changes is
easy….quantifying related cost savings can be tricky
Mid-market employers need member specific outcomes and savings—DxCG may be key
Verisk Health partners with us to improve process
Please type any questions into the Q&A box on your WebEx dashboard.
For more information about Verisk Health, or to request a copy of the slides:
32