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How to Get a Zero Health Care Cost Trend
- 1. How to Get a Zero Health Care Cost Trend Steven Aldana, Ph.D CEO WellSteps
- 2. Medical Costs per Person per Year $147 $356 $1,112 $2,851 $4,884 $8,411 $9,163 $9,597 $9,982 $0 $1,500 $3,000 $4,500 $6,000 $7,500 $9,000 $10,500 $12,000 $13,500 $15,000 1960 1970 1980 1990 2000 2010 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Kaiser Family Foundation
- 3. Medical Costs per Person per Year $147 $356 $1,112 $2,851 $4,884 $8,411 $9,163 $9,597 $9,982 $10,448 $10,942 $11,504 $12,132 $12,808 $13,488 $14,204 $14,944 $0 $1,500 $3,000 $4,500 $6,000 $7,500 $9,000 $10,500 $12,000 $13,500 $15,000 1960 1970 1980 1990 2000 2010 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Predicted Kaiser Family Foundation
- 4. Zero Health Care Cost Trend $11,590,407 $12,386,288 $13,603,419 $13,308,112 $12,273,168 $11,390,481 $0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 2009 2010 2011 2012 2013 2014 Zero Health Care Cost Trend Preventive Medicine, 2015 (in review)
- 5. 4 6 8 10 12 14 16 18 20 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Today 18% of GDP Percent of GDP Going to Health Care
- 6. U.S. Health Care as a Percentage of the GDP
- 7. U.S. Health Care as a Percentage of the GDP
- 8. U.S. Health Care as a Percentage of the GDP
- 9. January 10, 2223 Doctor Day in American 0% 20% 40% 60% 80% 100% 120% 1960 2010 2035 2060 2085 2110 2135 2160 2185 2210 2235
- 11. Health Insurance Premiums, Earnings and Inflation, 1999-2012 8% 24% 38%11% 29% 47% 38% 109% 172% 0% 20% 40% 60% 80% 100% 120% 140% 160% 180% 200% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 http://kff.org/health-costs/slide/cumulative-increases-in-health-insurance-premiums-workers-contributions-to-premiums-inflation-and-workers-earnings-1999-2012/
- 12. The Problem • Health care costs have and will continue to increase. • They will increase faster than salaries or inflation. • Employers and employees carrier the burden. • What can be done to slow the cost increases? • What can wellness do?
- 14. Drivers of Health Care Costs • Unhealthy behaviors • Salary and drug costs • Expensive technologies • Fragmented care • Lack of cost consideration • Fee for service • High admin costs • End-of-life care • Provider consolidation http://web1.millercenter.org/commissions/healthcare/HealthcareCommission-Report.pdf
- 15. Cost Reduction Strategies Drop insurance-cost shift Change carriers Negotiate rates Self insure High deductible plans Onsite clinics Disease management Wellness
- 16. Cost Drivers • Unhealthy behaviors • Salary and drug costs • Expensive technologies • Fragmented care • Lack of cost consideration • Fee for service • High admin costs • End-of-life care • Provider consolidation • Drop insurance-cost shift • Change carriers • Negotiate rates • Self insure • High deductible plans • Onsite clinics • Disease management • Wellness Cost Reduction Strategies
- 17. • Unhealthy behaviors • Salary and drug costs • Expensive technologies • Fragmented care • Lack of cost consideration • Fee for service • High admin costs • End-of-life care • Provider consolidation • Drop insurance-cost shift • Change carriers • Negotiate rates • Self insure • High deductible plans • Onsite clinics • Disease management • Wellness Cost Drivers Cost Reduction Strategies
- 18. Health Care Cost Control https://www.wellsteps.com/infographics
- 19. Claims 75% Pool Charge 5% Base Admin 11% Risk Charge 3% commission 3% Contribution to Profit or Reserves, 2% Ancillary benefits, 1% Where Your Insurance Premium Goes
- 20. Pool Charge How much of the Carrier’s Pool Experience is used? How much of the Group’s Experience is used? 400 200 100 2 300 # of employees 10% / 90%25 employees
- 21. How much of the Carrier’s Pool Experience is used? How much of the Group’s Experience is used? 400 200 100 2 300 # of employees 40% / 60%90 employees Pool Charge
- 22. How much of the Carrier’s Pool Experience is used? How much of the Group’s Experience is used? 400 200 100 2 300 # of employees 80% / 20%250 employees Pool Charge
- 23. How much of the Carrier’s Pool Experience is used? How much of the Group’s Experience is used? 400 200 100 2 # of employees 95% / 5%380 employees 300 Pool Charge
- 24. Claims 75% Pool Charge 5% Base Admin 11% Risk Charge 3% Commission 3% Contribution to Profit or Reserves, 2% Ancillary benefits, 1% Where Your Insurance Premium Goes
- 26. How to Get Zero Trend
- 27. Salt Lake County Wellness Program $200 $300 $400 $500 $600 $700 $800 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Participants Non Participants AverageCostPerClaim J Public Health Manag Pract. 2011 May-Jun;17(3):225-32
- 28. Bend the Trend, Not a Zero Trend $200 $300 $400 $500 $600 $700 $800 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Participants Non Participants AverageCostPerClaim J Public Health Manag Pract. 2011 May-Jun;17(3):225-32
- 29. Program Cost Program Savings ROI $1,456,788 ($919,542 for incentives) $4,841,898 $3,385,110 Cost Benefit Ratio of 3.32 J Public Health Manag Pract. 2011 May-Jun;17(3):225-32
- 30. • Self funded • Wellness program started in 2004 • Included biometric screening • Small campaigns • 41% participation • Significant incentive program J Public Health Manag Pract. 2011 May-Jun;17(3):225-32
- 31. Salt Lake County Wellness Program $200 $300 $400 $500 $600 $700 $800 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Participants Non Participants AverageCostPerClaim J Public Health Manag Pract. 2011 May-Jun;17(3):225-32
- 32. Health Care Costs Unhealthy behaviors Health risks Chronic disease Particip ation Zero Trend Wellness Model
- 33. Health Assessment Campaigns Culture Change Rewards Activity Tracker Screening Reminder Incentives Health Coaching Biometric screening WellSteps Guide Wearables Comprehensive Wellness Programming
- 34. Communication Drives Participation text messages CEO letter announcements kick-off meeting posters email company calendar push notifications postcards
- 36. Technology
- 38. Changes in Health Behavior Baseline Year 1 Year 2 <2 days of exercise/week 1.46 days 2.29 days 2.47 days (+69%) <60 minutes/week 18.79 min 113.20 min 134.71 min (+617%) <3 daily servings fruits/veggies 2.46 servings 3.48 servings 3.63 servings (+47%) <3 days of restful sleep/week 2.23 days 3.17 days 3.36 days (+51%) Smokers (days per week) 4.35 days 5.43 days 4.27 days (-1.6%) Alcohol Use (drinks/day) 1.31 drinks 1.16 drinks 1.10 drinks (-16%) American Journal of Health Behavior, Volume 39, Number 3, May 2015, pp. 345-351(7)
- 39. Risk Migration Baseline Follow-up High risk Medium risk Low risk High risk Medium risk Low risk
- 40. Risk Migration Baseline Follow-up High risk Medium risk Low risk High risk Medium risk Low risk
- 41. Risk Migration Baseline Follow-up High risk Medium risk Low risk High risk Medium risk Low risk
- 42. Exercise Days per Week Baseline (n) Year 2 (n) Change (%) Exercise (days/wk) ≤2 days/wk 3-4 days/wk 5 or more days/wk 502 845 526 American Journal of Health Behavior, Volume 39, Number 3, May 2015, pp. 345-351(7)
- 43. Exercise Days per Week Baseline (n) Year 2 (n) Change (%) Exercise (days/wk) ≤2 days/wk 3-4 days/wk 5 or more days/wk 502 845 526 390 912 571 -22 8 9 American Journal of Health Behavior, Volume 39, Number 3, May 2015, pp. 345-351(7)
- 45. Systolic Blood Pressure 129 148.7 131.5 143 110 115 120 125 130 135 140 145 150 155 120-140 >140 baseline year 1 Popul Health Manag. 2013
- 46. Systolic Blood Pressure Risk Migration N Decreased Score % MH Trend Chi-square P value Rate Ratio 95% CI Normal (<120) 906 19.1 < 0.0001 1.00 Reference Pre hyperten. (120-139) 1086 37.9 2.00 1.72-2.32 High (140-159) 322 62.7 3.35 2.81-3.99 Dangerous (≥160) 38 73.7 3.84 2.89-5.09 J Occup Environ Med. 2014 Jun;56(6):639-44
- 47. Diastolic Blood Pressure 86.2 80.3 75 77 79 81 83 85 87 >80 baseline year 1 Popul Health Manag. 2013
- 48. Cholesterol 217 261.5 215 247.5 200 210 220 230 240 250 260 270 200-240 >240 baseline year 1 Popul Health Manag. 2013
- 49. Glucose 116 105 100 102 104 106 108 110 112 114 116 118 >100 baseline year 1 Popul Health Manag. 2013
- 50. 22.2 27.2 35.2 22.6 27.5 34.9 20 22 24 26 28 30 32 34 36 <25 25-30 >30 baseline year 1 Body Mass Index Popul Health Manag. 2013
- 51. 0 10 20 30 40 50 60 70 80 1970 1980 1990 2000 2010 2020 USA England Canada Austria France Korea Brazil Percent Overweight or Obese W.H.O. 2013
- 52. More Published Results Group of Small Businesses 12 months JOEM August 2013 - Volume 55 - Issue 8 - p 895–900 Mid-Sized Business 12 months JOEM Volume 53, Number 9, September 2011 Mid-Sized Business Two-Year Follow-up Popul Health Manag. 2012 Oct;15(5):261-6 Large Organization Biometric Risk reduction JOEM Volume 56, Number 6, June 2014
- 53. Unhealthy behaviors Health risks Chronic disease Particip ation Where is the Chronic Disease Prevention Data?
- 54. Health Care Costs Unhealthy behaviors Health risks Chronic disease Particip ation Zero Trend Wellness Model
- 55. School District Wellness ROI Research Preventive Medicine, 2015 (in review)
- 56. Data Reviewed: • 7 years of claims data • Personal Health Assessment data • Biometric screening data • Employee eligibility data • Wellness program participation data Preventive Medicine, 2015 (in review)
- 57. The Research Process • Legal permissions, HIPPA compliance, decryption • Data cleaning, outliners, merging, range checking • SAS coding (6,000 lines of code) • Define participation, group creation • Adjust data for medical inflation • Set study parameters • Control for confounders: age, sex, baseline differences • Calculate ROI, program costs Preventive Medicine, 2015 (in review)
- 58. Predicted vs Actual Health Care Costs $0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 2009 2010 2011 2012 2013 2014 WellSteps Begins Predicted values from: http://kff.org/interactive/premiums-and-worker-contributions/
- 59. Actual Health Care Costs for Wellness Participants and Non participants $3,308 $3,805 $3,280 $3,330$3,414 $5,839 $6,177 $3,875 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 Baseline 2012 2013 2014 Participants Non participants WellSteps Begins Preventive Medicine, 2015 (in review)
- 60. Stop Loss Premium Amount per Employee Per Month Preventive Medicine, 2015 (in review) $21.00 $21.00 $20.50 $20.20 $20.30 $20.40 $20.50 $20.60 $20.70 $20.80 $20.90 $21.00 $21.10 2012 2013 2014 Stop Loss Premiums
- 61. Limitations • Not a randomized clinical trial • Control for outliners • Historical effects • Regression to the mean • Changes to benefits
- 62. Incentive Plan Year Must complete: Incentive 2011-2012 PHA Biometric screening $20 lower office copay $700 deductible reduced to $350 2012-2013 PHA Biometric screening $20 lower office copay $700 deductible reduced to $350 $40/month premium discount 2013-2014 PHA Biometric screening WellSteps campaign or approved alternate activity $20 lower office copay $700 deductible reduced to $350 $40/month premium discount
- 63. Employees Filing ≥ 1 Claims per Year 91% 91% 90% 67% 76% 69% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2012 2013 2014 Participants Non participants Preventive Medicine, 2015 (in review)
- 64. $5,025,138 -the total cost savings from participation in the wellness program over the three year period Preventive Medicine, 2015 (in review)
- 65. ROI Calculations (3 years combined) $0 $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 Costs Savings Incentives Salary Screening WellSteps $1,412,736 $5,025,138 Preventive Medicine, 2015 (in review)
- 66. ROI Savings ($5,025,138) Costs ($1,412,736) Benefit to Cost ratio of 3.6 = Preventive Medicine, 2015 (in review)
- 67. Health Care Costs Unhealthy behaviors Health risks Chronic disease Particip ation Zero Trend Wellness Model
- 68. Health Assessment Campaigns Culture Change Rewards Activity Tracker Screening Reminder Incentives Health Coaching Biometric screening WellSteps Guide Wearables Comprehensive Wellness Programming
- 69. Zero Health Care Cost Trend $0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 2009 2010 2011 2012 2013 2014 Zero Health Care Cost Trend Preventive Medicine, 2015 (in review)
- 70. Questions
- 75. Next Webinar... Answers to Wellness Questions Every Broker Should Know December 10th, 2015 Dr. Troy Adams