Introducing… · 4/14/2011  · $4,200,000,000,000 . in just 7 years (Milken Institute 2007) •...

Introducing…

Why?

The largest single threat to our nations business and government financial survival is the staggering cost and unsustainable trend of providing health care for our citizens.

“More People, Less Sick”The Inevitable Solution to Americas Health Care Crisis

• Total annual costs of chronic disease:-$1,600,000,000,000 NOW.-$4,200,000,000,000 in just 7 years (Milken Institute 2007)

• Doubling time is now less than 6 years and accelerating.

• $400,000 per household now… with 2030 point-of-no-return!

• Current Medicare debt alone will bankrupt USA in 20 years. David Walker…fmr. Comptroller General

US Health Care Spending Paradox

Figure 15. Two-Thirds of Medicare Spending is for People With Five or More Chronic Conditions

5+ chronic conditions

66%

No chronic conditions

1%

4 chronic conditions

13%

1-2 chronic conditions

10%

3 chronic conditions

10%

Commonwealth Fund 2008

3.0

3.2

3.4

3.6

3.9

4.1

4.4

2.9

3.0

3.2

3.4

3.7

3.9

4.1

2.42.5

2.62.8

3.03.1

3.3

3.4

3.6

2.4

2.6

2.8

2.3

2.7 2.9

$2

$3

$4

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Projected under current system

Insurance Connector plus selectedindividual options*Spending at current proportion(16.2%) of GDP

Commonwealth Fund, December 2008

0

1000

2000

3000

4000

5000

6000

7000

1980 1984 1988 1992 1996 2000 2004

AustraliaCanadaDenmarkFranceGermanyNetherlandsNew ZealandSwedenSwitzerlandUnited KingdomUnited States

0

2

4

6

8

10

12

14

16

1980 1984 1988 1992 1996 2000 2004

AustraliaCanadaDenmarkFranceGermanyNetherlandsNew ZealandSwedenSwitzerlandUnited KingdomUnited States

Total expenditures on healthas percent of GDP

•Average spending on healthper capita ($US PPP)

1 France2 Italy3 San Marino4 Andorra5 Malta6 Singapore7 Spain8 Oman9 Austria10 Japan11 Norway12 Portugal13 Monaco14 Greece15 Iceland16 Luxembourg17 Netherlands18 United Kingdom

19 Ireland20 Switzerland21 Belgium22 Colombia23 Sweden24 Cyprus25 Germany26 Saudi Arabia27 United Arab Emirates28 Israel29 Morocco30 Canada31 Finland32 Australia33 Chile34 Denmark35 Dominica36 Costa Rica37 United States of America38 Slovenia39 Cuba40 Brunei

The World Health Organization

Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

AUS CAN GER NETH NZ UK US

OVERALL RANKING (2010) 3 6 4 1 5 2 7

Quality Care 4 7 5 2 1 3 6

Effective Care 2 7 6 3 5 1 4

Safe Care 6 5 3 1 4 2 7

Coordinated Care 4 5 7 2 1 3 6

Patient-Centered Care 2 5 3 6 1 7 4

Access 6.5 5 3 1 4 2 6.5

Cost-Related Problem 6 3.5 3.5 2 5 1 7

Timeliness of Care 6 7 2 1 3 4 5

Efficiency 2 6 5 3 4 1 7

Equity 4 5 3 1 6 2 7

Long, Healthy, Productive Lives 1 2 3 4 5 6 7

Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290

Country Rankings

1.00–2.33

2.34–4.66

4.67–7.00

Overall Ranking

$8130/year for every man, woman and child in the US spent on “Medical Care”

Versus$1.21/year spent on awareness and prevention or

“Health Care”Managed Care 2008 ©MediMedia USA

$8130/year for every man, woman and child in the US spent on “Medical Care”

Versus$1.21/year spent on awareness and prevention or

“Health Care”Managed Care 2008 ©MediMedia USA

•For every $1 spent on medical and pharmacy costs, employers incur $2.30 in absenteeism, productivity and presenteeism costs.

•If condition is Depression, Stress or Anxiety-related, employers incur $20 in “soft costs” for every $1 spent on medical and pharmacy expenses. (Journal of Environmental and Occupational Medicine, 09)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1985 1995 2007

Obesity Trends 1985-2007

Very Good News for those with solutions …these realities are oddly still largely a secret

75-85% HC spending focused on treating:Preventable diet and lifestyle-based conditions

(NIH, CDC, WHO)

Majority of chronic illness is preventable

Very Good News for those with solutions …these realities are oddly still largely a secret

75-85% HC spending focused on treating:Preventable diet and lifestyle-based conditions

(NIH, CDC, WHO)

Majority of chronic illness is preventable

Chronic illness:

- late stage of health-disease continuum

…..a continuum that has proven modifiable

Risk Factors DiagnosisProgressive

Disability and costs

Diet &Lifestyle

There’s No Argument

New Insights and Approaches are Needed

Collect, Protect and Connect the Vital DataEmpowering Health Response-Ability

20

Data-Directed Health Trend Management

Disney “America’s Healthiest Company”

The Data most have Claims/Rx:

• Although connecting to it in new ways can save $$, still concludes trend is inevitable• Focuses on “Supply chain management”• Data collected after Dx/claim happens• Not actionable data• Reveals # of current diabetics at cost of X

The Data most don’t have Biomarkers & Lifestyle Trend Data:

• Primary predictors of future claims• Best chance to avoid claims• Gathered before Dx (trend tracking) • Yields most significant Trend Shift• Predictive power grows as data does• Reveals # of pre-diabetics and savings possible through prediction and prevention

Data Directed Health Trend Management

• Existing medical care (treatment) system:– Designed to “manage” chronic disease…ATF – Early Detection and Disease Management is NOT

Prevention– Prevention requires prediction first followed by behavior

modification and tracking results (individual and group)

•Awareness•Trend TrackingPredict •Incentives

•FeedbackBehavior•Reinforcement•Adjust approach

Reevaluate

• Remove Cost Barriers• Remove Access Barriers

Alert & Inform Individuals

• Improve Efficiencies• Decrease Burden

Compliment Medical System

• Denial Busting• Reality Check

Enable Health Response-Ability

• Personalized• Context

Inspires Participation

Effective Personal Health Promotion System

Trend Tracking (data you don’t have) Before diagnosis is the key!

23

Data Directed Health Trend Management

Case Study:Employer (union) has 14,429 participants in health plan

• 2009 Total HC spend was $122,846,396• 748 individuals accounted for $51,237,223 in claims (5% accounted for 41%)

We went back and looked these 748 individuals up

• In 2007 440 (58%) of these individuals were in “lowest risk” category as defined by insurance company (BC/BS). This means they incurred less than $1000 in claims that year (this is ONLY way insurance companies categorize!)

• Questions: • Were these 440 were all “low-risk” in 2007?Or…• Did we just lack data-points necessary to know what their risk actually was?

• We cannot prevent what we cannot predict

• Predicting, preventing and mitigating chronic and critical disease requires much more comprehensive tracking of trends over time,than has been available to date in the marketplace…until now

Predict Prevent Mitigate

25

“We already do screenings”

HighGlucose

HighHbA1c

Diabetes

Biomarkers: When captured routinely and interpreted in a linear way as “end point data” are indicators of Disease

26

“We already do screenings”

Year 3Year 2Year1

ElevatedTriglycerides

ElevatedTriglycerides

ElevatedTriglycerides

ElevatedHbA1c

ElevatedHbA1c

ElevatedALT/AST Ratio

But, when measured more broadly and interpreted as trend are “Predictors of Dysfunction” which is precursor to Disease

27

Early Detection(Already have co-morbidities)

Traditional(Progressive Disability and Costs)

Glucose HbA1c

ALT/AST

CRP

Trig/HDL Ratio

Diabetes

Predictive/Preventive(Objective and Subjective

actionable intelligence)

Fatty Liver

GGT

Insulin Resistance

Diet Coke x4-6/day

Diet primarily processed foods

What are the primary reasons this isn’t happening now in our medical delivery system?• Costs- can now provide this for less than 1 average office visit to doctor• Systems- necessary to collect and protect this data don’t exist• Understanding- that real prevention of most conditions is achievable

Analysis on 2,261,562 employee/patients data - 2 yearsand $4.8 billion spent on “medical care”

< 21% had a “preventive medical visit” < 4% had comprehensive metabolic panel (CMP - essential to

evaluating key trends: kidney, liver function, diabetes…)< 2% had their lipid panel done (essential to predicting C-V risk)~ 1% had their Glycosylated hemoglobin test done (best

single biomarker for metabolic syndrome and risk to diabetes)

< .06% had their hs-CRP done (key to determining C-V risk and trend)

We’re Missing The Key Data Points!

None of these Companies had ANY Health Trend Data or

Actionable Risk-Trend Reports!

$4.8 Billion = $0 Investments

“The Information You Don’t Have”

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Vital Data Often Missing

Fragmented Systems Data Not Accessible

Vital Data Collected & Protected

Vital Data Accessible & Utilized

Renal Failure

Diabetes1-20 years

(elevated HbA1c, BUN, Creatinine)

Metabolic Syndrome2-20 years

(elevated Trig/HDL and LDL ratios)

Dysglycemia5-30 years

(elevated Glucose or HbA1c)

Waist Circumference

Fatty Liver Disease (ALT/AST Ratio)

Skips B-fast

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Data Directed Health Trend Management

Conditions

Risk Factors

Bio-Predictors viaLifeStrive-Trend

Analysis

• Chronic• Critical• Degenerative

• + Biomarkers• Genetics• Lifestyle

• Biomarker Trend Analysis

• Diet, Lifestyle, Genetic and bio-predictive correlations

Pred

icts

Pred

icts

The Cost-Shift

20

45

3125

31

9

1913 15

29

60

4234

24

4637

72

57

4554

3945 47

60

71

0

25

50

75

Did not fill aprescription

Did not seespecialist when

needed

Skippedmedical test,treatment, or

follow-up

Had medicalproblem, did

not see doctoror clinic

Any of the fouraccess

problems

TotalInsured all year, not underinsuredInsured all year, underinsuredInsured now, time uninsured in past yearUninsured now

Source: The Commonwealth Fund Biennial Health Insurance Survey (2007).

All of this bad news has created unprecedented opportunity to deliver the solution:

• Can fill the gaps created by “cost shift”• Remove cost and access barriers to critical

health/prevention services• Help employers “soften the landing” when they raise

deductibles or premium contributions• Protect people from unforeseen health care expenses and

medical bankruptcy• 62% of all bankruptcies in America• 78% had health insurance• $17,749 average amount owedHarvard University 2007

When you are able to:• Improve awareness of key risk factors, follow up with

properly individualized education and inspirational support, you can help to prevent and mitigate chronic illness and associated expenses…

• Have ROI-oriented solutions cover the costs of these efforts, while providing important employee financial safeguards…

• Result: Benefits become sustainable and make sense to employers and employees on a whole new level…

Predict and Prevent-Annual 50-Point Biometric Test CRP (hs)Lipid panel (cholesterol, HDL, LDL, the risk ratio, triglycerides)Complete Blood Count (CBC) (WBC, RBC, Platelets, Hct, Hgb)Fluids and ElectrolytesThyroid Panel w/TSHLiver Enzyme PanelKidney PanelHbA1c (Diabetes)Mineral Profile

Includes online interpretation, online education, etc…

Mitigate-24/7/356 access to MD on the phoneCan fill prescriptions, answer questions, order tests, etc…• Market Value of program exceeds $1400…now available for about

1/10th of that cost!

Email and Personal LettersLS direct + Employer direct

Employees notified that their personal web portal is ready

Insured logs in, prints lab requisition, chooses local lab

Insured visits lab(5,000+ locations)

Linked to personal results & interpretative report < 48 hrs

Insured completes Health and Lifestyle Assessment

Personal Health Promotion Report & web mini courses

for awareness & actions

Communication to remind & inspire to “take next step”LS direct + Employer direct

Process Flow

39

Results reported with Alert and Trend Icons Personal Health Tracking Tools

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Single click to explanations and Personal Action Guidelines

41

Members – have instant access to Personal Health Trend data on

50 important biomarkers.

Employers learn more about workforce needs Identities & Data are Protected

Results reported with Alert and Trend Icons Personal Health Tracking Tools

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General Health & Condition Specific Coursese-Learning Communities

Members choose when they learn24-7-365 access

44

Collaborative LearningLearn from Experts

And from Peers “L.E.A.P.” System

“The Information You Don’t Have”

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Vital Data Often Missing

Fragmented Systems Data Not Accessible

Vital Data Collected & Protected

Vital Data Accessible & Utilized

Disability

Absenteeism

Data-Directed Health

Promotion

Productivity

HC Costs

Workers Comp

Rx

Global Risk Management

What innovations are working?

Advance-Funding of Benefits- Use structured finance vehicle to guarantee rate for 3 years (self funded or fully insured)Premium Contributions- Example: Raise by $70/month and communicate that they will only increase by $20/month if participate in health promotion activitiesUse Supplemental Benefits as incentive for participation-purchase base Critical Illness policy for participants. Works well in HDHP environments where these benefits being offered or considered

Questions?

Contact:LifeStrive @ (866) 479-1380www.lifestrive.comrperryman@lifestrive.com