1 November 16, 2010 National Business Coalition on Health A Data Driven, Employer Focused Value Based Health Strategy Initiative Presentation Sponsored

1

November 16, 2010

National Business Coalition on Health

A Data Driven, Employer Focused Value Based Health Strategy

Initiative

Presentation Sponsored by Pfizer

2

Empowering the EmployerEmpowering the Employer

William L. BruningPresident & CEO, Mid-America Coalition on Health Care

Douglas TappVice President, Total RewardsH&R BlockChairman - Board of Directors, Mid-America

Coalition on Health Care

3

Presentation FocusPresentation Focus

Background on the Kansas City Collaborative (KC2) initiative and its key partners

Introduce the American Health Strategy Project

Identify some of the VBB interventions that several employers are currently implementing

4

Mid-America Coalition on Health CareMid-America Coalition on Health Care

Improve the health of employees and their families

Promote employee and community wellness

Develop strategies for containing health care costs

Serve as a community resource in generating and communicating health care information

Over 30 years of collaboration toward incremental, Over 30 years of collaboration toward incremental, sustainable, and replicable change in health caresustainable, and replicable change in health care

Over 30 years of collaboration toward incremental, Over 30 years of collaboration toward incremental, sustainable, and replicable change in health caresustainable, and replicable change in health care

Mission:Mission:Mission:Mission:

5

Mid-America Coalition on Health CareMid-America Coalition on Health Care

Who We Are:Who We Are:Who We Are:Who We Are:

Founded: 1978 Established as a 501(c)(3)Founded: 1978 Established as a 501(c)(3)Founded: 1978 Established as a 501(c)(3)Founded: 1978 Established as a 501(c)(3)

Bi-State

60 members – 500,000 lives

Board of employers and all regional stakeholders

Budget $500,000 – split between dues and donations

4 employees

Fourth oldest employer Coalition in the nation

6

Value-Based Benefit Design: Restructuring Health BenefitsValue-Based Benefit Design: Restructuring Health Benefits

VBBD is a strategy that minimizes or eliminates out-of-pocket costs for high-value services in defined patient populations High-value services are identified through scientific evidence The more clinically beneficial and cost-effective the therapy is

for a patient group, the lower the out-of-pocket costs

Lowering out-of-pocket costs for high-value services has been found to improve access to and use of those services

More effective use of high-value services may positively impact the health of the targeted population Preventable adverse health consequences reduced Related high-cost health care services avoided

Chernew ME et al. Health Aff (Millwood). 2008;27:103-112; Fendrick AM et al. Am J Manag Care. 2001;7:861-867;Fendrick AM, Chernew ME. Am J Manag Care. 2006;12 (special issue):SP5-SP10.

7

How KC2 Defines Value Based BenefitsHow KC2 Defines Value Based Benefits

Taking a comprehensive approach to investing in health benefit and wellness program offerings;

Ensuring that beneficiaries receive high quality, evidence-based, and cost effective care;

Aligning incentives and removing barriers to getting the best care;

Using data to drive both decision-making and evaluation of health benefit and wellness programming.

In operationalizing “Value Based Benefits,” Kansas City employers have broadly defined it to mean:

Source: KC2 Project Team

8

KC2: A Unique Collaboration KC2: A Unique Collaboration

Proven track record testing and implementing national models

Bringing together 17 diverse employers and all regional health care stakeholders

Flexible program content designed to address dynamic employer needs

The “Coalition of Coalitions” Nearly 60 member coalitions

representing over 10,000 employers Support national dissemination of

learnings and replication of KC2 model

Project management Evidence-based

grounding Analytics and

technical strategies Funding assistance Participation in

national replication

Bruce Bagley, MDBruce Bagley, MDQuality DirectorQuality Director

Bruce Bagley, MDBruce Bagley, MDQuality DirectorQuality Director

Tom Parry, PhDTom Parry, PhDIntellectual DirectorIntellectual DirectorTom Parry, PhDTom Parry, PhD

Intellectual DirectorIntellectual DirectorJack Mahoney, MDJack Mahoney, MD

Medical DirectorMedical DirectorJack Mahoney, MDJack Mahoney, MD

Medical DirectorMedical Director

Marcia Wright, PharmDMarcia Wright, PharmDPharmacy DirectorPharmacy Director

Marcia Wright, PharmDMarcia Wright, PharmDPharmacy DirectorPharmacy Director

Creating Employer Collaboratives in New MarketsCreating Employer Collaboratives in New Markets

Oregon Coalition of Health Care

Purchasers

Dallas-Ft Worth Business Group on

Health

Midwest Business Group on Health

Pittsburgh Business Group on Health

Virginia Business Coalition on Health

Spreading the Collaborative Model Spreading the Collaborative Model

2008–2011

Engage and activate employers

Empower them to leverage existing data to support their health strategy

Facilitate implementation of VBB initiatives that promote prevention, lessen barriers and use evidenced based guidelines

Evaluate and publicize process learnings and outcomes

2010–2011

Test the approach with other coalitions

Refine and expand the tools and materials

Add to the Learnings

2011 and Beyond

Employer Guide

Package up materials and learnings for a la carte use with employers and coalitions

The Kansas City Collaborative:

The predecessor to

American Health Strategy Project

The Kansas City Collaborative:

The predecessor to

American Health Strategy Project

12

16 Employers, 63,000 KC Employees; 460,000 Lives Firm Wide16 Employers, 63,000 KC Employees; 460,000 Lives Firm Wide

Trademarks on this page are the property of their respective owners.

Firm WideFirm Wide Small to Mid-SizeSmall to Mid-Size Mid-Size to LargeMid-Size to Large JumboJumbo

#EEs 375–3,000 3,000–10,000 10,000+

Median Size Employer = 4009

13

Process of Applying Value-Based BenefitsProcess of Applying Value-Based Benefits

SustainableChange

© 2007 Mid America Coalition on Health Care

StartHere

Identify andcollect data

Integrate data

Use data toclassify risks

e.g., Chronic disease, lifestyle, high dollar

claims

Establish goals,design and conduct

worksite interventionsthat remove barriers to

healthy choices

Measure and evaluate outcomes

ROI

14

Baseline Assessment Tools and ReportsBaseline Assessment Tools and Reports

Community Report Individual Report


StructuredStructuredEmployerEmployer

WorkshopsWorkshops

StructuredStructuredEmployerEmployer

WorkshopsWorkshops

Data MappingData Mapping& Tracking& Tracking

Data MappingData Mapping& Tracking& Tracking

Structured Structured Employer Employer InterviewsInterviews

Structured Structured Employer Employer InterviewsInterviews

Initial Employer Initial Employer SurveysSurveys

Initial Employer Initial Employer SurveysSurveys

15

Implementing InterventionsImplementing Interventions

Community Report Individual Report

KCKC22 Business Health Implementation Strategy Business Health Implementation StrategyKCKC22 Business Health Implementation Strategy Business Health Implementation Strategy

KCKC22 Population Health Intervention Strategy Population Health Intervention StrategyKCKC22 Population Health Intervention Strategy Population Health Intervention Strategy


16

Identifying VBB InterventionsIdentifying VBB Interventions

Employer-specific

Measurable

Evidence-based

Optimizes outcomes

Definition:

Health Management Team

Actionable Data

Environment or Policy

Insurance Benefit Design

Employee Engagement

Vendor and Provider Value

Intervention Types


Health a Core Business Strategy

Health a Core Business Strategy

17

KC2 Business Health Implementation StrategyKC2 Business Health Implementation Strategy

Reflects Employers Business Related Health Implementation Plans

EvaluationEvaluationEvaluationEvaluation

Expenses/Cost TrendExpenses/Cost TrendExpenses/Cost TrendExpenses/Cost Trend

Focus of implementations

Types of Measures


BaselineBaselineFindingsFindingsBaselineBaselineFindingsFindings

BusinessBusinessHealth GoalsHealth Goals

BusinessBusinessHealth GoalsHealth Goals

Leadership/CultureLeadership/Culture

HMT StructureHMT Structure

Use of DataUse of Data

Access to DataAccess to Data

Actionable DataActionable Data

HealthManagement Team

HealthManagement Team

Building a HealthierCommunity

Building a HealthierCommunity

Coordinated Messaging

Coordinated Messaging

Employer Collaboration

Employer Collaboration

Community Capacity Building

Community Capacity Building

Community InvolvementCommunity Involvement

Participation in Community Events

Participation in Community Events

Participation in Collaboration

Participation in Collaboration

Participation in Message Campaigns

Participation in Message Campaigns

18

KC2 Population Health Intervention StrategyKC2 Population Health Intervention Strategy

Reflects Employers Population Health Intervention Plans

BaselineBaselineFindingsFindingsBaselineBaselineFindingsFindings

PopulationPopulationHealth GoalsHealth GoalsPopulationPopulation

Health GoalsHealth Goals

Participation RatesParticipation Rates

Self-Reported Behavior ChangeSelf-Reported

Behavior Change

BiometricsBiometrics

Risk Status ChangeRisk Status Change

Utilization ChangeUtilization Change

Overweight/ObesityOverweight/Obesity

High Blood PressureHigh Blood Pressure

High Blood SugarHigh Blood Sugar

High CholesterolHigh Cholesterol

SmokingSmoking

Diet and NutritionDiet and Nutrition

Physical ActivityPhysical Activity

Quit RatesQuit Rates

Med AdherenceMed Adherence

Receipt ofPreventive Care




Focus of interventions Types of Measures


Implementation Support ToolsImplementation Support Tools

Glossary of types of Interventions

Intervention Models

Guide to Business and Population Health Objectives

Intervention Grids

Cardiometabolic Road Map

19

Guide to Business and Population Health ObjectivesGuide to Business and Population Health Objectives

A workbook to help work through Planning and Implementation

Stepwise processSet GoalsChoose ObjectivesPlan and Implement

Interventions

20

Evidence Based ResourcesEvidence Based Resources

Intervention GridsBusiness Goals

–Health as a Core Strategy–Building a Healthier Community

Population Health Goals (Cardiometabolic Risk Focused)–Overweight/Obesity–High Blood Sugar–High Blood Pressure–High Blood Cholesterol–Smoking

Cardiometabolic Roadmap

21

22

KC2® Intervention GridKC2® Intervention Grid

Employer Applications of Value

Based Benefits

November 16, 2010

Employer Applications of Value

Based Benefits

November 16, 2010

Douglas Tapp

Vice President, Total Rewards

Employer Case StudiesEmployer Case Studies

Sprint - Nation’s largest independent local telephone provider and a leader in telecommunications innovation

Population Health Goal: Smoking

City of Kansas City, Missouri – Self-insured municipal government with unionized labor force and constantly changing and Council management structure as opposed to a traditional C-Suite

Business Health Goal: Strengthen Health Management Team

JE Dunn – 11th largest general building company in the U.S. with 18 office locations coast-to-coast

Population Health Goals: Weight, High Blood Pressure, Smoking

H&R Block - One of world’s largest tax services providers …

H&R Block: The CompanyH&R Block: The Company

25

EDUCATIONEDUCATION

H&R is one of the world's largest tax services providers More than 12,000 locations; retail office, on-line at

home or both! Utilizing more than 100,000 highly trained “tax

professionals” Prepared more than 550 million tax returns – still going Brand “icon” – 99%+ brand recognition Today, H&R Block:

– Prepares 1 in every 7 U.S. tax returns – Customized tax advice on more than 400 occupations– Files 1 in every 5 Earned Income Tax Credits

H&R Block: The CompanyH&R Block: The Company

26

EDUCATIONEDUCATION

Leading providers of business services through McGladrey and traditional banking solutions through H&R Block Bank

H&R Block success factors: Superior customer service A pledge to stand behind our work A commitment to serving clients where they

prefer to be reached — in a retail office, online, using software or a combination of methods.

H&R Block: Total Rewards PhilosophyH&R Block: Total Rewards Philosophy

27

Our Total Rewards Philosophy allows us to attract, motivate, develop and retain high-performing associates with the knowledge, skills, and abilities that will help H&R Block meet its long-term business objectives, while providing a rewarding work environment for our associates.

• Compensation that provides rewards based on individual and company performance

• Benefits to help associates manage their health, well being and financial planning for retirement

• Development that help associates grow their professional careers while balancing work and personal responsibilities.

Employee Assistance Strength in NumbersTuition AssistancePerformance Excellence

HealthLifeRetirementPaid Time OffPerks Plus/Well Power

SalaryShort Term IncentivesLong Term Incentives

Benefits

Development

Compensation

H&R Block: “Vision of Health”H&R Block: “Vision of Health”

28

Management Management Management Management TreatmentTreatmentTreatmentTreatment

PreventionPrevention

PreventionPreventionOpen Your Eyes!!Open Your Eyes!!Open Your Eyes!!Open Your Eyes!!

“Create a Culture of Wellness where

associates take responsibility for their health.”

ManagementManagementManagementManagement

H&R Block: “Vision of Health”H&R Block: “Vision of Health”

29

TreatmentTreatment TreatmentTreatment

Open Your Open Your Eyes!!Eyes!!

Open Your Open Your Eyes!!Eyes!!

ENGAGEMENT

RESPONSIBILITY

RESULTS

Prevention

H&R Block: “Vision of Health…MYTHS”H&R Block: “Vision of Health…MYTHS”

30

“PUSH”

Prevention

“I’m too busy”

“It’s not convenient…

I’m in the field”

“I’m young”

“I have a strong family

history”

“Isn’t thattoo private”

“That’s nice for the staff

but…”

31

H&R Block: Health Intervention StrategyH&R Block: Health Intervention Strategy

Reflects Employers Population Health Intervention Plans

BaselineBaseline

FindingsFindings

BaselineBaseline

FindingsFindings

PopulationPopulation





Self-Reported

Behavior Change

Self-Reported

Behavior Change




NeoplasmNeoplasm

Weight/ObesityWeight/Obesity

StressStress











Focus of interventions Types of MeasuresPHASE 1 Wellness


32

H&R Block: Value-Based Benefits Design ProcessH&R Block: Value-Based Benefits Design Process

SustainableChange

StartHere

Identify andcollect data

Integrate data

Use data toclassify risks

e.g., Chronic disease, lifestyle, high dollar

claims

Establish goals,design and conduct

worksite interventionsthat remove barriers to

healthy choices

Measure and evaluate outcomes

ROI

© 2007 Mid America Coalition on Health Care

Why did we decide to focus on Wellness? It starts at the beginning; the root cause of illness and the need

for treatment may stem from not having healthy habits or the education, i.e. what you eat, lack of exercise, family history.

Many times, you don’t know you aren’t healthy or you choose to ignore the signs.

At Block, we believe a partnership is the key. With education, our associates were ready.

33

Why Wellness?Why Wellness?


34

Neoplasms were the number one driver of cost? Prevention is key; warning signs abound Early detection is important

– whose responsibility? But…associates need to know the signs


35

“Early signs” In all indications, we were catching it late Increased inpatient admissions and average length of stay People entering the hospital were sicker


36

Our population was aging and a disproportionate amount of claims were attributable to ages 45+


37

We also started to think about other contributing factors We knew our business was going through big changes Change in leadership, reductions in force, tough economic

environment STRESS, weight, eating became real concerns as evidenced

through claims, screenings and discussions with employees

Environment, policy, business core values Implement a robust Wellness program “Building a Healthy You”

Insurance Benefit Design Free health risk assessment Free biometric screening – “Know Your Numbers” campaign Free preventative physicals Free maintenance meds (pilot) Incentives – “carrots and sticks” approach

Employee Engagement and Responsibility Messaging regarding a healthy lifestyle (flu shots, stress) CARROTS – Point$ bank, premium credits, HSA company match STICK – Tobacco premium, limit plan choices, timing

38

H&R Block - So what did we do?H&R Block - So what did we do?

39

H&R Block … and RESULTS?H&R Block … and RESULTS?

HRA participation

Screening participation

18% 50%Current Trend5.2%

21% 24%

64% 63%

15% 13%

0%

20%

40%

60%

80%

100%

Past Current

High: 6+ Risks Moderate: 3-5 Risks Low: 0-2 Risks

“high” health risks 16%

53%

31%

9%

54%

37%

Baseline Current

40

H&R Block: What’s Next?H&R Block: What’s Next?

BaselineBaseline

FindingsFindings

BaselineBaseline

FindingsFindings






Self-Reported

Behavior Change

Self-Reported

Behavior Change




NeoplasmNeoplasm

Weight/ObesityWeight/Obesity

StressStress











Focus of interventions Types of Measures

PHASE 2


H&R Block – The Healthcare ProgramH&R Block – The Healthcare Program

Focus on Consumerism and Wellness Consumerism = actively engaged in decision making Exceptional use of on-line tools and plan cost estimator Over 70% generic utilization in RX plan

Continue to offer medical plan choice but… highly incentivize our high deductible health plans

Enrollment trend toward full HDHP/HSA plans; 18-64% over 3 years

Reward wellness activities with incentives – non-tobacco use discount, premium credit and cash incentives for participation in wellness (health assessment participation to qualify) Total Wellness screenings are above normative ranges; little difference in wellness

activity rates between plan For 2011, moving to outcomes-based incentive design with health assessment and

biometric screenings required to earn incentives and receive company HSA contribution

Focus on network utilization Approximately 95% in all plan types

Discussionwww.machc.org

Bill [email protected]

Doug Tapp

Discussionwww.machc.org

Bill [email protected]

Doug Tapp

© 2010 Kansas City Collaborative All Rights Reserved. PG286306

Documents

1 November 16, 2010 National Business Coalition on Health A Data Driven, Employer Focused Value Based Health Strategy Initiative Presentation Sponsored