Better Care, Better Health and Lower Cost

James E. Pope, MD, FACC

Chief Science Officer, Healthways

September 16, 2010

WWW.HEALTHWAYS.COM

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What is Driving Cost

Mozaffarian, Wilson and Kannel, Circulation 2008

$$$$$

Chronic Disease is driving increasing morbidity and cost…

…. and then you die.

But good news: There are treatments!

Bruckert ,E Eur Heart J Suppl 2005;7:L16-L20© The European Society of Cardiology 2005.

Relative odds reduction according to number of years in trial and reduction in LDL-c

Meta-analysis of 49 Clinical TrialsIschemic Heart Disease Risk Reduction

Lifestyle Changes and Risk Reduction

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“Exercise, exercise, exercise.

It's the only wonder drug we

have.”

Adults who are physically

active not only have a lower

risk of disease, depression and

chronic pain from conditions

like arthritis and back pain but

are also less vulnerable to

dementia than their inactive

peers.

-- Dr. Rosanne Leipzig, vice chair of the department of geriatrics at Mount Sinai School of Medicine - Time Magazine, June 22, 2009

It’s All About Prevention

Proven Solutions

Silver Sneakers Senior Fitness Solution• Lower total health care costs

• Lower hospitalization rate

• Cost & hospitalization rates lower for individuals participating > once a week

• Newly diagnosed depression lower in individuals participating > once a week

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Nguyen, H.Q., Ackermann, R.T., Maciejewski, M., Berke, E., Patrick, M., Williams, B., LoGerfo, J.P. (2008). Managed-Medicare Health Club Benefit and Reduced Health Care Costs Among Older Adults. Preventing Chronic Disease, 5(1), 1-10. http://www.cdc.gov/pcd/issues/2008/jan/07_0148.htm

Huong, H.Q., Maciejewski, M.L., Gao, S., Lin, E,Williams, B., & LeGerfo, J.P. (2008). Health Care Use and Costs Associated with Use of a Health Club Membership Benefit in Older Adults with Diabetes. Diabetes Care, 31(8), 1562-1567. http://care.diabetesjournals.org/content/vol31/issue8.

Huong, N.Q., Koepsell, T., Unuetzer, J., Larson, E.,& LoGerfo, J.P. (2008). Depression and Use of a Health Plan-Sponsored Physical Activity Program by Older Adults. American Journal of Preventive Medicine 35(2), 111-117. http://www.ajpm-online.net/article/S07493797(08)00381-4/abstract

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10% Risk Reduction$434 BILLION

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The Call to Action

Actuarial model that can score the value of health risk reduction

Demonstrates the potential savings from:

PreventionHealth PromotionChronic Care Management

Enormous value to be gained by• Helping Medicare beneficiaries stay

healthy and/or progress more slowly in disease severity

• Getting people to Medicare entry in a better health status

Source: Center for Health Research, Ingenix Consulting Analysis (2009)Medicare Beneficiaries starting number as of May 2010 (Kaiser Family Foundation)

10% Risk Reduction$652 BILLION

Chronic Disease Driving Cost

0%

20%

40%

60%

80%

100%

None 1 2 3 4 5+

26

40

68

90

6

15

42

72

0%

20%

40%

60%

80%

100%

0-19 20-44 45-64 65+

1 or more chronic conditions 2 or more chronic conditions

Percent of U.S. population with chronic conditionsby age group

Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.

Percent of Medicare expenses by beneficiarychronic condition status

Number of chronic conditions

Prevalence increases w

ith age

Cost increases w

ith Prevalence

Medicare Health Support (MHS) Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)1

Few Key Points• Three year randomized controlled studies of chronic care

management• Beneficiaries with diabetes and / or heart failure

• Selection of sicker individuals than average FFS Medicare• HCC2 score of 1.35 or greater (actual range 2.2 – 2.5)

• Eight pilots, assigned specific geographies• Different approaches selected to maximize learning

• Allowed to modify program design based on learning

• Participants needed to consent to receive program interventions• Lag time between program start and engagement of population

1 Title VII – Sec. 721 Under Traditional Fee for Service, Subtitle C – Voluntary Chronic Care Improvement2 Hierarchical Condition Code

Population Attributes

• PBPM Cost per beneficiary per month 3 X

• Hospital Admission Rate 2.5 X

• Hospital Bed-Days 2.5 X

• Skilled Nursing Facilities SNF admit rate 1.5 X

MHS vs. FFS Medicare

• Older, sicker, higher mortality• Seeing ~ 7-10 physicians on average

• Take ~10-20 medications at any point in time

• About 1% dying each monthSource: Healthways MHS program experience

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CMS FindingsGovernment Reports on Healthways MHS Performance

Source: Final Liability for Performance Monitoring Report; Mathematica Policy Research Submission to CMS (April 2009)Final Reconciliation for Healthways Medicare Health Support Program; Actuarial Research Corporation Submission to CMS (April 2009)Evaluation of Phase I of Medicare Health Support Pilot Program Under Traditional Fee-for-Service Medicare, McCall et al. Report to Congress (October 2008)Evaluation of Phase I of the Medicare Health Support Pilot Program Under Traditional Fee-for-Service Medicare: 18-Month Interim Analysis Report to Congress (June 2007)

Process of Care• Improvement in all 5 process of care measures:

Engagement• Consent rate of 89%• 65% continuous participation after consent

Physician support• All randomly-selected community-based

physicians reported that program could benefit beneficiaries with chronic conditions

Improved key clinical metrics

Gross savings created in both 1st and 2nd clinical cohorts

Net cost savings created in 2nd cohort

94% beneficiary satisfaction

CMS Scorecards on Healthways Reports to Congress (re Healthways)

• Help people adopt and maintain healthy lifestyle• Help reduce and where possible, eliminate health

risk• Optimize care for people with chronic conditions

Three Simple Aims

How NotTo EndUp Here

Prevalence of Chronic Disease

WWW.HEALTHWAYS.COM

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Center for Health Research

701 Cool Springs Blvd

Franklin, TN 37067

research@healthways.com

1414

Engagement Reduces Hospital Readmissions

The Impact of Post-Discharge Telephonic Follow-Up on Hospital Readmissions

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Accepted

(in press)

Harrison,P; The Impact of Post-Discharge Telephonic Follow-Up on Hospital Readmissions, 2010 Submitted Population Health Management

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Emory Study: Analysis of the Treatment EffectGreater Impact Observed for Active Participants

“… statistically significant decrease in spending

among those who fully participated in the program.

Total annual Medicare costs were 15% lower in 2007

for active participants, controlling for age, gender,

race and baseline risk. ”

Atherly, AJ, Thorpe, KE; Analysis of the Treatment Effect of Healthways’ Medicare Health Support Phase I Pilot ; Submitted Health Affairs, Jun 2010

DRAFT

Submitted

Journal of Population Health Management

“The Healthways study offers more proof that we know what works, and have the

ability to improve health and lower costs by engaging people and providing them with the support they need."

Kenneth E. Thorpe, PhD

Chair, Department of Health Policy and Management

Emory University Rollins School of Public Health

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MHS Outcomes in Important SubgroupsImpact of Predictive Model–Directed End-of-Life

Randomized control with treatment & control cohorts per CMS design

Focused on those in greatest need

Based on predictive model Top 10% death rate: 333 per 1000 Bottom 70% death rate 7 per 1000

Demonstrated statistically significant savings in the last 6 months of life for a total savings of

$5.95 million.

Hamlet, K; Am J Manag Care. 2010;16(5):379-384

Impact of Predictive Model–Directed End-of-Life Counseling for Medicare Beneficiaries