County of Sacramento Review of Population Health … of Population Health through Kaiser Permanente Data. ... Explore the Ionic History of Kaiser ... Tunnel rescue squad serving the

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A BETTER WAY to invest in employee health

County of Sacramento

Review of Population Health through Kaiser Permanente Data

Dr. Diane Dailey, M.D., Chief of Business Health EngagementEileen Peterson, MPH, RD, TPMG Business Health Consultant, Public AffairsPatricia Purvis, Executive Account Manager, Strategic Accounts

1/18/2017

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Meeting Topic Guide

• The people enrolled

• The health status

• How health status influences chronic conditions

• The overall impact of population health on claims

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Explore the Ionic History of Kaiser Permanente…….

Patient at Contractors General Hospital, circa 1934

A talented young surgeon and a Vision

Dr. Garfield in front of his hospital, Mojave

Desert, 1935

Tunnel rescue squad serving the Colorado River Aqueduct Project workers, circa 1933

KP’s Oakland Medical Center started with rebuilding of the burned out shell of a former

hospital, Dr. Garfield on right, 1942

Sidney R. Garfield, MD1906 - 1984

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Your group at a glance

* The Kaiser Permanente regionally adjusted benchmark values are based on the weighted average of the purchaser’s distribution of members across the Kaiser Permanente regions for the time period being measured.

Member demographics County of SacramentoKaiser Permanente adjusted regional

average*Comparison

Subscribers 7,727 - -

Members 18,750 - -

Average age 33.2 33.9 .7 yrs younger

Gender (% female) 52.7% 50.6% 2.1% pts higher

Average family size 2.4 1.8 0.6 higher

Enrollment Stability Index 95.1% - -

County of Sacramento | Measurement period: OCT-01-2015 through SEP-30-2016

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Your results: lifestyle risks overview

^ ISS (Insufficient Sample Size) will be displayed if eligible member population for the prevention measure is less than 30. + As a newly reported measure, data is available beginning Q2 2013. For prediabetes and diabetes, not all members with an elevated fasting glucose test result > 126 or hemoglobin A1c > 6.5 will develop a diabetes diagnosis based on a single test result. An actual diabetic diagnosis is based on a number of clinical criteria. * Trust for America’s Health and the Robert Wood Johnson Foundation, 2013. ** CDC, 2014. *** American Heart Association, accessed September 9, 2013. **** CDC, accessed September 6, 2013.

Measure DescriptionYour

results, 2014 Q3^

Your results,

2016 Q3^

Kaiser Permanente adjusted regional

average

National comparative

data

Adult weight (BMI) % of adult members who are overweight or obese 74.2% 75.1% 68.2% 68.7%*

Childhood weight % of child members who are overweight or obese 31.4% 31.0% 31.5% 31.7%*

Exercise+% of adult members who are not meeting the minimum exercise recommendation

67.2% 66.4% 65.9% N/A

Prediabetes+ % of adult members who had a prediabetic test result 27.0% 29.2% 31.1% 37.0%**

Diabetes+ % of adult members who had a diabetic test result 12.7% 13.1% 11.8% 12.3%**

Cholesterol% of adult members with borderline high or high total cholesterol

35.0% 35.9% 35.9% N/A

Blood pressure % of adult members with blood pressure >=140/90 8.6% 9.7% 7.9% 33.3%***

Smoking rates % of adult members who smoke 10.6% 9.7% 10.0% 19.0%****


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Your results: preventive services overview

The data measurement period for preventive services lags a quarter behind lifestyle risks. It takes more time to collect and validate the data because each measure has a different eligible population.

* Continuously enrolled members during measurement period. ^ ISS (Insufficient Sample Size) will be displayed if eligible member population for the prevention measure is less than 30. + 2014 HEDIS® scores (90th percentile). ** CIS Combo 3.

Measure* DescriptionYour

results, 2014 Q2^

Your results,

2016 Q2^

Kaiser Permanente adjusted regional

average

National comparative

data+

Breast cancer screenings

% of eligible population screened 86.4% 82.1% 86.9% 82.4%

Cervical cancer screenings


Colorectal cancer screenings


Childhood immunization rates**



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UnderweightBMI < 18.5

NormalBMI 18.5–24.9

OverweightBMI 25.0–29.9

ObeseBMI 30.0 or higher

Your results: adult weight

Ages 21 to 74. Excludes members who utilized maternity services.The customer values will be displayed as 0% if the eligible member population for the metric is less than 30.

of your member population was measured in the last 12 months

75.1% of your 2016 Q3 adult member population is overweight or obese


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Your results: adult weight

* Van Nuys et al., American Journal of Health Promotion, May/June 2014.

On average, an overweight or obese employee costs an employer $2,295 more a year in direct and indirect medical expenses than an employee at a healthy weight.*

Your results in Direct and indirect costs related to weight

x

estimated additional annual direct and indirect costs

Overweight or obese adult members

6,440 members are overweight or obese

$2,295 additional medical costs


$14,779,800ISS

2016 Q3

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Normal test resultFasting glucose < 100

or hemoglobin A1c < 5.7

Prediabetic test resultFasting glucose 100–125

or hemoglobin A1c 5.7–6.4

Diabetic test result*

Fasting glucose > 126 or hemoglobin A1c > 6.5

Your results: glucose

* Not all members with an elevated fasting glucose test result > 126 or hemoglobin A1c > 6.5 will develop a diabetes diagnosis based on a single test result. An actual diabetic diagnosis is based on a number of clinical criteria.Total percentage of members ages 18 and older. The customer values will be displayed as 0% if the eligible member population for the metric is less than 30.Data isn’t available for any region prior to Q2 2013.

of your member population wasmeasured for glucose in the last 3 years

42.3% of your 2016 Q3 member population had a prediabetic or diabetic test result


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Your results in Medical costs related to diabetes

x

estimated additional annual medical costs

Your results: glucose

Employees with diabetes can cost their employers $4,413 more a year on average than nondiabetic employees.*

* National Business Coalition on Health, February 2012.† Not all members with an elevated fasting glucose test result > 126 or hemoglobin A1c > 6.5 will develop a diabetes diagnosis based on a single test result.An actual diabetic diagnosis is based on a number of clinical criteria.

Adult members with diabetic test results†

905 members have diabetes$4,413 additional medical costs

$3,993,765


†

2016 Q3

ISS

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DesirableTotal cholesterol < 200

BorderlineTotal cholesterol 200–239

HighTotal cholesterol > 240

Your results: cholesterol

Total percentage of members ages 18 to 75. Components of total cholesterol include LDL, HDL, and triglycerides.The customer values will be displayed as 0% if the eligible member population for the metric is less than 30.

of your member population wasmeasured for cholesterol in the last 5 years

35.9% of your 2013 Q3 member population has borderline to high total cholesterol


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Your results in Medical costs related to high cholesterol

x


Your results: cholesterol

* Goetzel et al., Health Affairs, 2012.

Employees with high cholesterol

Annual medical expenses for employees with high total cholesterol are about $92 more than expenses for employees with lower cholesterol.*

701 members have high cholesterol

$92 additional medical costs

$64,492


2016 Q3

ISS

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DesirableBP systolic/diastolic <140/90

UndesirableBP systolic/diastolic ≥ 140/90

Your results: blood pressure

The percentage of members ages 18 to 85 who came to a doctor during the measurement period and had a blood pressure reading. The customer values will be displayed as 0% if the eligible member population for the metric is less than 30.

of your member population was measured in the last 12 months


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Your results in Medical costs related to high blood pressure

x


Your results: blood pressure

Medical expenses for an employee with high blood pressure are $1,378 more than for an employee without high blood pressure.*

* Goetzel et al., Health Affairs, November 2012.

Employees with undesirable blood pressure

917 members have undesirable blood pressure

$1,378 additional medical costs


$1,263,626

2016 Q3

ISS

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Percentage that smokes

Your results: smoking

The customer values will be displayed as 0% if the eligible member population for the metric is less than 30.

of your member population age 18+ with a recorded result for smoking status


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Your results in Direct and indirect costs related to smoking

x

estimated additional annual direct and indirect costs

Your results: smoking

* Berman et al., tobaccocontrol.bmj.com, June 2, 2013.

Just one smoking employee can cost an employer $5,816 more per year compared to nonsmoking workers.*

Percentage that smokes

1,254 members smoke$5,816 additional medical costs


$7,293,264

2016 Q3

ISS

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The impact of chronic conditionsChronic conditions can have a significant impact on your employees’ quality of life. They’re also a primary driver of health care costs. Our integrated system of care and focus on member engagement help you improve your employees’ health and well-being while combating those costs.

People with chronic conditions account for up to 80% of health care costs. They also account for:*

* California Department of Public Health, 2013.

Hospital admissions

Prescriptions

Doctor’s office visits

Workers’ compensation claims cost about twice as much for employees with chronic conditions.** And these claims also result in more time away from work.

** Laws and Colon, NCCI Research Brief, October 2012.

Diabetes increased the average price of a claim by

$3,169Hypertension increased the average price of a claim by

$2,687Chronic obstructive pulmonary disease increased the average price of a claim by

$2,501

County of Sacramento | Measurement period: Jul-1-2015 through Jun-30-2016

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The importance of engagement

* Hibbard and Greene, Health Affairs, February 2013.

When people with chronic conditions are more engaged in their health, they are more likely to:

adhere to treatment

monitor their condition at home

get regular chronic care

Higher engagement is also linked to better health outcomes and lower costs.*

At Kaiser Permanente, our integrated care delivery makes it easier for members to actively participate in and manage their care, wherever they are:

At home At work At our facilities Online and on the go


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The calculations for this graph use DxCG methodology.

Percentage of costs from members with chronic conditions

of your costs are driven by of your members1

1 Continuously enrolled members during measurement period.

Percentage of your costs driven by chronic conditions

Percentage of U.S. employees who have at least one chronic condition or are overweight — and many of them have multiple chronic conditions.2

2 Witters and Agrawal, Gallup-Healthways Well-Being Index, January 2–October 2, 2011, gallup.com. 3 Brownlee, Center for Advancing Health, April 18, 2012.

People with multiple chronic conditions are more likely to end up in the hospital.3

86%


Percentage of members with

chronic conditions

22%63%

22.3%

77.9%

63.0%

37.0%

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* Continuously enrolled members during measurement period.Note: Major chronic conditions = diabetes, asthma, coronary artery disease, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and depression. Calculations for this graph use DxCG methodology.

Percentage of members compared to percentage of cost by condition*

of your costs are driven by of your members*

Percentage of your costs driven by conditions — segmented

10%

0%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Members Costs

2 or more major chronic conditions 3.4% 21.3%

1 major chronic condition 14.6% 28.7%

Additional chronic conditions 4.3% 13.0%

Cancer 0.7% 1.9%

Back pain 7.1% 7.0%

Arthritis 1.4% 2.1%

Injuries (other than back pain) 7.7% 4.4%

Maternity without other conditions 1.5% 5.0%

All other 59.5% 16.6%

22%63%

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Inpatient - $ PMPM and $ / Day

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Inpatient – Days /1000 and ALOS

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Inpatient Claims Top 10 - DRG

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Outpatient – $ PMPM and $/Visit

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Pharmacy Detail: Drug Category by Dollars in Claims, Drug Category by Medication Type

Generic37%

Brand34%

Specialty29%

2015 - % of Total Rx $

Generic36%

Brand34%

Specialty30%

2016 - % of Total Rx $

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Top 25 Drugs by Total Scripts sorted by Therapeutic Class

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Top 25 Drugs by Net Claims sorted by Therapeutic Class

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County of Sacramento Review of Population Health … of Population Health through Kaiser Permanente Data. ... Explore the Ionic History of Kaiser ... Tunnel rescue squad serving the