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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
$4
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Projected under current system
Insurance Connector plus selectedindividual options*Spending at current proportion(16.2%) of GDP
Commonwealth Fund, December 2008
0
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2000
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7000
1980 1984 1988 1992 1996 2000 2004
AustraliaCanadaDenmarkFranceGermanyNetherlandsNew ZealandSwedenSwitzerlandUnited KingdomUnited States
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2
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1980 1984 1988 1992 1996 2000 2004
AustraliaCanadaDenmarkFranceGermanyNetherlandsNew ZealandSwedenSwitzerlandUnited KingdomUnited States
Total expenditures on healthas percent of GDP
•Average spending on healthper capita ($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!
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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
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“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
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“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
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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
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Results reported with Alert and Trend Icons Personal Health Tracking Tools
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Single click to explanations and Personal Action Guidelines
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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
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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
