MEDICAL SCHEMES – A VEHICLE TO IMPROVE EMPLOYEE HEALTH

Jane Ball - Medscheme

TACKLING POOR HEALTH – A BUSINESS IMPERATIVE

Absenteeism costs the local economy between R12bn and R16bn annually.

Productivity losses associated with chronic diseases cost up to 400% more than the cost of treating the diseases themselves.

For a company to perform well, it needs healthy people. The fewer healthy people you have, the worse your business outcomes.

THE IMPACT OF POOR HEALTH ON ABSENTEEISM

days lost per 100 work days for high risk employees

day for employees with low risk health status

12

VS

1

POOR PRODUCTIVITY AND ABSENTEEISM IS LINKED

Higherabsenteeism amongst

self-reported unproductive employees

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WHAT COULD BE HAMPERING SUCCESS?

Stand-alone interventions– no data integration

EAPAbsenteeismMgt Wellness

Days

Health

Portal

Medical

Scheme

Generic offering with insufficient focus on the needs of specific groups

Little published evidence to inform programme design– ROI not usually calculated– no link to healthcare outcomes

FLU VACCINATION CAMPAIGNS SHOULD BE TARGETED

Resource Utilisation Band

5 fewer sick days(per 100) for high risk

employees who vaccinated

No flu vaccine

Flu vaccine

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EFFECTIVE HIV MANAGEMENT REDUCES ABSENCE DAYS

AfA – doing well

AfA – doing poorly

40

35

30

25

20

15

10

5

0

Ab

se

nc

e D

ay

s /

Em

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Absenteeism is 50% lower for employees who are doing well

when compared with employees who are

doing poorly

-50%

LESSONS LEARNT, BEST PRACTICE SUGGESTIONS

Alignment, Integration

Data analysis and actuarial modelling –

risk stratification

to focus resources

Clinical pathways

implemented by committed

healthcare professional

s

Empowering employees for

self-management

Coordinated, effective implementation of initiatives

Ongoing measuring

and monitoring of

outcomes

The medical scheme should be a key weapon in the employer’s

arsenal

WHY FOCUS ON VALUE TO THE EMPLOYER?

3

CONSEQUENCES: CLAIMS EXPERIENCE

Index:

Individual vs group claims

experience

• Risk adjusted

• Hospital claims only for similar

benefits

01

Anti-selection, missing lives and resultant higher

claims experience

0.90

1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70

1.80

0-1 2-19 20-34 35-44 45-54 55-64 65+ Avg

25% higher claims

from individuals on

like-for-like basis

Chronic medicine adherence should be promoted through medical scheme initiatives and employer

wellness initiatives

EMPLOYERS SHOULD ENCOURAGE CHRONIC MEDICINE ADHERENCE

High risk employees

without a chronic

registration show a higher

rate of absenteeism than

adherent employees

registered on the chronic

programme

18.0%

16.0%

14.0%

12.0%

10.0%

8.0%

6.0%

4.0%

2.0%

0.0%

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0 - 40% 40 - 60% 60 - 80% 80 - 100%

Medicine Adherence

CARE COORDINATION

“Care coordination is a conscious effort to ensure that all key information needed to make clinical decisions is available to patients and providers. It is defined as the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate

appropriate delivery of health care services.”

Initiatives to improve coordination of care have a direct impact on absenteeism levels – across all risk categories

Resource Utilisation Band (RUB)

Employees with a low level of coordination

Employees with a medium level of coordination

Employees with a high level of coordination

20%

15%

10%

5%

0%0 1 2 3 4 5Ra

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WELL COORDINATED CARE - LOWER ABSENTEEISM RATES

Source: Medscheme Health Intelligence Unit

0.5 fewer absence days per employee in the

treatment group – on time that would have

been spent in hospital alone

PATIENT CENTRED DISEASE MANAGEMENT REDUCES HOSPITALISATION

Predictive modelling is used to identify beneficiaries with multiple chronic conditions and a high chance of hospitalization in the next year. Active disease management for these individuals.

Impatient admission cost savings

R445.90 plpm

Impatient admission rate

85 per 1000 intervened lives

Hospital average length of stay

0.54 days

CONCLUSION

THANK YOU