Please join us to learn how your employer clients can ...bhcgwi.org/wp-content/uploads/2016/11/Broker-meeting-slides-02-0… · • Culture - customs and traditions, and the beliefs

Proprietary & Confidential

All Rights Reserved

1BHCG

Health Conference

February 2018

Ray Fabius MD

Co-Founder

HealthNEXT

Please join us to learn how your employer clients can motivate consumers to make better health care decisions and how they can build and sustain cultures of health & wellbeing

Ray Fabius MDHonored to be With You Today

• Over 25 years of medical management experience

with Thomson Reuters, GE, Walgreens, Aetna,

Cigna and others

• Served as front line primary care physician for over

a decade

• Published articles, book chapters and three books

• Adjunct Faculty – Harvard, Jefferson, ACOEM

• Distinguished Fellow & Faculty Member of

American Association of Physician Leadership

• Co-founder of HealthNEXT

– Emerging Leader in building organizational

cultures of health

Proprietary & Confidential All rights reserved2

MY BACKGROUND: PHYSICIAN EXECUTIVE: PROVIDERS, PAYERS, PURCHASERS, A VENDOR / SUPPLIER, A PHARMACEUTICAL , AN INFORMATICS / CONSULTANCY

http://michaelpilla.com/clients/fabius/pages/100406_tr_675.htm

Title Population Health: Its Value & What

it takes to Achieve it TODAY’S AGENDA

• Define population health, population health management and cultures of health and wellbeing

• Delineate the evolution of medical management

• Establish the connection between health & wealth and provide evidence that a healthy workforce is a competitive advantage

• Appreciate that all health care constituents can collaborate and contribute to building cultures of health

What is Population Health ?

Implement Health Interventions

Impact Determinants of Health

Improve Health Status

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Confidential

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Proprietary &

Confidential

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6

POPULATION HEALTH

Examples of Interventions

CREATE TAXES TO IMPROVE POPULATION HEALTH

POPULATION HEALTH


Proprietary &

Confidential All Rights

Reserved

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CREATE LAWS TO IMPROVE POPULATION HEALTH

POPULATION HEALTH


Proprietary &


Reserved

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CREATE MEDICAL BREAKTHROUGHS TO IMPROVE POPULATION HEALTH

POPULATION HEALTH


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CREATE SAFER WORKPLACES TO IMPROVE POPULATION HEALTH

POPULATION HEALTH DETERMINANTS

• Intrapersonal – knowledge, attitude,

education, risks, access

• Social – peers, family, friends

• Employment – co-workers, policies,

workplace, security, income, purpose

• Community – environment, rules,

regulations

• Culture – norms, values, beliefs

Culture

Community

Workplace

Social

Personal

Stay well where you live, work and play

Proprietary & Confidential All Rights Reserved

HEALTH DETERMINANTS

• Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health.

• Education – low education levels are linked with poor health, more stress and lower self-confidence.

• Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions

• Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.

Proprietary &

Confidential

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HEALTH DETERMINANTS

• Social support networks – greater support from families, friends and communities is linked to better health.

• Culture - customs and traditions, and the beliefs of the family and community all affect health.

• Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses.

• Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.

• Health services - access and use of services that prevent and treat disease influences health

• Gender - Men and women suffer from different types of diseases at different ages.

Proprietary & Confidential All Rights Reserved 12

Lifestyle 51%

Heredity 20%

Environment 19%

Health Services 10%

Health Behaviors: The Main Mortality Risk Factors in U.S.

Lifestyle

Heredity

Environment

Health Services

Mokdad AH, et.al. Actual Causes of death in the United States, 2000. JAMA. 2004; 291:1238-1245.

Lifestyle: Strongest Determinant of Mortality

36

Pro

prie

tary

& C

on

fidentia

l

All

Rig

hts

Rese

rve

d

POPULATION HEALTH:Our Lifestyle Determines Our Health

The Centers for Disease Control

and Prevention (CDC) estimates…• 80% of heart disease and stroke

• 80% of type 2 diabetes

• 40% of cancer

…could be prevented if only

Americans were to do three

things:✓ Stop smoking

✓ Start eating healthy

✓ Get in shape

✓ Drink in moderation

“Don’t tell me your strategy, show

me your budget and I will tell you

your strategy.” Jack Welch

So How Much Do We Spend on Prevention?

Very Little = 3%

Population Health ManagementA Foundation for a Culture of Health

Necessary BUT not Sufficient


17

What is Your Chronic Illness Burden? Data & Analytics

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

High bloodpressure

High cholesterol depression Diabetes Heartburn GERD Astma Heart Disease

134

Proprietary & ConfidentialAll Rights Reserved

THE EVOLUTION OF MEDICAL MANAGEMENT: Connecting Health & Performance


Poor Health Impacts –Safety, Service & FinancialsContinuum of Employee Performance Outcomes

20Proprietary & Confidential All Rights Reserved

THE EVOLUTION OF MEDICAL MANAGEMENT:

THE FUTURE IS NOW

21

Utilization

Management

Disease

Management

Population

Health

Health &

Productivity

Leadership and

Corporate Culture

Leadership & Management

Support, Organizational Culture

and Policies, Alignment of

Business & Health Goals

Program Design and

Implementation

Planning and Program Goals, Integration of

Data Systems & Informatics, Diagnostics &

Assessment, Incentives, Multi-Component &

Tailored Interventions, Screening and Triage,

Ecological Interventions, Communications,

Health Benefits

Program Evaluation

Measurement &

Evaluation, Effective

Tools, Accountability,

Learn from Results, ROI

SOURCE: CDC Worksite Health Index Project

Culture

of

Health


: THE NEW BENCHMARK US HEALTHCARE COST TRENDS VS. TRUVEN HEALTH ANALYTICS CLIENTS

22

93

113

121

85

95

105

115

125

2005 2006 2007 2008 2009 2010

Co

mp

ou

nd

An

nu

al

Tre

nd

(2

005 =

100)

High Performer Net Cost Trends 2005 -2010 Adjusted For Consumer Price

Index (CPI-U) Inflation

High Performing Clients MarketScan Mercer

TRUVEN HEALTH ANALYTICS High

Performers Clients

Eight employers, with self funded plans, spanning multiple industries who also utilize TRUVEN HEALTH

ANALYTICS decision support and analytic consulting services. These clients consistently outperformed net

pay trend rates for the broader 53 client group each year and cumulatively from 2005 – 2010. As a group,

they have consistently made innovative use of healthcare data to support all aspects of population health,

productivity and plan management.

MarketScanA group of over 50 TRUVEN HEALTH ANALYTICS clients with 5 million members covered in self funded

plans that contributed to MarketScan continuously since 2005.

2010 Mercer National SurveyA comprehensive survey of 2,836 US employers. Reflecting the average reported healthcare trend rates

across group size, geographic region and industry type.


Demonstrating a Sustainable Culture of Health

Significant Return on Investment

Average Savings 2002-2008 =

$565/employee/year

Estimated ROI: $1.88 - $3.92 to $1.0023


Culture of Health – Becoming a Science

A Roadmap for Improving the Health of Your Employees

and Your Organization

www.ihpm.org/pdf/EmployerHealthAssetManagementRoadmap.pdf

1. Develop a Vision

2. Gain Leadership Support

3. Focus on Policies & Workplace

4. Cultivate a Data Warehouse

5. Set Goals & Program Elements

6. Implement Evidence Based Benefits

7. Leverage the Provider Community

8. Benchmark Best Practices


MY RECENT RESEARCH INTEREST – MEASURING CULTURES OF HEALTH

HealthNEXT EHOA™ Proprietary Methodology

10 Weighted Assessment Categories

• People & management

• Marketing & communications

• Data warehousing

• Health & wellness plan design

• Environment

• On-site health activities

• Health & wellness activities

• Incentives and benefits design

• Engagement & navigation

• Vendor integration

25

• Perfect score 1000

•Benchmark score 650-700

•218 “Elements”

• In 10 “Categories”

• 11 “Thresholds” of

implementation

• 5 “Degrees” of completion



People & Management Support

Marketing & Communications

Data Warehousing

Health & Wellness Plan Design

Environment

Onsite Health Activities

Incentives & Benefit Design

Engagement & Navigation

Health & Wellness Activities

Vendor Integration

26

EHOA – Scores vs. Benchmark2010 – 2017 FINAL

Confidential All Rights Reserved2/9/2018 27

CategoriesMax Score

Target Culture of Health Score

2017 Refresh 2015

Refresh2014

Refresh2013

2012(Back

Casting)

2011(Back

Casting)

2010(Back

Casting)

People & Management Support 100 75 81 80 72 68 56 53 46

Marketing & Communication 100 75 84 83 81 50 35 22 11

Data Warehousing 100 75 75 61 57 51 49 49 47

Health & Wellness Plan Design 50 35 32 31 26 26 21 19 17

Environment 100 75 54 54 49 34 27 25 24

On-site Health activities 100 60 46 44 43 38 38 36 36

Health & Wellness Activities 200 150 114 100 96 87 79 77 76

Incentives & Benefit Design 100 60 45 45 32 31 31 26 24

Engagement & Navigation 100 66 55 51 37 26 25 26 25

Vendor Integration 50 30 20 20 14 10 8 8 8

Total Score: 1000 701 605 570 506 420 369 341 314

Actual

Key Learning• Each COH organization gets to benchmark there via different

routes; different focus & priorities, specific to their needs and

corporate culture

• There were many costly distractions and “false-trails”, as each

occasionally tried new (non-integrated ideas & fads)

• They all achieved success through a critical mass of

“elements” they did consistently, over an extended period

• But, as importantly:

– Sequence matters

– Establishing a continuous improvement measurement and

troubleshooting “culture”; cockpits, dashboards, & scorecards

– With a multi-year strategic investment priority; top to bottom

– With actively engaged clinical / technical support; balancing

efficiency with effectiveness

• We identified that, (per Peter Drucker): “culture eats strategy for

breakfast”

– The secret-sauce is what we call creating

• “CULTURES OF HEALTH & SAFETY”


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28

“Culture

Eats

Strategy

for

Breakfast”

ACCESS TO TRADITIONAL HEALTH SERVICES

THE MEDICALLY HOMELESS

What % of first 600,000 visits to Retail

Clinics had no place to send the medical

care follow up report?– A) 40%

– B) 30%

– C) 20%

– D) 10%

29

The primary issue is not the building of medical homes

but the elimination of the medically homeless.

Answer A) 40%


All Rights Reserved

MANAGING A POPULATIONMoving The Population & Physicians To Benchmark

Trusted Clinician-Patient Relationships

Confidential All Rights Reserved

Medically

Homeless

Practice

Or

Clinic

Affiliated

Trusted

Clinician

Affiliated

Certified

Medical

Home

Move the population into high scoring, certified practices

High Scoring

Certified

Medical

Home


All Rights Reserved

Beyond The Medical HomeNavigating a Complex System

THE 4 RIGHTS OF HEALTHCARE

• getting the right patient

• to the right service

• at the right time

• for the right cost.


All Rights Reserved

31

Beyond The Medical HomeNavigating a Complex System

THE 4 RIGHTS OF HEALTHCARE

• getting the right patient

• to the right service

• at the right time

• for the right cost.


All Rights Reserved

32

Disease & Condition Management, High Performance

Networks; Centers of Excellence & Health Advocacy

Industry Moving to Comprehensive View

“Total Worker Health”

Culture of Employee Wellbeing = Health Prevention,

Health Promotion & Health Protection



All Rights Reserved34

ACOEM / HealthNEXT Research (September 2013)

Marketplace rewards companies

who achieve cultures of health:

• Used the ACOEM Corporate Health

Achievement Award (CHAA) culture

of health award winners as a stock

portfolio

• A portfolio of approximately twenty

publicly traded award winners; over

nearly two decades

• Published September 2013 in the

JOEM

• Once again the portfolio

outperformed the market

significantly; in all four test

scenarios

3 More Studies RECENTLY PUBLISHED

Marketplace rewards companies who achieve cultures of health

Health Enhancement Resource

Organization High Scoring

Companies

Health Project Award Winning

Companies

CHAA Award winning

companies

35


THE ULTIMATE GIFT OF HEALTH:

Compression Of Morbidity

Crimmins E M , Beltrán-Sánchez H J Gerontol B Psychol Sci Soc Sci 2011;66B:75-86

© The Author 2010. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

The longer you

stay healthy and

vital, the shorter

your period of

morbidity before

life ends.

De

gre

e o

f

We

lln

ess

The Goal Should

Be Sudden Death

in Overtime

The longer you stay healthy and vital,

the shorter your period of morbidity before life ends.


For More Information

• Contact me at [email protected]

• Check out my startup – www.healthnext.com

• For a copy of the Culture of Health Roadmap

http://www.ihpm.org/pdf/EmployerHealthAssetManagementRoadmap.pdf

• To learn more about communities of health

http://resources.iom.edu/PopHealth/Health-Lens.html

• To buy my book http://www.jblearning.com/catalog/9780763780432/• Follow me on Twitter @rayfabiusmd

mailto:[email protected]

http://www.healthnext.com/

http://www.ihpm.org/pdf/EmployerHealthAssetManagementRoadmap.pdf

http://resources.iom.edu/PopHealth/Health-Lens.html

http://www.jblearning.com/catalog/9780763780432/


All Rights Reserved

38BHCG

Health Conference

February 2018

Ray Fabius MD

Co-Founder

HealthNEXT

Please join us to learn how your employer clients can motivate consumers to make better health care decisions and how they can build and sustain cultures of health & wellbeing

Documents

Please join us to learn how your employer clients can ...bhcgwi.org/wp-content/uploads/2016/11/Broker-meeting-slides-02-0… · • Culture - customs and traditions, and the beliefs