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8/7/2019 THR Keynote Feb 2011
1/13
Accountable HealthcareUtilizing Your Programs toInfluence Cultural Change
Presented by: Jeff StreseDirector of Human Resources
Southern Methodist University
8/7/2019 THR Keynote Feb 2011
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Southern Methodist UniversityA private university of 11,000 students near the center of Dallas, SMU offers
strong undergraduate, graduate, and professional programs through seven
schools in the humanities and sciences; business; the performing, visual,
and communication arts; engineering; education and human development;
law; and theology.
Locations: Dallas campus, SMU-in-Plano, SMU-in-Taos Benefit Eligible Groups: Faculty & Staff, Early Retirees and Retirees
Faculty/Staff
2,287 benefit eligible, 2,092 enrolled in health plan
Blue Cross Blue Shield of Texas (since 2005)
Retirees
417 enrolled in retiree health plan
Emeriti Retiree Health Solutions (since 2008)
2
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Cultural Challenges
Higher Education demands Best Practicebenefits approach
Different needs of faculty & staff population
Strategic decisions need buy-in from FacultySenate, Benefits Council, etc.
Aging demographic
Average employee age is 47
2 year large claim spike
3
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Health Risk Identification
Health Risk
Assessment
Lab Values:Biometrics
Cost Analysis:Claims Data
Continued Risk
Claim & Clinical
Management
Intervention
TobaccoMetabolic
Syndrome
Clinical
Stress
Musculo-
skeletal
Reversed Risk
Ongoing
Monitoring
Trend Elimination Strategy
Keep theHealthy,Healthy
2011 Trajectory Health, LLC
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Employers must view
patient accountability astheir risk management
responsibility
Patients dont want to
be engaged in insurance
Disease production anddestruction cannot be
slowed with patient
compliance
High degree of variability
in provider quality andmedical outcomes
High degree price
variability even within a
network
Lack of integration in mosthealthcare delivery
systems
Focused gatekeeper
initiatives work
Accountabilityin Healthcare is Coming
Confidential-Not for Distribution2011 Trajectory Health, LLC
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Accountable Healthcare at SMU
Developed and launched organizational initiative in 2010 based on
healthcare inflation and reform
More aggressive levers in plan design for 2011 Eliminated lower deductible participants migrating to higher
deductibles
Incentivize mail order and generics
Implemented consumer driven, pre-procedure analysis Compass
All age appropriate screenings are at no cost to the participant
Increased stakeholder outreach awareness building for change
management reasons
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Who is REALLY Incurring Claims?
Intervention Challenge:
Who is going to move to
Red and Yellow next,
and how do you keep them
from getting there?
Healthy Status
Episodic Status
Catastrophic
Paid Claims
$0 - $999
7%
$1,000 - $9,99943%
> $10,00050%
# of Claimants> $10,000
5%
$0 - $99955%$1,000 - $9,999
40%
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Impacting Claim PatternsDisease & Pre-Disease Management
Disease Management Pre-Disease Management
Naturally Slim/Healthy Lifestyles
10-Week Clinical Intervention
Program Metabolic Syndrome Education
Pre and Post Program Biometric
Screenings
Health Coach
Online Wellness Community
NS Town
Healthy Status
Episodic Status
Catastrophic
Employee Wellness Program Wellpower Wellness Web Site On-site Biometric Screenings Annual Preventive & Diagnostic
Care Special Beginnings for Expectant
Mothers 24-Hour Nurseline Flu Shots
# of Claimants> $10,000
5%
$0 - $999
55%$1,000 - $9,99940%
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Metabolic Syndrome Improvement
All SMU Participants Benchmark
100%
47.1%
-53%
0%
10%
20%30%
40%
50%
60%
70%
80%
90%
100%
% of Population with MetS
Pre
Post
Change
932018
100%
54.8%
-45%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% of Population with MetS
Pre
Post
Change
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Clinical Lab Improvement
N = 154
71%
45%
56% 57%53%51%
23%
59%
32%
23%
-28% -50% 6% -43% -56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Elevated WaistCircumference
ElevatedTriglycerides
Reduced HDL["good
cholesterol"]
Elevated BloodPressure
Elevated FastingGlucose
Percentage of Participants
Prevalence of Specific Risk Factors
Pre
Post
Change
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Weight Loss
6
14
20
25
12 12
13
0
5
10
15
20
25
30
Gained 0 to
5
5 to
10
10 to
15
15 to
20
20 to
25
25 to
30
30+
CountofParticipants
Pounds Lost During Program
MetS Participants WeightLoss
N=93
Average Weight Loss: 12.7 pounds
Total Pounds Lost: 1177.4 pounds
Average Weight Loss: 11.8 pounds
Total Pounds Lost: 1823.9 pounds
11
25
31
40
2319
2 3
0
5
10
15
20
25
30
35
40
45
Gained 0 to5 5 to10 10 to15 15 to20 20 to25 25 to30 30+
Count of Participants
Pounds Lost During Program
All Participants WeightLoss
N=154
Count of Participants
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Next Steps at SMU
Implement more cost saving levers in 2012 plan
design Cost goal: $70 (SMU)/$30 (Employee)
Phase in more incentives for healthy
Lay the groundwork for cost penalties forunaccountable participants (unhealthy)
Targeted communication and education (increase
generics, mail order, screenings)
Increase organizational outreach to penetrate faculty
culture
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Questions?