UK Health Care Task Force

Prevention and Wellness as a Cost Containment ComponentAugust 2001

Objectives

Identify the opportunity for savings through prevention and wellnessIdentify strategies that can be employed to capture these savingsDiscuss critical design components of successful program implementationCurrent UK status

Primary area of focus

High Risk/Behavioral Based Programming – health improvement on a population basisMedical Consumerism/Self-Care – addressing the inappropriate emergency type utilizationOther suggested strategies – such as after-care/recurrence prevention, primary prevention etc.

50%

20%

20%

10%

Lifestyle

Environment

Biology

Health Services

Lifestyle Accounts for 50% of Deaths

Source: CDC (1980)

Big Picture

High Risk Employees Cost More

Impact on Individual Health Care Costs:High versus Lower-Risk Employees

70.2%

46.3%

34.8%

21.4% 19.7%14.5% 11.7% 10.4%

-50%

-25%

0%

25%

50%

75%

100%D

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Stre

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Glu

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Wei

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Toba

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Past

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Blo

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Exer

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Perc

ent

Individuals at high risk for depression have 70.2% higher costs than those at lower risk

Individuals at high risk for depression have 70.2% higher costs than those at lower risk

Source: Goetzel et al. (1998)

Bottom LineMillions Can Be Saved

$0

$2

$4

$6

$8

$10

Projecting Medical Care Cost Increases Using Four Scenarios of Lifestyle Risk

Rates

Source: Leutzinger et al. (AJHP 2000) *1998 Dollars

Program holds risks

constant

Program reduces

risks 0.1%/yr

Program reduces

risks 1%/yr

No program w/ current risk

trends

Co

st(i

n

Mil

lio

ns*

)

$9.96$8.85

$7.89

$2.22

$7.74 Million Saved/Year

$7.74 Million Saved/Year

So what does it cost UK?

Three methodologies– By # risks– By type of risk – over 5 years– By type of risk – 1 year

So what does it cost UK?

Health BehaviorsCosts associated with high risks are estimated to

be between $8 - $12 million dollars annually

So what does it cost UK?

Inappropriate UtilizationHard to quantify at this point as there was no time to collect plan specific data in this areaIt is know that the state avg. ED utilization is higher than the national averageAccess to care may play a factor here at UK

So what does it cost UK?

Primary prevention/after-careLack of attention to after-care/recurrence prevention could have significant impact upon experience levelsAccess to primary prevention within the state is below average for mammography screening, PAP smears and eye exams for diabeticsNo time to collect plan specific data in this area

Objectives

Identify the opportunity for savings through prevention and wellness

Identify strategies that can be employed to capture these savingsDiscuss critical design components of successful program implementationCurrent UK status

Comprehensive Programs Have Positive ROI

HealthPromotion

Short-Term Long-Term

$3-$83-5 Years

$2-$51st Year

DemandManagement

Demand Management:Medical Consumerism

Designed to educate and provide resources to individuals so that they best use the health care resourceMost typically booklets, telephonic and/or web basedHigh training necessary

What does the data say?

37% of adults and 32% of children in Ky. use the ER every 6 monthsAvg. number of ED visits in state is higher than national average

Objectives

Identify the opportunity for savings through prevention and wellness

Identify strategies that can be employed to capture these savingsDiscuss critical design components of successful program implementationCurrent UK status

Comprehensive Programs Have Positive ROI

HealthPromotion

Short-Term Long-Term

$3-$83-5 Years

$2-$51st Year

DemandManagement

Health Promotion/Risk Reduction

Geared towards broad based population health improvementAddresses modifiable health behaviorsUK has the perfect situation to establish programming and is moving in this direction

Health Promotion/Risk Reduction

Prevalence – the percentage of the population in which these conditions exist as determined by UKHMO satisfaction surveys and/or statistics for the National Center for Health Statistics

Cost – determined through application of research data comparing symptomatic plan members cost to asymptomatic plan members cost

Prevalence

UKHMO Survey Data

Depression – 2.1%Elev. Glucose – 5.3%HBP – 20.8%Heart Disease – 2.8%

National/KY Health

Data

Stress – 18.5%Excess Weight – 20%Sedentary - 32%Tobacco – 20%

UKHMO Prevalence Rates

Risk Area Prevalence # in planDepression 2.10% 164Elevated Glucose 5.30% 413HBP 20.80% 1,622Heart Disease 2.80% 218Stress 18.50% 1,443Extreme Weight 20.00% 1,560Sedentary 32.00% 2,496Tobacco 20.00% 1,560

Cost

Avg. cost of study plan participant was $1,712.Additional or excess cost was clearly associated with the presence of lifestyle related illness and/or risk factors.Results were confirmed both long and short term.

CostRisk Area Annual CostExcess CostAverage Cost $1,712 $0Risk free $1,166 -$546Depression $2,713 $1,001Stress $2,212 $500Elevated Glucose $2,423 $711Extreme Weight $2,222 $510HBP $2,142 $430Sedenatry $2,064 $352Tobacco Use $1,967 $255Heart Disease $4,083 $2,371

Cost to UKHMO

Risk Area # in plan Excess CostAverage Cost 0 $0Depression 164 $164,164Stress 1,443 $721,500Elevated Glucose 413 $293,643Extreme Weight 1,560 $795,600HBP 1,622 $697,460Sedenatry 2,496 $878,592Tobacco Use 1,560 $397,800Heart Disease 218 $516,878

Financial Results

Reduced reliance on pharmaceuticalsDecreased experienceAnnual savings of $8 - $12 million dollars annually (once completely implemented)

Objectives

Identify the opportunity for savings through prevention and wellnessIdentify strategies that can be employed to capture these savings

Discuss critical design components of successful program implementationCurrent UK status

Behaviorally stagedFocus on maintenance and reinforcementProgram beyond risk or disease specificTailored to health and safety riskIncentives for participation

Principles of Effective Program Design

Source: Serxner (in press)

Repeated contactsVaried formatsPersonalizationLow cost & portableEasy to administerEmphasis on health and productivity

Principles of Effective Program Design

Source: Serxner (in press)

Multiple distribution channelsBuilt in program evaluationLong-term orientationIntegrated with Safety, Occupational Health, EAP, and TrainingVisible management support

Principles of Effective Program Design

Source: Serxner (in press)

Objectives

Identify the opportunity for savings through prevention and wellnessIdentify strategies that can be employed to capture these savingsDiscuss critical design components of successful program implementation

Current UK status

UK Status

UK has taken steps to implement comprehensive programPro-active partnership between UKHMO, UK Health Plans and UK WellnessBe Health Improvement Plan (Be H.I.P)Needs greater emphasis and integration

Primary area of focus

High Risk/Behavioral Based Programming – health improvement on a population basisMedical Consumerism/Self-Care – addressing the inappropriate emergency type utilizationOther suggested strategies – such as after-care/recurrence prevention, primary prevention etc.

After-care prevention

Cardiac RehabilitationComplications from diabetesCancer Screenings

There is a general lack of emphasis on prevention and of recurrence, which is arguably as

important as occurrence

After-care/prevention (cont.)

Cardiac Rehabilitation – KY statistics fall nearly 25% below national average in beta-blocker prescription.Diabetes - KY below avg. on eye exams annually for diabetics.Cancer Screenings - KY below average in annual cervical cancer screens and mammograms

To achieve impact

Comprehensive structure and vision for the medical plan which includes these strategiesContinued integration with providersEnhanced employee communications/educationCommitment and resources

Aldana SG. Financial impact of worksite health promotion and methodological quality of the evidence. Art of Health Promotion 1998; 2(1):1-8.

Anderson DR, Whitmer RW, Goetzel RZ, Ozminkowski RJ, Wasserman J, Serxner SA. The relationship between modifiable health risks and group-level health care expenditures. American Journal of Health Promotion 2000; September/October: 45-52. Burton WN, Conti DJ, Chen CY, Schultz AB, Edington DW. The role of health risk factors and disease on worker productivity. Journal of Occupational and Environmental Medicine 1999; 41(10): 863-877.Edington DW, Yen LT, Witting P. The financial impact of changes in personal health practices. Journal of Occupational and Environmental Medicine 1997; 39(11): 1037-1047.Fries JF, Harrington H, Edwards R, Kent LA, Richardson N. Randomized Controlled Trial of Cost Reductions from a Health Education Program: The California Public Employees’ Retirement System (PERS) Study. American Journal of Health Promotion 1994; 8(3): 216-223.Goetzel RZ, Juday TR, Ozminkowski RJ. A systematic review of return-on-investment studies of corporate health and productivity management initiatives. AWHP’s Worksite Health 1999 (Summer); 12-21.Gold DB, Anderson DA, Serxner, S. Impact of a telephone-based intervention on the reduction of health risks. American Journal of Health Promotion 2000; Nov/Dec: 97-106.

References

Leutzinger JA, Ozminkowski RJ, Dunn RL, Goetzel RZ, Richling DE, Stewart M, Whitmer RW. Projecting future medical care cots using four scenarios of lifestyle risk rates. American Journal of Health Promotion 2000; 15(1): 35-44.Ozminkowski RJ, Dunn RL, Goetzel RZ, Canior RI, Murnane J, Harrison M. A return on investment evaluation of the Citibank, N.A., health management program. American Journal of Health Promotion 1999; 14: 31-43.Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1995-1998 update (IV). American Journal of Health Promotion 1999; 13:333-345.Serxner SA. Practical Considerations for Design and Evaluation of Health Promotion Programs in the Workplace. Disease Management and Health Outcomes (in press). Serxner SA, Gold DB, Anderson DR, & Williams, D. The impact of a worksite health promotion program on short-term disability usage. Journal of Occupational and Environmental Medicine 2001; 43(1): 25-29.US Department of Health and Human Services (1980) Ten leading causes of death in the United States. Atlanta: Center for Disease Control, July.Wood EA, Olmstead GW, Craig JL. An evaluation of lifestyle risk factors and absenteeism after two years in a worksite health promotion programs. American Journal of Health Promotion 1989; 4(2): 128-113.

References

UK Health Care Task Force

Prevention and Wellness as a Cost Containment ComponentAugust 2001