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Who We Are. Health benefits company headquartered in Louisville, Kentucky 45 year existence with a legacy of embracing change Approximately 11 million membersGeographic and socioeconomic diversity Diverse lines of businessGovernmentEmployersDirect to ConsumerA laboratory for consumerism
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1. Consumerism in health care
2. Who We Are Health benefits company headquartered in Louisville, Kentucky
45 year existence with a legacy of embracing change
Approximately 11 million members
Geographic and socioeconomic diversity
Diverse lines of business
Government
Employers
Direct to Consumer
A laboratory for consumerism …
As a way to improve health
As a way to control costs
As a way to engineer experience
… and Innovation
Innovation Center
Health Services Research Center
Humana Europe
3. What do insurers in the US do? Manage insurance risk (whom to cover and at what price)
Design products (what’s covered, at what level, with what premium and co-payment)
Contract with providers & configure networks (decide whom to contract with, on what basis, and at what price)
Manage utilisation risk (utilisation review, case management, nurse advice, authorisations, etc)
Manage transactions (pay providers and manage claims)
Manage Information
4. Convergence of forces
Demography
Chronic illness
Pace of new technology
Rising expectations
The rise of the “experience” economy
Democratisation of information and expertise
Healthcare systems need demand and delivery side reforms
“If you want the same result, keep doing what you’re doing”
5. Consumerism is Here Deep cultural trend
Related to other social and demographic factors
Aging of the baby-boomers
Ideological swing toward personal responsibility
Facilitated by technology
Democratization of clinical knowledge
Genomics and personalized medicine
Personal health monitoring
Healthcare lags behind other industries
6. Expert systems
Focused on the system
Regulation, planning, system engineering
Economics, medicine, engineering sciences
Evidence-based care
Explicit cost-benefit tradeoffs
Value-based health benefits
Value-based purchasing
Cost and quality transparency
Medical expertise is valued
7. Choice, independence, and transparency
Looking from the outside–in
Importing from other industries
Customizing and personalizing
Leveraging technology
Humanizing health care
Taking an ecological perspective
Making it fun
9. Transforming Consumer Experience
10. Predicting individual health risk
Improving decision quality
Understanding attitudes and behaviors
Working through incentives
Engineering experience
Coaching healthy behavior Focus on delivering value to consumers
Customized benefits
Personalized services
Focus on delivering value to consumers
Customized benefits
Personalized services
11. Identify consumer needs for behavior change on a segmented basis (eventually an individual basis)
Provide the right incentives for that consumer to engage in that behavior change
Provide necessary support tools and communications to help the consumer achieve that goal
Reward the consumer for milestones and achievements
Reassess consumer needs based on progress made…repeat steps 1-4.Identify consumer needs for behavior change on a segmented basis (eventually an individual basis)
Provide the right incentives for that consumer to engage in that behavior change
Provide necessary support tools and communications to help the consumer achieve that goal
Reward the consumer for milestones and achievements
Reassess consumer needs based on progress made…repeat steps 1-4.
12. Severity & event prediction
Health risk assessment
Disease cluster / progression
Segmentation / clustering
Data visualization
Evaluation
Knowledge discovery methods
Behavior analytics Creating an Engine for Ongoing Insights
14. From individuals to populations
15. Segmentation and engagement
16. A New Marketplace Approach Is Emerging [Not required. Use level of audience sophistication on topic to determine if needed.]
[Time: 1 minute]
This is the foundation for a new approach.
The National Business Group on Health identified organizations that have been successful in managing their healthcare costs.
These Best Performers averaged only a 5% trend increase over a two-year period versus a 10% and 15% increase from the other categories.
How did the Best Performers manage their healthcare costs so effectively?
Integrating
Educating
Analyzing and measuring impact
[Not required. Use level of audience sophistication on topic to determine if needed.]
[Time: 1 minute]
This is the foundation for a new approach.
The National Business Group on Health identified organizations that have been successful in managing their healthcare costs.
These Best Performers averaged only a 5% trend increase over a two-year period versus a 10% and 15% increase from the other categories.
How did the Best Performers manage their healthcare costs so effectively?
Integrating
Educating
Analyzing and measuring impact
17. Today’s Dilemma [Not required. Use level of audience sophistication on topic to determine if needed.]
[Time: 1 minute]
Traditionally only direct behavioral health care expenses have been analyzed
But the correct focus is analyzing the impact of both direct and indirect behavioral health expenses.
When you do so the direct expense of 2-3% expands to approximately 60%.
[The Medicare Humana program includes Prescription Drug Plans, Behavioral Utilization Management, Behavioral Health Calls, etc.] [Not required. Use level of audience sophistication on topic to determine if needed.]
[Time: 1 minute]
Traditionally only direct behavioral health care expenses have been analyzed
But the correct focus is analyzing the impact of both direct and indirect behavioral health expenses.
When you do so the direct expense of 2-3% expands to approximately 60%.
[The Medicare Humana program includes Prescription Drug Plans, Behavioral Utilization Management, Behavioral Health Calls, etc.]
18. Integrated Medical-Behavioural Health Model [Not required. Use level of audience sophistication on topic to determine if needed.]
[Time: 2-4 minutes depending upon detail presented]
[Talking points if drilling down on the details further in presentation.]
I’ll go in to further detail around most of the points on this slide in a minute.
Before moving forward let me just mention that our IMBH approach is centered around integration with the health plan while ensuring the member receives the behavioral expertise needed to identify and manage their condition.
[If not drilling down further on IMBH, but want to provide just a high-level overview then select a few key items to discuss based upon presentation objective. Recommend ensuring we discuss Corphealth’s Approach. Do not read the entire slide. This is just a “info on a page” slide for you to pick and choose what is relevant for your meeting.]
[Not required. Use level of audience sophistication on topic to determine if needed.]
[Time: 2-4 minutes depending upon detail presented]
[Talking points if drilling down on the details further in presentation.]
I’ll go in to further detail around most of the points on this slide in a minute.
Before moving forward let me just mention that our IMBH approach is centered around integration with the health plan while ensuring the member receives the behavioral expertise needed to identify and manage their condition.
[If not drilling down further on IMBH, but want to provide just a high-level overview then select a few key items to discuss based upon presentation objective. Recommend ensuring we discuss Corphealth’s Approach. Do not read the entire slide. This is just a “info on a page” slide for you to pick and choose what is relevant for your meeting.]
19. IMBH Savings – Early Medicare Results [Not required.]
[Time: 3 minutes]
[NOTE: THIS IS MEDICARE DATA ONLY]
Program participants that completed their goals had lower healthcare costs than the control group by over $5,520 per year
Program participants that did not “graduate” the program had lower healthcare costs than the control group by almost $1,680 per year
What is most interesting is that regardless of whether a member completed the program, is in process of the program or dropped out – there is still a savings of $780 per participant. [Average out across all through participation levels]
Projected savings assumed Contact Rate across co-morbid population, Engagement Rate, Goals Completion Rate and different savings capture rates
At a 3.5% contact rate across 1.3 million members, projected annual savings is $33 million
[Not required.]
[Time: 3 minutes]
[NOTE: THIS IS MEDICARE DATA ONLY]
Program participants that completed their goals had lower healthcare costs than the control group by over $5,520 per year
Program participants that did not “graduate” the program had lower healthcare costs than the control group by almost $1,680 per year
What is most interesting is that regardless of whether a member completed the program, is in process of the program or dropped out – there is still a savings of $780 per participant. [Average out across all through participation levels]
Projected savings assumed Contact Rate across co-morbid population, Engagement Rate, Goals Completion Rate and different savings capture rates
At a 3.5% contact rate across 1.3 million members, projected annual savings is $33 million
20. Management of advanced Diabetes and CHF
21. Motivational support for healthy behaviour
22. Typical Results
23. Ethnographic research
Understand members, their families, and experience
Understand how to communicate with members
Early results regarding
Product complexity
Support for low-income employees
Support for the healthy during acute episodes
Cognitive processes and decision analysis
Understand how individuals make decisions for more effective/persuasive guidance and interventions Anthropology of health Another key element for change and innovation is a deep and “intimate” understanding of consumers – the people who get health benefits and use healthcare. And we are bridging the gap that has limited transaction-oriented companies
Examples of new approaches include ethnography and decision science.
This year we are “living” with 36 families for the year . . . doing video, audio and written diaries tracking and learning from their decisions.
Less than six months into this we have some meaningful preliminary findings
Consumers see value in increased plan design choices, but
Consumer confidence is declines in proportion to product complexity
Consumers have trouble understanding the value of their benefits -- and seeing the relationship between premium and out-of-pocket costs
Consumers learn by doing – transparency and using benefits increases understanding
There is a potential “collar divide”: special assistance needs to be targeted to lower income employees
The chronically ill are well served by guidance and support services – but the healthy may need better support during acute episodes
In addition we are doing ______ work in understanding how people make decisions – for example, how _____ people decide to take medications.
Another key element for change and innovation is a deep and “intimate” understanding of consumers – the people who get health benefits and use healthcare. And we are bridging the gap that has limited transaction-oriented companies
Examples of new approaches include ethnography and decision science.
This year we are “living” with 36 families for the year . . . doing video, audio and written diaries tracking and learning from their decisions.
Less than six months into this we have some meaningful preliminary findings
Consumers see value in increased plan design choices, but
Consumer confidence is declines in proportion to product complexity
Consumers have trouble understanding the value of their benefits -- and seeing the relationship between premium and out-of-pocket costs
Consumers learn by doing – transparency and using benefits increases understanding
There is a potential “collar divide”: special assistance needs to be targeted to lower income employees
The chronically ill are well served by guidance and support services – but the healthy may need better support during acute episodes
In addition we are doing ______ work in understanding how people make decisions – for example, how _____ people decide to take medications.
24.
Use of health services
Promoting health planning
Personalized health tips
Supports better care decisions Personalised communication
25. Incentives
27. We prefer to take an ecological view. All of us working, using, or supporting the health system – patients, caregivers, facilities – exist in an economy, a social system, an organic environment – and all of us are influenced by and influence each of these systems. We prefer to take an ecological view. All of us working, using, or supporting the health system – patients, caregivers, facilities – exist in an economy, a social system, an organic environment – and all of us are influenced by and influence each of these systems.
28. Virtual Me connects users to:
Their Health
Health financing
Health Records
Care Providers
Virtual Me connects users to:
Their Health
Health financing
Health Records
Care Providers
31. Games for Health
33. Summary From health care to health – physical, mental, social well-being
Manage population through smart segmentation and personalisation
Data driven decision making but deep consumer insight
Leverage technology but humanise care
Invest today for future savings
Cede control but provide support
Redesign system to integrate experience
Engage people by meeting them where they are