UK Health Care Task Force

1. UK Health Care Task Force Prevention and Wellness as a Cost Containment Component August 2001

2. Objectives • Identify the opportunity for savings through prevention and wellness • Identify strategies that can be employed to capture these savings • Discuss critical design components of successful program implementation • Current UK status

3. Primary area of focus • High Risk/Behavioral Based Programming – health improvement on a population basis • Medical Consumerism/Self-Care – addressing the inappropriate emergency type utilization • Other suggested strategies – such as after-care/recurrence prevention, primary prevention etc.

4. Lifestyle Accounts for 50% of Deaths Source: CDC (1980) Big Picture

5. Impact on Individual Health Care Costs: High versus Lower-Risk Employees Individuals at high risk for depression have 70.2% higher costs than those at lower risk Source: Goetzel et al. (1998) High Risk Employees Cost More

6. Projecting Medical Care Cost Increases Using Four Scenarios of Lifestyle Risk Rates $9.96 $8.85 $7.89 $7.74 Million Saved/Year Cost (in Millions*) $2.22 No program w/ current risk trends Program reduces risks 0.1%/yr Program reduces risks 1%/yr Program holds risks constant Source: Leutzinger et al. (AJHP 2000) *1998 Dollars Bottom LineMillions Can Be Saved

7. So what does it cost UK? • Three methodologies • By # risks • By type of risk – over 5 years • By type of risk – 1 year

8. So what does it cost UK? Health Behaviors Costs associated with high risks are estimated to be between $8 - $12 million dollars annually

9. So what does it cost UK? Inappropriate Utilization • Hard to quantify at this point as there was no time to collect plan specific data in this area • It is know that the state avg. ED utilization is higher than the national average • Access to care may play a factor here at UK

10. So what does it cost UK? Primary prevention/after-care • Lack of attention to after-care/recurrence prevention could have significant impact upon experience levels • Access to primary prevention within the state is below average for mammography screening, PAP smears and eye exams for diabetics • No time to collect plan specific data in this area

11. Objectives • Identify the opportunity for savings through prevention and wellness • Identify strategies that can be employed to capture these savings • Discuss critical design components of successful program implementation • Current UK status

12. Short-Term Long-Term Demand Management Health Promotion $3-$8 3-5 Years $2-$5 1st Year Comprehensive Programs Have Positive ROI

13. Demand Management:Medical Consumerism • Designed to educate and provide resources to individuals so that they best use the health care resource • Most typically booklets, telephonic and/or web based • High training necessary

14. What does the data say? • 37% of adults and 32% of children in Ky. use the ER every 6 months • Avg. number of ED visits in state is higher than national average

15. Objectives • Identify the opportunity for savings through prevention and wellness • Identify strategies that can be employed to capture these savings • Discuss critical design components of successful program implementation • Current UK status

16. Short-Term Long-Term Demand Management Health Promotion $3-$8 3-5 Years $2-$5 1st Year Comprehensive Programs Have Positive ROI

17. Health Promotion/Risk Reduction • Geared towards broad based population health improvement • Addresses modifiable health behaviors • UK has the perfect situation to establish programming and is moving in this direction

18. 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

19. 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% Prevalence

20. UKHMO Prevalence Rates

21. 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.

22. Cost

23. Cost to UKHMO

24. Financial Results • Reduced reliance on pharmaceuticals • Decreased experience • Annual savings of $8 - $12 million dollars annually (once completely implemented)

25. Objectives • Identify the opportunity for savings through prevention and wellness • Identify strategies that can be employed to capture these savings • Discuss critical design components of successful program implementation • Current UK status

26. Principles of Effective Program Design • Behaviorally staged • Focus on maintenance and reinforcement • Program beyond risk or disease specific • Tailored to health and safety risk • Incentives for participation Source: Serxner (in press)

27. Principles of Effective Program Design • Repeated contacts • Varied formats • Personalization • Low cost & portable • Easy to administer • Emphasis on health and productivity Source: Serxner (in press)

28. Principles of Effective Program Design • Multiple distribution channels • Built in program evaluation • Long-term orientation • Integrated with Safety, Occupational Health, EAP, and Training • Visible management support Source: Serxner (in press)

29. Objectives • Identify the opportunity for savings through prevention and wellness • Identify strategies that can be employed to capture these savings • Discuss critical design components of successful program implementation • Current UK status

30. UK Status • UK has taken steps to implement comprehensive program • Pro-active partnership between UKHMO, UK Health Plans and UK Wellness • Be Health Improvement Plan (Be H.I.P) • Needs greater emphasis and integration

31. Primary area of focus • High Risk/Behavioral Based Programming – health improvement on a population basis • Medical Consumerism/Self-Care – addressing the inappropriate emergency type utilization • Other suggested strategies – such as after-care/recurrence prevention, primary prevention etc.

32. After-care prevention • Cardiac Rehabilitation • Complications from diabetes • Cancer Screenings There is a general lack of emphasis on prevention and of recurrence, which is arguably as important as occurrence

33. 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

34. To achieve impact • Comprehensive structure and vision for the medical plan which includes these strategies • Continued integration with providers • Enhanced employee communications/education • Commitment and resources

35. References 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.

36. 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.

37. UK Health Care Task Force Prevention and Wellness as a Cost Containment Component August 2001