do you know your numbers? national governors association using data, technology, and benefit design...
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Do You Know Your Numbers?
National Governors Association
Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs
Loews Madison Hotel, Washington, DCJune 24, 2013
Why focus on obesity?• Inconsistent long-term health
care outcomes Deaths and catastrophic claims resulting
from surgery Many who had the surgery regained weight
• Health care claims costObesity-related conditions were 29% of
FY 2010 claims dollarsProjected $12 million cost for obesity
surgery in FY 2010$750,000 catastrophic claim resulting
from obesity surgery
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General Assembly Action• Mandated coverage by Code of
Virginia• Proposed elimination of
bariatric surgery coverage to 2010 General Assembly
• Objected to by bariatric surgeons
• Developed alternative in lieu of coverage elimination
• Included language in Appropriations Act to develop pre-gastric bypass surgery pilot program
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Pilot Program Goals• Long-term, sustainable weight
loss• Improve outcomes
Reinforce lifestyle changes Address behavioral health issues Educate about risks and post-
surgery requirements
• Offer options to deal with obesity before decision to have surgery
• Leverage learnings as appropriate
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Program Components• Strictly enforced medical policy
criteria - NIH guidelines• 12-month coaching program prior
to surgeryWeightBehavioral healthNutritionDisease management
• 24 months of post-surgery follow-up
Weight coach with incentive for continued engagement
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February 2010 to May 2013
Program Participation• 341 members enrolled• 232 members actively participated• 109 members discontinued
participation• Reasons for disengagement
Commitment change Eligibility changeBacked out after learning moreNo longer wanted surgeryLength of program
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54%
33%
13%
1st Year 2nd Year 3rd year
Participation
68%
32%
Disengagement
Engaged Disengaged
Program Engagement• Engagement is key• 60 days is turning point for
engagement Anger and resentment turn to
acceptance and understanding Level of engagement is an indicator
of successful post-surgery outcome Connection with coach is a primary
motivator for staying on track
• After 75 days participation, there is positive correlation between length of engagement and decrease in participant’s BMI
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BMI change vs. length of engagement by surgery disposition and status with least squares regression and 95% CI in shade. (n = 78)
February 2010 to June 2012
Program Results• Focus is on lifestyle changes
necessary for post-surgery success
• 88% have demonstrated weight loss
• Weight loss is not a program requirement
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18%
31%39%
12%Weight Change
20 lbs + Lost11- 19 lbs Lost0-10 lbs Lost
Stopped smoking
Increased confidence
Increased activity/exercise
Improved nutrition
0% 20% 40% 60% 80% 100%
8%57%59%62%65%
78%80%81%
Lifestyle Changes
Condition Improvement
• Diabetes 50%
• Blood Pressure 46%
• High Cholesterol 15%
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Program Satisfaction Survey Results
50%44%
6%
Program Sat-isfaction
Very Satis-fiedSatisfiedNot satis-fied
• 63 members participated in a post year-one satisfaction survey
92%
8%
SurgeonSupport
Supportive
Not Support-ive 92%
8%
CoachQuality
Excellent
Very Good
99%
1%
Better Prepared
YesNo
99%
1%
Lifecoach-connect
Satisfied
Not Satis-fied
100%
Meet Goals
Yes
97%
3%
Post Surgery Coaching
YesNo
98%
2%
Recommend Program
YesNo
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COVA Care FY 2008 to FY 2013
Number of Patients Treated
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FY 2008
FY 2009
FY 2010
FY 2011
FY 2012
FY 2013
0
500
1000
1500
2000
509 486307 18 19 36
1268 1376
1159
808 6761019
Number of Patients
Original Surgery
Rollout of the pilot program began in 2010
20% reduced number of patients in FY 2013 from FY 2008
93% reduced number of original surgeries in FY 2013 from FY 2008
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COVA Care FY 2008 to FY 2013
Medical Expense
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Rollout of the pilot program began in 2010
86% reduced expenses in FY 2013 from FY 2008
FY 2008
FY 2009
FY 2010
FY 2011
FY 2012
FY 2013
$0.0
$2.0
$4.0
$6.0
$8.0
$10.0
$12.0$10.5$10.6
$5.6
$0.8 $1.3 $1.5
Millions
Medical Expense
DRGs 619 to 621- Inpatient Only - All Payers - CY 2010, 2011 Discharges
Virginia Health Information
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• Collaborated with Bariatric Doctors• Reduced complications by 3%
V
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Comparison of Pilot to Control Group
Future Metrics Have pilot participants received more
pre-surgery interventions to support weight management without surgery?
Are pilot participants better prepared?
Did pilot members have better clinical outcomes?
Did co-morbidities improve?
Are pre-surgical, surgical and post-surgical costs comparable to the control group?
Were costs lower for those individuals that still required surgery?
Did the additional spend by the Commonwealth for those pilot participants result in better outcomes for the members?
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Questions
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