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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, DC June 24, 2013

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Page 1: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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

Page 2: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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Page 3: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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Page 4: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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Page 5: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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Page 6: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

6/24/2013

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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

Page 7: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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)

Page 8: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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Page 9: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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Page 10: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

6/24/2013

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COVA Care FY 2008 to FY 2013

Number of Patients Treated

6/24/2013

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

Page 11: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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

Page 12: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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Page 13: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

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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Page 14: Do You Know Your Numbers? National Governors Association Using Data, Technology, and Benefit Design to Manage State Employee and Retiree Health Programs

Questions

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