health plans and population health management
DESCRIPTION
Forging smart partnerships with experts in population health management allows health plans to focus on their core business and enhance their service offerings in an increasingly competitive environment. Glenn Leary, vice president of business development for HealthFitness, has had a front row leadership seat in this change, seeing population health management programs along the risk continuum take root and grow in the health insurance sector. After a decade working with United HealthGroup and its population health management subsidiary in product development, account management and new business development, Leary has devoted the past five years to focused work in consulting with health plans for design of HealthFitness’ health management and productivity solutions for the health plan and large employer market. Leary is well-versed in the regulatory, market and operational drivers that influence the health plan landscape, and the leverage that a well-executed health management product suite can bring to health plans. He offers a checklist health plans should consult in choosing a consultative partner in the sector.TRANSCRIPT
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A Partnership Checklist for Population HealthJune 14, 2012
Join the conversation on Twitter at #healthweb
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Today’s Discussion
1. The health plan landscape
2. Why population health management?
3. Health Plan Top 10 Checklist
4. Q&A
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The Health Plan LandscapeHow is the market respondingto regulation?
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Changing landscape, health plan evolution
Regulatory Drivers Market Response
ACA--Increasing the number of insured consumers B-to-C shift in insurance marketing
Medical Loss RatioDesign quality improvement activities that can be measured and verified.
Accountable Care Organizations Collaborate as conveners, participants, value-based payers
Comprehensive Primary Care Multi-purchaser initiative for com-prehensive, accountable care
Health Insurance Exchanges (HIX) Design consumer-focused plans
Mergers and acquisitions High level of activity in both horizontal and vertical directions
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Changing landscape, health plan evolution
Regulatory Drivers Market Response
ACA: Increasing the number of insured consumers
• Consumer-centric products and services
• Low-or-no cost preventive care services
• Wellness services—health risk assessments, biometric screening, health coaching, reimbursement for smoking cessation, chronic care management
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Changing landscape, health plan evolution
Regulatory Drivers Drivers—Affordable Care Act Market Response
Medical Loss Ratio • Measured and verified• Can include:
- Population health/wellness- Care management- Case management- Chronic care management
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Changing landscape, health plan evolution
Regulatory Drivers Market Response
Accountable Care Organizations
Collaborate as conveners, participants, value-based payers• CMS Pioneer ACOs• Medicare Shared
Savings Program• Commercial ACOs
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Changing landscape, health plan evolution
Regulatory Drivers Market Response
Comprehensive Primary Care Multi-purchaser initiative for comprehensive, accountable primary care
Apr 2012CMS released selected markets
May 2012Health plan payersapply to participate
Aug 2012Practicesannounced
Sep 2012Project launch
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Changing landscape, health plan evolution
Regulatory Drivers—Affordable Care Act Market Response
Health Insurance Exchanges (HIX)
$1B
Design consumer-focused plans• Supreme Court ruling in ACA
(June 2012)• Est. 26M to 67M to enroll (Rand)• Customer mix:
- High risk only? - Employees of small/medium
size companies with lean policies
- Large employer groups• Bronze, Silver, Gold and
Platinum plans
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Federal HIX Establishment Grants
Source: Healthcare.gov fact sheet
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Regulatory Drivers—Affordable Care Act
Market Response
Mergers and acquisitions High level of activity in both directions--horizontal & vertical
Changing landscape, health plan evolution
Hospital Hospital
Health Plan Hospital Practice
Health Plan
Hospitals
Practices
Data/ AnalyticsPHM
Hospital Practice
Hospital Practice
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Why Population Health Management?
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Why engage in a population health management strategy?• Decades-long record with large employers as demand-
side strategy to reduce claims costs• Right side of the MLR equation• Health risk data gathered BEFORE claims filed• Retain traditional customers (large/medium employers)• Attract new customers (new consumer marketplace)
R
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Consumer Trust
Core Business
Experience Readiness
Health plan-based PHM vs. partnership
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The Health Plan Top 10 Checklist
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10Single source
On-site program delivery
Proven experience
People
Recognition
Stable, scalable
Customized, flexible
Accountability
Outcomes & science-based
Technology & data
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EXPERIENCE• Scale• Complex client needs• Implementation
PERSONALIZATION• Client customization • Unique client needs • Participant experience
ENGAGEMENT• Intrinsic behavior change
For comprehensive, integrated health management programming
• Centralized accountability—one contract, one management structure, one bill
• Simplicity in integrating data to measure performance
• Optimum program delivery—no finger-pointing• Member experience--One phone number, one portal,
warm transfers
Single source
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EXPERIENCE• Scale• Complex client needs• Implementation
PERSONALIZATION• Client customization • Unique client needs • Participant experience
ENGAGEMENT• Intrinsic behavior change
On-site program delivery capabilities
• Choose a vendor who can bring services to the doorstep of multiple, diverse employer-clients of your plan
• On-site screenings bring more to the employer-client bottom line—better participation, less time away from the job
• Company-owned screeners vs. rent-a-nurse• On-site health improvement classes• On-site program administration
On-site program delivery
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EXPERIENCE• Scale• Complex client needs• Implementation
Proven experience and expertise
• Consultative partnership resources• Ability to gauge health trends across different
employer-client types—manufacturing, service, high-tech, public employee, etc.
• What engagement activities really work in different settings? Focus groups, data mining resources
Experience & expertise
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EXPERIENCE• Scale• Complex client needs• Implementation
PERSONALIZATION• Client customization • Unique client needs • Participant experience
ENGAGEMENT• Intrinsic behavior change
Technology is a good tool, but people turn the key on engagement
Layers of support: • Customer service• Program development experts• Implementation experts• Behavioral science experts• Outcomes experts• Data and technology experts• Occupational health, health advising, health risk
assessment, medical oversight, etc.
Experience & expertise
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EXPERIENCE• Scale• Complex client n• eeds• Implementation
ENGAGEMENT• Intrinsic behavior change
Recognition and references
• PHM partner name recognition• Client testimonials• Third-party recognition for PHM excellence
• Award-winning clients
Innovations in Prevention Award
Recognition & references
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EXPERIENCE• Scale• Complex client needs• Implementation
PERSONALIZATION• Client customization • Unique client needs • Participant experience
ENGAGEMENT• Intrinsic behavior change
Stable, scalable and national in scope
• Proven track record and financial stability• Ability to provide services in multiple locations at
the same time—geographic and resource reach• Ready to grow as you grow
Stable & scalable
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EXPERIENCE• Scale• Complex client needs• Implementation
PERSONALIZATION• Client customization • Unique client needs • Participant experience
ENGAGEMENT• Intrinsic behavior change
Customized, flexible, consultative approach
• Comprehensive, integrated program• Modular approach to fit with plan’s own programs• Customizable templates– Incentives– Service options—Coaching? Occupational health?
Wellness classes? Screenings?– Program needs and preferences—telephonic,
on-site, web-based, all of the above– Portal platform
• Complete customization and client branding• Expert adviceCustomized & flexible
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EXPERIENCE• Scale• Complex client needs• Implementation
PERSONALIZATION• Client customization • Unique client needs • Participant experience
ENGAGEMENT• Intrinsic behavior change
Pricing and performance—accountability
• Pricing—based on utilization of services• Performance—outcomes based measurement• Measurement, verification of participation and
outcomes essential in more transparent environment (ACOs, HIX)
Accountability
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EXPERIENCE• Scale• Complex client needs• Implementation
PERSONALIZATION• Client customization • Unique client needs • Participant experience
ENGAGEMENT• Intrinsic behavior change
Outcomes methodology and science-based approach
Look for REAL gains, not what-ifs• Lower claims costs• Change in risk factors from high to low• Can your partner demonstrate the value of the
program with clear, unambiguous data?
Outcomes-, science-based
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ROI Claims Analysis MethodologyMeasurement
Pre-Program Year Program YearMeasurement
Post-Program Year
Participants Baseline
Characteristics
Participants - Measure
Difference in Claims Spend
Participants Receive Services
Matching
Process
Reference Baseline
Characteristics
Reference - Measure
Difference in Claims Spend
Compare
T1 to T2
Outcomes-, science-based
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EXPERIENCE• Scale• Complex client needs• Implementation
PERSONALIZATION• Client customization • Unique client needs • Participant experience
ENGAGEMENT• Intrinsic behavior change
Technology and data capabilities
• Data sharing needed for accountability in reform efforts—ACOs, PCMHs, HIX
• Data transfer• Integrating data from disparate sources• Engagement factor• eHealth portal with your branding• Personalized consumer environment
Technology & data
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Question & Answer SessionGLENN LEARYVice President, Business Development HealthFitnesswww.HealthFitness.com