how to get a zero health care cost trend

How to Get a Zero Health Care Cost Trend

Steven Aldana, Ph.DCEO WellSteps

Medical Costs per Person per Year

1960 1970 1980 1990 2000 2010 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023$0

$1,500

$3,000

$4,500

$6,000

$7,500

$9,000

$10,500

$12,000

$13,500

$15,000

$147 $356 $1,112

$2,851

$4,884

$8,411 $9,163

$9,597 $9,982

Kaiser Family Foundation

Medical Costs per Person per Year

1960 1970 1980 1990 2000 2010 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023$0

$1,500

$3,000

$4,500

$6,000

$7,500

$9,000

$10,500

$12,000

$13,500

$15,000

$147 $356 $1,112

$2,851

$4,884

$8,411 $9,163

$9,597 $9,982 $10,448

$10,942 $11,504

$12,132 $12,808

$13,488 $14,204

$14,944

Predicted

Kaiser Family Foundation

Zero Health Care Cost Trend

2009 2010 2011 2012 2013 2014$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$11,590,407$12,386,288

$13,603,419 $13,308,112$12,273,168

$11,390,481


Preventive Medicine, 2015 (in review)

468

101214161820

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

Today 18% of GDP

Percent of GDP Going to Health Care

U.S. Health Care as a Percentage of the GDP

January 10, 2223 Doctor Day in American

0%

20%

40%

60%

80%

100%

120%

1960 2010 2035 2060 2085 2110 2135 2160 2185 2210 2235

Health Insurance Premiums, Earnings and Inflation, 1999-2012

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120%

20%

40%

60%

80%

100%

120%

140%

160%

180%

200%

8%

24%38%

11%

29%

47%

38%

109%

172%

http://kff.org/health-costs/slide/cumulative-increases-in-health-insurance-premiums-workers-contributions-to-premiums-inflation-and-workers-earnings-1999-2012/

The Problem

• Health care costs have and will continue to increase.• They will increase faster than salaries or inflation.• Employers and employees carrier the burden.• What can be done to slow the cost increases?• What can wellness do?

Drivers of Health Care Costs

• Unhealthy behaviors• Salary and drug costs• Expensive technologies• Fragmented care• Lack of cost consideration• Fee for service• High admin costs• End-of-life care• Provider consolidation

http://web1.millercenter.org/commissions/healthcare/HealthcareCommission-Report.pdf

Cost Reduction Strategies

Drop insurance-cost shiftChange carriersNegotiate ratesSelf insureHigh deductible plansOnsite clinicsDisease managementWellness

Cost Drivers• Unhealthy behaviors• Salary and drug costs• Expensive technologies• Fragmented care• Lack of cost consideration• Fee for service• High admin costs• End-of-life care• Provider consolidation

• Drop insurance-cost shift• Change carriers• Negotiate rates• Self insure• High deductible plans• Onsite clinics• Disease management• Wellness

Cost Reduction Strategies

• Unhealthy behaviors• Salary and drug costs• Expensive technologies• Fragmented care• Lack of cost consideration• Fee for service• High admin costs• End-of-life care• Provider consolidation

• Drop insurance-cost shift• Change carriers• Negotiate rates• Self insure• High deductible plans• Onsite clinics• Disease management• Wellness

Cost DriversCost Reduction

Strategies

Health Care Cost Control

https://www.wellsteps.com/infographics

Claims 75%

Pool Charge 5% Base Admin 11% Risk Charge

3%

commission 3%Contribution to

Profit or Re-serves 2%

Ancillary ben-efits 1%

Where Your Insurance Premium Goes

Pool Charge

How much of the Carrier’s PoolExperience is used?

How much of the Group’s

Experience is used?

400

200

100

2

300

# of employees

10% / 90%25 employees



Experience is used?

400

200

100

2

300

# of employees


Pool Charge



Experience is used?

400

200

100

2

# of employees


300

Pool Charge

Claims 75%

Pool Charge 5% Base Admin 11% Risk Charge

3%

Commission 3%Contribution to

Profit or Re-serves 2%

Ancillary ben-efits 1%

Where Your Insurance Premium Goes

Loss Ratio

10%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

80%Claims

20% Admin 80% loss ratio

How to Get Zero Trend

Salt Lake County Wellness Program

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013$200

$300

$400

$500

$600

$700

$800

Participants Non Participants

Ave

rage

Cos

t Per

Cla

im

J Public Health Manag Pract. 2011 May-Jun;17(3):225-32

http://www.ncbi.nlm.nih.gov/pubmed/21464684





Bend the Trend, Not a Zero Trend

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013$200

$300

$400

$500

$600

$700

$800

Participants

Ave

rage

Cos

t Per

Cla

im







Program Cost Program Savings ROI

$1,456,788($919,542 for

incentives)

$4,841,898 $3,385,110

Cost Benefit Ratio of 3.32







• Self funded• Wellness program started in 2004• Included biometric screening• Small campaigns• 41% participation• Significant incentive program







Salt Lake County Wellness Program

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013$200

$300

$400

$500

$600

$700

$800

Participants

Ave

rage

Cos

t Per

Cla

im







Health CareCosts

Unhealthybehaviors

Healthrisks

Chronicdisease

Participation

Zero Trend Wellness Model

Health Assessment

Campaigns

Culture Change

Rewards Activity Tracker

Screening Reminder

Incentives

Health Coaching

Biometric screening

WellSteps Guide

Wearables

Comprehensive Wellness Programming

Communication Drives Participation

text messages

CEO letter

announcements

kick-off meetingposters

email

company calendar

push notifications

postcards

Technology

Unhealthybehaviors

Participation


Changes in Health Behavior

Baseline

Year 1

Year 2

<2 days of exercise/week 1.46 days 2.29 days 2.47 days (+69%)

<60 minutes/week 18.79 min 113.20 min 134.71 min (+617%)

<3 daily servings fruits/veggies 2.46 servings 3.48 servings 3.63 servings (+47%)

<3 days of restful sleep/week 2.23 days 3.17 days 3.36 days (+51%)

Smokers (days per week)

4.35 days 5.43 days 4.27 days (-1.6%)

Alcohol Use (drinks/day) 1.31 drinks 1.16 drinks 1.10 drinks (-16%)

American Journal of Health Behavior, Volume 39, Number 3, May 2015, pp. 345-351(7)

Risk Migration

Baseline

Follow-up

High risk Medium risk Low risk

High risk Medium risk Low risk

Exercise Days per Week

Baseline (n) Year 2 (n) Change (%) Exercise (days/wk) ≤2 days/wk 3-4 days/wk 5 or more days/wk

502845526


Exercise Days per Week

Baseline (n) Year 2 (n) Change (%) Exercise (days/wk) ≤2 days/wk 3-4 days/wk 5 or more days/wk

502845526

390912571

-2289


Unhealthybehaviors

Healthrisks

Participation


Systolic Blood Pressure

120-140 >140110

115

120

125

130

135

140

145

150

155

129

148.7

131.5

143

baselineyear 1

Popul Health Manag. 2013

Systolic Blood Pressure Risk Migration

N Decreased Score

%

MH Trend Chi-square P

value

Rate Ratio

95% CI

Normal (<120) 906 19.1 < 0.0001 1.00 Reference

Pre hyperten. (120-139) 1086 37.9 2.00 1.72-2.32

High (140-159) 322 62.7 3.35 2.81-3.99

Dangerous (≥160) 38 73.7 3.84 2.89-5.09

J Occup Environ Med. 2014 Jun;56(6):639-44

Diastolic Blood Pressure

>8075

77

79

81

83

85

87 86.2

80.3

baselineyear 1


Cholesterol

200-240 >240200

210

220

230

240

250

260

270

217

261.5

215

247.5

baselineyear 1


Glucose

>100100

102

104

106

108

110

112

114

116

118116

105

baselineyear 1


<25 25-30 >3020

22

24

26

28

30

32

34

36

22.2

27.2

35.2

22.6

27.5

34.9baseline

year 1

Body Mass Index


1970 1980 1990 2000 2010 20200

1020304050607080

USA

England

Canada

Austria

France

Korea

Brazil

Percent Overweight or Obese

W.H.O. 2013

More Published Results

Group of Small Businesses 12 monthsJOEM August 2013 - Volume 55 - Issue 8 - p 895–900

Mid-Sized Business 12 monthsJOEM Volume 53, Number 9, September 2011

Mid-Sized Business Two-Year Follow-upPopul Health Manag. 2012 Oct;15(5):261-6

Large Organization Biometric Risk reductionJOEM Volume 56, Number 6, June 2014

https://www.wellsteps.com/images/stories/manuscripts/small_business_cohort.pdf



https://www.wellsteps.com/images/stories/manuscripts/Woodard_and_Curran_paper.pdf

https://www.wellsteps.com/images/stories/manuscripts/WC_two_year_results.pdf

https://www.wellsteps.com/images/stories/manuscripts/wellsteps_biometric_article.pdf



Unhealthybehaviors

Healthrisks

Chronicdisease

Participation

Where is the Chronic Disease Prevention Data?

Health CareCosts

Unhealthybehaviors

Healthrisks

Chronicdisease

Participation


School District Wellness ROI Research


Data Reviewed:

• 7 years of claims data• Personal Health Assessment data• Biometric screening data• Employee eligibility data• Wellness program participation data


The Research Process

• Legal permissions, HIPPA compliance, decryption• Data cleaning, outliners, merging, range checking• SAS coding (6,000 lines of code)• Define participation, group creation• Adjust data for medical inflation• Set study parameters• Control for confounders: age, sex, baseline differences• Calculate ROI, program costs


Predicted vs Actual Health Care Costs

2009 2010 2011 2012 2013 2014$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

WellStepsBegins

Predicted

Actual

Predicted values from:http://kff.org/interactive/premiums-and-worker-contributions/

Actual Health Care Costs for Wellness Participants and Non participants

Baseline 2012 2013 2014$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$3,308$3,805

$3,280 $3,330$3,414

$5,839$6,177

$3,875

Participants Non participants

WellStepsBegins


Stop Loss Premium Amount per Employee Per Month


2012 2013 2014$20.20

$20.30

$20.40

$20.50

$20.60

$20.70

$20.80

$20.90

$21.00

$21.10

$21.00 $21.00

$20.50

Stop Loss Premiums

Limitations

• Not a randomized clinical trial• Control for outliners• Historical effects• Regression to the mean• Changes to benefits

Incentive PlanYear Must complete: Incentive

2011-2012 PHABiometric screening

$20 lower office copay$700 deductible reduced to $350

2012-2013 PHABiometric screening

$20 lower office copay$700 deductible reduced to $350$40/month premium discount

2013-2014 PHABiometric screeningWellSteps campaign or approved alternate activity

$20 lower office copay$700 deductible reduced to $350 $40/month premium discount

Employees Filing ≥ 1 Claims per Year

2012 2013 20140%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%91% 91% 90%

67%76%

69%

Participants Non participants


$5,025,138

-the total cost savings from participation in the wellness program over the three year period


ROI Calculations (3 years combined)

Costs Savings$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

IncentivesSalaryScreeningWellSteps

$1,412,736

$5,025,138


ROI

Savings ($5,025,138) Costs ($1,412,736)

Benefit to Cost ratio of 3.6

=


Health CareCosts

Unhealthybehaviors

Healthrisks

Chronicdisease

Participation


Health Assessment

Campaigns

Culture Change

Rewards Activity Tracker

Screening Reminder

Incentives

Health Coaching

Biometric screening

WellSteps Guide

Wearables

Comprehensive Wellness Programming


2009 2010 2011 2012 2013 2014$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000



Predicted

Questions

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