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HealthCare Expense Reduction

Process needed to flatten renewal cost and lower healthcare spending

Dean Hettesheimer

on 11 February 2014

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Transcript of HealthCare Expense Reduction

Population Health Management

Increasing Profits and Productivity
Employers Need a New Benefit Strategy

What if we do nothing?
You will continue the annual experiences of the past 10 years with your increasing healthcare costs.
Idea 1
Put in the benefits delivery platform and Population Health Management System to connect all healthcare silos, disparate data sets, providers, wellness coaches, disease management and others. Consolidate all benefit plan delivery to 1 URL/website, creating a single source log in for your members. Maximize efficiency, data integrity and simplicity.
Idea 2
Connect your wellness program to our Population Health Management System. Design outcome based financial incentives to drive behavior change; outcome based wellness initiatives are part of Obamacare.
• Forty-five percent of adults had at least one of three diagnosed or undiagnosed chronic conditions—hypertension, hypercholesterolemia, or diabetes; one in eight adults (13%) had two of these conditions; and 3% of adults had all three chronic conditions
• Nearly one in seven U.S. adults (15%) had one or more of these conditions undiagnosed
Chronic disease is typically 75% modifiable and represents 70% of your healthcare spending

Benefit Plans Need Better Engagement, Educatation and Simplification
Historically, wellness plans engage 5% of members. Medical literacy = disease treatment compliance which is less than 67% per diagnosis. Every aspect of current benefits have a different website, log in and password. Complicated.
If you have a healthcare benefit cost of increase problem that you haven't been able to solve, you need a new strategy.
HealthCare Spending

Increasing HealthCare Cost
Inept Wellness Initiatives
Decreasing Productivity
Increasing Sick Pay
Increasing Disability
Increasing Worker's Comp Cost
New Strategy
Identify Current Cost Drivers
Engage 100% of All Members
Improve Communication
Craft Outcome Based Incentives
Put an End to Medical Illiteracy
Employ a New Benefit Delivery System
Create a Long Term Strategy
Implement Population Health Management
Managed Benefit Delivery Platform
Improve Member's HealthCare
Charge More for Unhealthy Lifestyles
Obesity - 35.7% of the U.S. is obese
Smoking - >19% of adults in the U.S. smoke
Alcohol - >65% of adults in the U.S. consume
People are not concerned about the realities of unhealthy lifestyles and do not correlate lifestyle to wealth
The Problem
Current benefit plan reporting is a look back over the last 12 months of processed claims. You do not "see" the undiagnosed and pre- diagnosed state of health that are not claims.

Wellness programs do not connect with data and typically only target employees. 50+% of claims are for dependents.

This strategy manages <20% of your risk.
What are the Costs?
Your covered population has 8.3% diagnosed diabetics @ an average cost of $13,976 each per year.
You have 3.1% undiagnosed, who will show up as a 5 figure+ Emergency Room claim and maybe a Worker's comp claim.
34.89% o your members are pre-diabetic, becoming diabetic over the next 10 years.
31% of your members are Hypertensive, many diagnosed, however 2/3 do not have good control. Hypertensive related claims cost over $93 billion annually.
33.5% of your members have High Cholesterol and only 1 of 3 have it under control.
Target 100% for engagement
Employers have to engage 100% of employees and dependent spouses. "State of Health" can be improved when driven by enviable financial incentives earned through results. All benefits can be delivered through a single website, log in and password, SIMPLICITY.
Why things improve
All disparate data sets are connected
All data is 100% actionable
All covered members are targeted - 100%
100% of your risk is identified, then managed
Member needed healthcare interventions are delivered through automation
Simple and familiar user interface
Modifiable risk factors clearly illustrated - as behavior improves, productivity increases; Absenteeism, Disability, Sick Pay, HealthCare Need and Worker's Comp claims decrease
How problems can be resolved
Troubling health trends threaten American's ability to achieve optimum health and financial security for retirement.
Obesity is a national epidemic
Soaring personal debts
Decreasing personal savings: <$10,000 per person
Lack of information correlating lifestyle to disease and impact on retirement savings "The Retirement Crisis" - Senator Harken

...Our "Strategy" helps individuals by empowering with knowledge to make better choices for long-term Health to Wealth success.
You may discover a lower price through shopping carriers
You can shift more cost to employee, accomplishing affordability
You will not have to change your "culture"
Changing carriers, contact professionals, networks - doctors and hospitals
Disease progression continues
Healthcare costs increase
Healthcare complications increase
Benefit satisfaction diminishes as costs are further shifted to employees
Talent becomes difficult to retain and attract
Productivity decreases
Company profits decline
All healthcare professionals have the benefit of working from the up to date health record
Engagement in all benefit plans is enhanced because of the single source log in website and familiar user interface
All plan members have a Personal Health Record
All employer communications and corporate wellness initiatives are managed, tracked and scored through the user interface
A single family member can be credentialed to manage all family member's health from their user interface
Plan member perception that their privacy is diminished.
"Supercharge" your wellness program
"Supercharge" disease management
Members with pre-disease states will be managed
Individual "Modifiable Risk" reports are created and viewable 24/7 on the user interface
Healthcare data is updated immediately upon receipt in the system through automation
Needed individual healthcare alerts are delivered as interventions directly to the member through automation
Immediate ROI to employer
Member resistance to automation
Member concern over their privacy regardless of the fact that this is 100% HIPAA and State privacy compliant
HR push back because of automation
We Manage the Entire Healthcare Supply Chain
All healthcare professionals work from our system
Collect, organize, credential all available healthcare data
Make 100% of data actionable
Automate the delivery of needed interventions
Measure and report 24/7 on demand
"Modifiable Risk Reports"
Identifying modifiable risk to each member communicates to the member in detail how each of their bad behaviors correlates to chronic disease progression. This helps to motivate behavior change, stop or slow disease progression and improves the member's "State of Health." Engaging 100% of adult members.
The next steps
Sharing of data:
Benefit plan summaries
Healthcare claims data
Pharmacy claims data
Management reports

We prefer to work with a bilateral NDA and feasibility studies can be commissioned for a fee - determined by account specifications. A "SCOPE of Work" has to be performed to identify set up cost and final pepm pricing.

HealthCare Trends in the U.S.
Challenging Games Foster Continued Engagement…

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