Concurrent Session –Wednesday, July 20th 4:00 pm –5:00 pm · 2020. 4. 1. · Concurrent Session...

Concurrent Session –Wednesday, July 20th4:00 pm – 5:00 pm

The Wellness of Your Absence Program

Linda Croushore,MEd, CRC, LPCUPMCDirector of Disability Services

Dr. Michael Parkinson, MD, MPH, FACPMUPMC WorkPartnersSr. Medical Director for Health and Productivity

Highly integrated system with an academic medical center hub affiliated with the University of Pittsburgh Schools of Health Science

2.8 million lives enrolled in a portfolio of insurance products 10,000 local employer groups

25 hospitals400+ outpatient locations35 cancer centers64K employees

3,400 employed physicians

International clinical operations and advisory services

Organization Introduction


Organizational Philosophy• Collaborate and partner to identify and

deliver flexible and tailored solutions

• Deliver an integrated total worker health approach for each individual

• Measure and report proven outcomes

• Holistically approach each occurrence – not just file the paperwork

• Continue to innovate and develop best in class programming, reporting and customer service

$2.8 T on Health Care: 75% Behaviors, 30% Waste What Are We Trying to Do Anyway?

Health MeasurePittsburgh Ranking

vs. 14 Similar U.S. Economic Regions

Diabetes 19% 13th

Fatal Heart Attacks 25.3% 12th

Obesity 36.6% 10th

Our Mutual Challenge: Growing Healthier and More Productive Employees and Businesses


Institute of Medicine: Healthy Workforce Definition* HEALTHY

• Demonstrating optimal health status as defined by positive health behaviors; minimal modifiable risk factors; and minimal illnesses, diseases, and injuries

PRODUCTIVE• Functioning to produce the maximum contribution to achievement of personal

goals and the organizational mission

READY• Possessing an ability to respond to changing demands given the increasing

pace and unpredictable nature of work

RESILIENT• Adjusting to setbacks, increased demands, or unusual challenges by bouncing

back to optimal “well‐being” and performance without incurring severe functional decrement

IOM: Integrating Employee Health: A Report for NASA 2007

Up the Road from a Hospital in PAHow About Just “Less Disease”?

Mediterranean (or Asian) Diet + Nonsmoker + Daily Activity + Moderate Alcohol Use*

Disease Reduction Compared to U.S. Comment

Heart Disease 64%*−83%**80% due to modifiable risk

factors

Cancer 60%* Approximates NCI estimates

Diabetes 91%** No type 2 epidemic

All‐cause Mortality 50%* 25‐year Okinawa program —

similar findings

* Knoops et al and **Rimm, Stampfer, JAMA 2004;292:1433‐1439


Determinants of Health and Disease Where and How We Live, Learn, Work, and Play

Social Environment

Physical Environment

Genetic Environment

IndividualResponse

‐ Behavior‐ Biology

Health &Function Disease Health Care

Well‐Being Prosperity

Evans, R. G., Barer, M. L., & Marmor, T. R. (1994)Why Are Some People Healthy and Others Not?. New York: Aldine De Gruyter

Behaviors Drive Medical, Disability, Absenteeism, Workers’ Compensation, and Total Employer Costs

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

19-34 35-44 45-54 55-64 65-74 75+

Medium Risk

High Risk

Non‐Participant

Edington. Am J Health Promotion 15(5):341‐349, 2001

Low risk

Creating a Legitimate Strategy to Get in Front of Rising Medical Costs & Improve Workforce Health & Productivity


UPMC Conducted a 5-Year Cohort Study to Assess Impact of Incentivized Health & Wellness

MyHealth Impact -- cost savings achieved through health improvement

*Sum of savings 2007‐2011

30% = $750B: Excess Cost, Waste, Inefficiency* . . . And Likely Underestimated

*IOM 2011: The Healthcare Imperative: Lowering Costs and Improving Outcomes

Unnecessary servicesOveruse, misuse, defensive medicine, higher cost but no value

Inefficient deliveryFragmentation, lack of coordination

Excess admin costs

Excessive pricesRx, med devices, physician and hospital services

Missed preventionPrimary, secondary, tertiary

Fraud


Optimize Environment

Speed TransitionsCare‐Home‐

Work

OptimizeChronicCare

Minimize Acute Care

Increase Healthy Behaviors

Reduce Excessive Surgery

Employer Health & Productivity Road Map™*“Understand, Improve, and Partner With Your Doctor”

Incentivized Health Management Program or Consumer‐Directed Health Plan

*Parkinson MD. Employer Health and Productivity Roadmap™ Strategy, JOEM 55 (12) Supp Dec 2013.


Speed Transitions

Care-Home-Work

OptimizeChronic

Care

Minimize Acute Care

Increase Healthy

Behaviors


H&P Alignment Assessment Report and Gap Analysis

Health and Performance Total Economic Opportunity

Ergonomic evaluation and support

Population risk profile and movement “Champion Index” i.e., % optimal health

Biometric clinical lab changes

Clinical preventive services

Lifestyle coaching enrollment and graduation

Visits/1000 by site of traditional and alternative care (eVisitsetc.)

Prevalence of impactable acute visits

Condition prevalence

DM coaching enrollment & graduation

ID/referral process —% active vs. % passive

Shared decision‐making completion before surgery

Back surgeries

Proportion of LBP people who use SDM tool

Advanced imaging rate

Top 4‐5 sentinel conditions (excluding pregnancy) that drive TAW

Absence data changes over time

Employer Health & Productivity Road Map™* “Sentinel Dashboard Metrics”

*Parkinson MD. Employer Health and Productivity Roadmap™ Strategy, JOEM 55 (12) Supp Dec 2013.

Why Does Optimizing the Workplace Environment Matter?

Alignment of rewards and responsibilities leads to cost savings:

• Improved employer business practices represent up to 28% of cost savings

• Improved employee health status represents up to 11% of cost savings

• Allowing employees to partner in shared rewards (profits) and shared responsibilities (benefits) can increase productivity up to 20%

(Gardner and Lynch, 2011)


Why Does Optimizing the Workplace Environment Matter?

Maximal alignment of rewards and responsibilities can:

• Reduce medical spend by $2,500 PPPY

• Decrease STD up to 50%

• Decrease worker's compensation up to 65%

• Decrease turnover for top performers up to 50%

• Increase revenue up to 35%

(Gardner and Lynch, 2011)

Health and Productivity Performance Index

Health and Productivity Performance Index(HaPPI)

Culture & Environment-Leadership

-Culture-Built Environment

Programs and Health-Integrated Absence Mgmt

-Programs and Resources-Communications

Roles, Responsibilities and Rewards

-Policy alignment

-Compensation and Benefit alignment

The HAPPI assessment was developed from Best in Class tools to help employers identify areas for improvement and health related cost savings.

Fit-Friendly Worksites


Speed Transitions

Care‐Home‐Work

OptimizeChronicCare

Minimize Acute Care



Employer Health & Productivity Road Map “Understand, Improve, and Partner with Your Doctor”

• “Champion Index” % optimal health

• Population risk profile and movement

• Biometric changes +/‐

• Clinical preventive services

• Lifestyle coaching enrollment and graduation


Increasing Health Behaviors with Lifestyle Coaching and Better Linkages to Physician Practice

Competency based programs that address those risk factors that drive health and productivity costs – linked to physician practice

• Tobacco Cessation

• Physical Activity

• Resiliency Training and Stress Management

• Nutrition Improvement

• Weight Management

• MyHealth Selections

• HealthyU incentivizes participation in competency-based programs

Six Time National Platinum Award-Winning Results

• Incentivized wellness

• Incentives drive behavior change


Speed Transitions

Care‐Home‐Work

OptimizeChronicCare

Minimize Acute Care




• Visits/1000 by site of traditional and alternative care

• HealthTrak and eVisits

• Cost and on‐site care options

• Prevalence of impactable acute visits


Minimize Avoidable or Inefficient Acute Care• Reduce incidence and prevalence of illness and disease

• Shift from “high risk” to “medium” and “low risk”

• Decrease the “demand for demand” for avoidable illness

• Create new, convenient, efficient, lower cost delivery platforms

• Expand connectivity and reimbursable eVisit capabilities via HealthTrak

• Expand alternative sites and modes of care through on-site clinic functions, physician linkages, and on-site health coaching

• Higher convenience, access, customer satisfaction for “routine” care resulting in higher productivity at work

• HealthyU incentivizes risk identification via health risk assessment (HRA) completion and reduces risk through programs such as DM and Lifestyle Coaching

Norman Rockwell Had It Right!“Medical Home” Re-visited

My New “Medical Home”? My Way, My Time, for Less $$


Trend to “Move Care Forward”: Where It’s Most Needed – Not Where Most Comfortable

MyHealth@Work: Expanding the role of onsite health, safety, and performance

Short-term and long-term return on investment



Speed Transitions

Care‐Home‐Work

OptimizeChronicCare

Minimize Acute Care




• Condition prevalence

• Identification and referral process

• % “active”

• % “passive”

• Disease Management Coaching:

• Enrollment and graduation

Optimize Chronic Care

Produce competent, engaged employees, consumers, and patients

• Active and early self-identification through health risk assessments (HRAs, biometric screenings, and aligned incentives)

• Curriculum-based graduation from integrated disease conditions and lifestyle online, group and 1:1 coaching

• Physician perspective: “You’re paying my patients for following my advice”

• Patient-centered medical home deployment

Health plan deployment of practice-based care managers

“Hands-on” support for improving competency and closing “gaps in care”

“Prescribe Engagement”: Health Coaching for Lifestyle, Disease Management and Shared Decision-making

Condition and HealthManagementADHDAsthmaCOPDCKDAnxiety and DepressionDiabetesCardiac conditionsLow Back PainMaternitySubstance Use

• Evidence‐based coach‐supported and self‐study options to:

• Prepare and plan to make changes• Set short‐term goals to work toward long‐term

goals• Facilitate problem‐solving and learning from

experience• Develop self‐efficacy and gain social support• Build skills for maintenance of healthy behaviors• Become more competent and engaged in medical

decision‐making with doctor

Lifestyle ImprovementNutritionTobacco CessationWeight ManagementPhysical ActivityStress Management

Shared Decision making SupportBack, Hip, Knee andShoulder PainBariatric Treatment Breast or Prostate Cancer Heart Disease Crohn’s Disease Uterine Fibroids Benign Prostatic Hyperplasia (BPH)



Speed Transitions

Care‐Home‐Work

OptimizeChronicCare

Minimize Acute Care




• Shared decision‐making before surgery with interactive online tool

• Best practice step therapy pathway for low back pain• Reduce:

• Number of low back surgeries• Advanced imaging rate

• Expand to more discretionary surgeries

“Patient Activation” – And Why It Matters• Chronic Care Model (Wagner) “informed, activated patients”

• Stanford Chronic Disease Self-Management Program

• Patient Activation Measure (PAM)• Knowledge, skills, beliefs, confidence for managing health and

health care

• Activated patients compared to “passive” patients*• Better health behaviors, clinical care, clinical outcomes,

more appropriate care use (less unplanned care), lower cost

• Altarum Consumer Engagement (ACE) assessment tool

• Ownership, navigation, commitment, informed choice

• UPMC Health Plan signed licensing agreement for use and study

* J Gen Int Med 2012;27:52026 and Health Aff 2013;32:216‐222

Reduce Excessive Surgery• 75% of surgeries and hi-tech procedures are “preference sensitive”

and up to 50% may be overused

• Shared decision-making results in informed decisions that promote changing behavior, exploring medical options, and reducing unnecessary costs

• Low back pain surgery, coaching, and worksite ergonomics focus for 2014

• Physician and PT adherence to best practice back care management pathway to be monitored

• Incentives for completion of shared decision-making tool/process and enrollment/graduation from back pain coaching program


RX for Wellness: Why prescribe healthy behaviors? The power of the white coat

• The clinician/patient conversation is very potent in promoting and sustaining positive behavior change outcomes

• Prescription denotes an expectation for follow-up and “filling” the order

• Conveys foundational importance and promotes patient activation and engagement

RX for Wellness: Motivating your patient for health improvement and chronic care

VIDEO TO PLAY HERE

Rx for Wellness referrals By typePhysician “Prescriptions for Engagement”

* Referrals from 5/1/14‐ 2/29/16** Passive referrals for CM LOB including incentivized from CY15

• Lifestyle coaching (nutrition, weight, tobacco, activity, stress) 70%

• Chronic disease & shared decision-making 30%

• Compared to traditional identification/referral routes, 2X-10X greater engagement


Powering the Health & Productivity Road Map: Moving to Maximally Effective Health and Cost Savings

HealthyU: Designing Plans to Address the Health and Financial Concerns of the Entire Population

“Clinically Credible”Account with Incentives

Deductible Is a “Speed Bump” Not a

“Jersey Barrier”

• Preventive services 100% covered

• “Clinically credible” account funding with additional “rollover” balances year‐to‐year

• “Deductible in middle” is a “speed bump” not a barrier to appropriate use

• Incentives for completing HRA/biometrics, healthy behaviors, and care engagement

Out‐of‐Pocket Max Both Compassionate

and Competitive

• Highest users solve OOP and total yearly cost

• Must be “compassionate” financially and “competitive” relative to other options and/or previous year’s experience

• Incentives for enrolling in and graduating from health coaching program and surgery choices for sickest, highest users must be significant to offset expenses

Preventive Services

How CDHPs Lead to Smarter Health Care

• Consumers have a financial stake

• Consumers control a portion of health care dollars

• If I stay healthier, I spend less of my money

• I can save money from year to year

• More emphasis on preventive care

• Less overuse of medical services

• Price and quality information lets consumers have more productive discussions with their doctors

• Reduces excessive diagnostic testing and bias toward high-tech, procedural approach

It’s my health and my money, and I’m going to take better care of both.



Speed Transitions

Care‐Home‐Work

OptimizeChronicCare

Minimize Acute Care




• Top four to five conditions

that drive TAW

• Absence changes over time

Coordination of “Stove-piped” Programs Has Produced Decreased Absenteeism and Improved Productivity

Nature & Nurture:Arrow goes BOTH Ways and FASTER!!

• Genome is millions of years old ‐ thought to be changeable only over generations

• Expression of those genes ‐ via proteins they produce ‐ can be altered in an individual through changes in environment• Telomere lengthening

• Epigenetics ‐ and an emerging understanding of near term use of natural foods and other environmental factors – changes core understanding of health, disease and “treatment”

• Examples: Breast CA only 5‐10% hereditary factors; prostate “ca” reversal


Root cause lifestyle medicine approach toundoing chronic disease epidemic: “Eat, Move, Think”

Mindfulness, purpose, stress reduction

Whole-food, plant-based diet

Physical Activity

Very Brief MSK 101: Bones, Joints, Tendons, Ligaments

• Its all about the MUSCLES• Strong muscles stabilize joints

• Particularly major muscle groups – abdomen, back, quadriceps, hamstrings

• Blood flow relatively poor – so healing time prolonged (relative to skin, soft tissues)

• Rest, Ice, Compression, Elevation (RICE) acutely

• Inactivity (e.g. “bedrest”) except in immediate or most severe injuries prolongs recovery• Early, gradual movement (e.g. physical therapy) indicated in most all

common musculoskeletal injuries

47

The Burden of Low Back Pain

• 43-60% of Americans report spine pain in the past 3 months

• 20% of persons with low back pain report that they cannot work

• Lifetime incidence approaching 90%

The Burden of Musculoskeletal Diseases in the United States, 2008 http://www.boneandjointburden.org/


Increasing Utilization of Higher Cost Interventions for LBP

Deyo et al. J Am Board Fam Med. 2009

Minimal change in office visits for low back pain since 1990

Yet …. Lack of Improved Outcomes

Deyo et al. J Am Board Fam Med. 2009

Self-reported functional limitations, mental health and social limitations worse in 2005 than 1997; costs now exceed $85 billion

I Can’t Help It ... It “Runs In My Family”


Estimated 2014 annual cost of Unscheduled Time Away from Work (UTAW) for UPMC ‐$66.8M

• Integrated Absence Management provided an average annual savings of $6.5M*

• Total savings of $45.6M over the past seven years

*assuming estimated productivity cost per eligible employee in baseline year

$1,000

$1,050

$1,100

$1,150

$1,200

$1,250

$1,300

$1,350

2007 2008 2009 2010 2011 2012 2013 2014

Productivity Cost per Eligible

Productivity Cost per Eligible without Integration Actual Productivity Cost per eligible

The Results

Questions?

Concurrent Session –Wednesday, July 20th 4:00 pm –5:00 pm · 2020. 4. 1. · Concurrent Session...

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Transcript of Concurrent Session –Wednesday, July 20th 4:00 pm –5:00 pm · 2020. 4. 1. · Concurrent Session...