Population Health is Good BusinessThe Changing Healthcare Landscape

HFMA CT Annual MeetingJune 5, 2014

Anne Elwell, RN, MPHVP, Community Relations Qualidigm

Health and Chronic Disease

• As of 2012, 50% of Americans have one or more chronic conditions (diabetes, arthritis, cancer, heart disease)

• Obesity – 178 million adults (1/3), one in five children

Health Risk Behaviors

Lack of exercise or physical

activityPoor nutrition

Tobacco use Alcohol abuse

Cost• Account for more than 75% of healthcare costs• 81% of hospital admissions, 91% of prescriptions, 76% of

MD visits• Diabetes: $245B, $176B in direct medical costs and $69B

in lost productivity• Arthritis: $128B, $81B in direct medical costs and $ 47B

in lost productivity• Tobacco: $289B, $133B in direct medical costs and $ 156B in lost productivity

Cost: Adolescent/Adult Obesity• Medical costs in US estimated at $147B- 10% of all medical

spending

• If current trends in the growth of obesity continue, total healthcare costs attributable to obesity could reach $861 to $957 billion by 2030, which would account for 16% to 18% of US health expenditures.

• Obesity increases annual employer medical spending by 27.4%

• Total excess cost related to adolescent overweight and obesity is estimated to be $254B ($208 B in lost productivity, $46B in direct medical costs

Childhood Obesity: A National Crisis

• One of three children ages 2-19 years are overweight or obese

• One third of all children born in US in year 2000 are expected to develop diabetes

• Current generation may have shorter lifespan than their parents

• Childhood obesity costs approximately $3 billion per year in direct medical costs

National Security

• Childhood obesity is a national security threat• One in four Americans are unfit for military

service because they are too heavy

What about CT?

• Chronic diseases account for 6 out of 10 of the leading causes of death

• Costs of treatment and loss of productivity equal $16.2 billion

• Continued growth could reach $44.5 billion by 2023

• But…

The Good News!

• Addressing modifiable risk factors for chronic disease

• Save lives and reduce economic impact by $11.9 billion in 2023

Smoking Nutrition Physical activity Obesity Early detection

What about the Impact on Business?

“The single biggest force threatening US workplace productivity as well as healthcare affordability and quality of life, is the rise in chronic conditions.”

Facts• US hourly health benefits: $2.38/worker/hour vs.

foreign trade weighted average of $0.96

• Almost 80% of workers have one or more chronic diseases

• Severely obese women are absent twice as much as their normal weight coworkers

• Obese workers have greater rates of workmen’s comp claims than average weight workers

Absenteeism and “Presenteeism”

• Absenteeism: largely due to chronic illness• Presenteeism: responsible for the largest

share of lost economic output associated with chronic health problems

How can we turn this ship around?

What can Business do?

“By incentivizing chronic disease prevention and management, we can create a healthier United States: One that can, in the context of business, produce a stronger and fiscally healthier US economy poised to compete in the global marketplace.”

What is Population Health?

A cohesive, integrated, and comprehensive approach to healthcare that considers the distribution of health outcomes within a population, the health determinants that influence the distribution of care, and the policies and interventions that impact and are impacted by the determinants.

This Approach Requires

• Coordination of different interventions– Health promotion– Prevention– Screening– Behavior change– Consumer education (self management, disease

management, chronic care management)

Population Health

• Eliminate healthcare disparities• Increase safety• Promote effective, equitable, ethical and access to care

More Good News: Good Health is Good Business

• Healthier people are happier, work harder, and are more efficient

• Unhealthy workers are sluggish, overtired and unhappy

• Every $1 invested in employee wellness programs yields approximately $4 in savings through reduced sick days, high productivity and decreased costs

Wellness Programs

• Humana Vitality: Wellness Program– Health costs of engaged members decreased 12%– Absenteeism of engaged members decreased 15%

• Chronic care program results– Decreased costs by 40%– Decreased readmissions by 50%

Wellness in Four Steps

1. Determine the needs of employer and employee

2. Analyze the data and create a plan

3. Create a communication plan

4. Put in an incentive plan

You Don’t have to do it Alone

State and Local Government Schools

Faith-based Organizations

Other Organizations

and Campaigns

Shape Up RI (SURI)

• Statewide internet based program involving team-based competition to increase physical activity and achieve weight loss

• Results– 30% achieved a clinically significant weight loss– Reduced obesity from 39-31%

Business Case

• Modest weight losses of 5-10% have been shown to reduce the incidence of diabetes by over 50%, with each kilogram of weight loss reducing incident diabetes by 16%

• Every unit change in BMI reduces medical costs by 2.3%

Connecticut’s Plan for Reducing Chronic Disease

Decreasing Readmissions

Patient-Centered Medical Home

• Promising strategy to transform the organization and delivery of primary care

• Strengthens the physician-patient relationship

• Focuses on the needs of the whole person, provides high quality and coordinates continuous integrated care

Choosing Wisely• Choosing Wisely aims to

promote conversations between providers and patients by helping patients choose care that is: – supported by evidence– not duplicative of other tests or

procedures already received– free from harm– truly necessary

Per Congressional Budget Office, 30% of healthcare

testing is unnecessary

“The cost of waiting for people to get sick far exceeds the cost of helping healthy people stay well.”

"Never doubt that a small group of thoughtful,

committed citizens can change the world; indeed,

it's the only thing that ever has."

- Margaret Meade

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Anne Elwell, RN, MPHVP, Community Relations

QualidigmAelwell@qualidigm.org

(860) 632-6322