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Using Risk Based Incentives and Wellness Programs to Foster Healthier Behavior By Jeff Wu

Regional Head of Accident and Health Insurance, Generali Asia

November 16-17, 2015, Singapore

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An interesting study Healthcare cost increases with age

Source: Data for 2010 “Health Care Costs – From Birth to Death” Dale H. Yamamoto.

0

0.5

1

1.5

2

2.5

3

US Commercial aging curve

Male Female

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

US Medicare aging curve

Male Female

0

2000

4000

6000

8000

10000

12000

14000

16000

Health cost weights, by age group – New Zealand

Male Female

0

1

2

3

4

5

Australian Government health spending by program based on age

Medicare Benefits Schedule Pharmaceutical Benefits Scheme

Public hospitals

Source: Department of Health, Australia Currency: NZD

Source: 2010 Data, Ministry of Health, New Zealand

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An interesting study Sub-healthy individuals are at high risk of developing diseases if not treated in time, but their sub-health status

can be eliminated simply by psychological interventions and/or lifestyle modifications, e.g. increasing physical

activity and following an healthy diet.

3 States - Health, Sub-health and Disease

Source: 2013 “Sub-health: definition, criteria for diagnosis and potential prevalence in the Central region of China”

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

20 - 39 40 - 59 ≥ 60

Age-specific prevalence of health, subhealth and disease among 1473 Chinese adults

Health Subhealth Disease

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An interesting study The conditions of concern among the elderly are primarily those associated with chronic disease.

Prevalence of Selected Chronic Diseases

Source: “Chartbook on Aging in America” by Allan C. and H. Brotman

282

119

385

80

274

443

119

58

214

58

129

253

45

29

59

9

38

48

0 50 100 150 200 250 300 350 400 450

Hearing Impairment

Visual Impairment

Hypertension

Diabetes

Heart Disease

Arthritis

USA - Rate per 1,000 persons

17-44 years 45-64 years 64+ years

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Many chronic diseases have been associated with personal habits and, conversely, each of these habits

may be associated with several diseases.

Prevention of Chronic Diseases

Smoking

• Chronic obstructive pulmonary disease

• Lung cancer

• Coronary heart disease, stroke and lower respiratory tract infections

• Dementia

• Cataracts

• Blindness and visual loss

Diet

• Cancer of the colon, pancreas and prostate.

• Cardiovascular and cerebrovascular disease

• Diabetes

• Osteoporosis

Physical activity

• Reduces the risk of falling and fracturing bones

• Reduces the risk of coronary heart disease

• Reduces the risk of high blood pressure, colon cancer, and diabetes

• Reduces anxiety and depression

• Helps to maintain healthy bones, muscles and joints

• Fosters improvements in mood and feelings of well-being

Stress and Isolation

• Increases blood pressure, abnormal stress response, heart disease and poor sleep

• Strong correlated with Depression

• Increases chances of developing dementia and Alzheimer’s disease

Source: “Prevention and the Elderly: Risk Factors”

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Falls are a significant problem for the elderly. It is estimated that one out of three older adults (those aged

65 or older) falls each year but less than half talk to their healthcare providers about it.

Falls and healthcare costs

Source: British Colombia, Canada 2004/2005 “The evolution of senior’s falls

prevention in British Colombia”

0

2

4

6

8

10

12

14

16

65-74 75-84 85 +

Average length of Hospital Stay (in days) Canada

All causes Falls

0

20

40

60

80

100

120

140

65-69 70-74 75-79 80-84 85 +

Rate per 1000 Population of Fall-related Hospital Admissions of Older

Adults Western Australia

Males Females

Source: “Injury in Western Australia: The Health System Cost of Falls in Older

Adults in Western Australia”

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Some researches have highlighted how an active and healthy lifestyle influences the

healthcare costs, especially for older adults.

How personal habits influences medical costs

Currency: 1987 USD

Source: “Higher Direct Medical Costs Associated with Physical Inactivity” by Pratt,

Macera, Wang

0

1000

2000

3000

4000

5000

6000

7000

40 45 50 55 60 65 70 75 80 85 +

Healthcare cost per person per year (Canada)

Non - Smokers Smokers

0

500

1000

1500

2000

2500

3000

3500

15 - 24 25 -34 35 - 44 45 -54 55 - 64 65 -74 75 +

Medical costs of active and inactive people without physical limitations –

both sexes - USA

Active Inactive

Currency: 1988 USD

Source: JJ Barendreght et al. New Engl J Med 1997

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0 200 400 600 800 1000 1200 1400

Job satisfaction

Cholesterol

Body weight

Stress

Smoking

Systolic blood pressure

Diastolic blood pressure

Medical /drug use

Perceived health fair/poor

Physical activity

Life satisfaction

Alcohol

Medical Problems

Absence of illness

Medical claims costs for people who indicate a low risk in category

Medical claims costs for people who indicate a high risk in category

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An interesting study

Risk factor High risk criterion

Illness Days More than 5 days in the past year

Existing Medical

Conditions

Self-reported heart problems, cancer,

diabetes, past stroke, chronic

bronchitis/emphysema

Alcohol Male: More than 14 drinks per week.

Female: More than 7 drinks per week.

Life Satisfaction Partly or not satisfied

Physical Activity Less than one time per week

Perceived Health Fair or Poor

Medical/Drug for

Relaxation Use almost every day or sometimes

Diastolic Blood Pressure Greater than 89 mmHg

Systolic Blood Pressure Greater than 139 mmHg

Smoking Current cigarette smoker

Stress

Greater than 20 (based on a composite

score from questions related to personal

life and hours of sleep)

Body Weight Body Mass Index (BMI) equal to or

greater than 27.5 kg/m2

Cholesterol Greater than 239 mg/dL

Job Satisfaction Disagree or strongly disagree

Risk factors related to healthcare cost

Source: The University of Michigan Health Management Research Center

Currency: USD

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From the study analyzed in the previous slide, we can

group the risk factors that are correlated with each other:

Non Modifiable risk factors:

Absence of illness, medical problems

Modifiable risk factors:

Physical Activity correlated: physical activity, diastolic

and systolic blood pressure, body weight, cholesterol

Bad habits: alcohol, smoking, drug abuse

Personal perception: perceived health, life satisfaction,

stress, job satisfaction 0 1000 2000 3000 4000

Personal Perception

Bad habits

Physical Activitycorrelated

Non Modifiable factors

Medical claims costs for people who indicate a low risk in category

Medical claims costs for people who indicate a high risk in category

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An interesting study We can group the risk factors in two main categories: modifiable and non-modifiable.

Some risk factors are modifiable, some are not

• Conditions that increase the risk but cannot be changed

• Examples: age, gender, family medical history Non modifiable

• Risk factors that can be changed or treated

• Examples: smoking, physical activity, body weight Modifiable

Currency: USD

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Focus of Wellness Programs

Early detection

Quit bad habits

Health Education

Physical Activity

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Examples of Wellness Programs

Prevention Check-up, healthy nutrition, stop-smoking, fitness & exercise coaching, stress

management, etc.

Tele assistance /

Telemedicine

Measuring and monitoring of vital signs through dedicated tele medical devices in

order to react in case of medical emergency and guarantee autonomy and peace of

mind for care givers

Rehabilitation

management

Coordination of medical, social and professional rehabilitation programs after a heavy

injury in order to bring the injured back to “normal” life

Chronic Disease

Management

Information provision, coaching, compliance monitoring, tele care and healthcare

services for specific populations suffering chronic diseases

Medical advice

hot line Medical advice for persons with acute health problems based on evidence

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Key success factors for any wellness programs

A successful wellness program should be result-oriented.

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Verifiable

• Can the program track and verify the result?

Enforceable

• Can the program enforce people to take the corrective measures?

Modifiable

• Is the program targeting risk factors that people can change?

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Chronic Disease Management

This device helps to monitor chronic illnesses with multiple

data captures. For example, for patients with cardiac

illness, monitoring of blood pressure, cortisol levels and

cholesterol.

Tele assistance

For elderly, a prompt medical treatment is very important.

This device allow people to react in case of medical

emergency and guarantee autonomy.

Diet tracker

The sensor allow people to keep a track of their diet.

Possibility to monitor diet of elderly and suggest the right

diet advices.

Wearable devices can be helpful

Physical Activity tracker

Monitoring and access the data generated by today’s

fitness trackers allow insurers to design enforceable fitness

programs and verify the results.

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Wellness Program Modifiable Enforceable Verifiable

Prevention

Tele assistance /

Telemedicine

Rehabilitation

management

Chronic Disease

Management

Medical advise hot line

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An interesting study The Effectiveness of Wellness Programs

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An interesting study It is the world's largest scientific, incentive-based wellness solution for individuals and corporates: by

rewarding healthy behavior it is aimed to give members and their family knowledge and motivation to make

healthy living.

Discovery Vitality Program

Education activities

• Health Assessment

• First aid certification

• Monthly medical Visit

• Kids Health Assessment

Fitness activities

• Verified workout (partner health club, device, mobile app)

• Sports league

• Athletic events

• Kids sport league and events

Prevention

• Health screenings

• Flu shot

• Nicotine test

• Dental exam

• Vision exam

• Kids prevention (exams and immunizations)

Healthy Living

• Blood donation

• Double points if you are healthy (based on BMI, blood pressure systolic, blood glucose, total cholesterol)

Hotel stays

Amazon.com gift cards

Movie tickets

Fitness devices

Electronics

Source: Humana Vitality Program www.humana.com/vitality/

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An interesting study Practical tips for wellness programs

• Foster healthier behavior

• Decrease medical cost

Wellness programs based on prevention

• Design personal goals

• Reward healthy behavior

Incentives for engagement

• Can make more verifiable the wellness programs Wearable devices

• 24h medical hot line

• Avoid unnecessary medical visit Medical advice hot line

• Can guarantee autonomy to elderly

• Offered as added service Tele assistance

• Aim to educate the patient

• Identify health and care patient’s need

Chronic Disease Management Program

• Very important after a fall

• Offered as added service

Rehabilitation Management

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Thank You