Transcript Taking Health Care Consumer Engagement to the Next Level

Taking Health Care Consumer Engagement to
the Next Level: The Employer’s Role
Paul Landgraf
Guardian Industries
[email protected]
About Guardian Industries
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Headquartered in Auburn Hills, Michigan
Privately held companies with 19,000 employees
60 work locations in 21 countries, on five continents
Large manufacturer
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World’s largest mirror manufacturer
World’s 2nd largest manufacturer of flat glass
Tier 1 supplier of auto glass and body trim
One of the largest manufacturers and distributors of fiberglass and building
materials
 Unique culture
– Accountability extends to personal health
– Significant leadership support
The Challenge:
Guardian’s Largest Expenses
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Raw Materials
Labor, Administration, Payroll Taxes
Freight
Depreciation
Maintenance and Repair
Furnace Energy
Electricity/Utilities
Health Care
Packaging
Guardian Management point of view:
“Employee health and productivity are business issues”
The Ongoing Problem
 1 plant, 374 employees, average age = 40
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87% participated in screenings and HRA
42% classified as obese (BMI over 30)
30% had blood pressure over 140/90
32% have never had complete physical
26% reported tobacco use
63% seldom or never exercise
59% had 5 or more health risks
68% reported their own health as either good or excellent
Reinventing HealthGuard
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Started in 1984 -- “Seven Steps For Better Living”
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1. Exercise
2. Diet
3. Limiting alcohol use
4. Avoidance of smoking and illegal drugs
5. Blood pressure awareness and control
6. Use of seat belts
7. Developing positive attitudes.
It may sound dated today, but the expectations were clear
Today our focus has changed
– It is not about turning joggers into marathoners; the problem is getting members off
the couch
– Not a traditional “wellness” perspective; now much more clinical, outcomes driven,
we talk about health
What Do We Want Folks to DO?
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Health screenings and physicals
Health risk assessments
Exercise, “Winner’s Circle” participation
HealthGuard activities and education
Preventive care
No tobacco on U.S. property
Respond to Care Considerations and participate in
Disease Management if contacted
Guardian Health Risks
Blood Pressure
Body Mass Index
2006
Smoking
2007
Cholesterol
N =1,581
Glucose
0%
AHA/ ACC
Guideline
10%
20%
CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval.
30%
40%
50%
CareEngine: Identifying Gaps in Care
SOLVD study: ACEI
reduces CHF mortality
by 11.3% and
hospitalization by 18%
CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval.
AHA/ ACC
Guideline
Who is Spending the Money?
100%
90%
94%
39.1%
80%
70%
60%
19.2%
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40%
4%
30%
41.7%
20%
2%
AHA/ ACC
Guideline
10%
0%
% of Population
CONFIDENTIAL- May not be copied, reprinted or redistributed without prior written approval.
% of Health Care Costs
Condition Management – Where’s
the Savings?
 Fendrick and Chernow will be releasing a review of the current
literature, critical of most study protocols
 Need to “separate the dolphins from the tuna”
 Target well – ROI is greatest when you
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Identify the highest risk patients
Availability of effective services, real clinical value
Services have low current use
Price responsive so people will readily comply
 ROI is lost when lower risks are swept in, patient would have done
intervention anyway, or will not do the intervention; look at copays,
reach rates, opt-ins
 We focus on the chronically and acutely ill
The Problem
 Wanted to improve engagement in Condition Management,
especially in higher risk groups
 Strategy – the carrot or the stick?
 We wanted to address two issues
 How to increase engagement in Condition Management, and
 How to improve drug therapy adherence
 Willing to consider Value Based Insurance Design approach,
but dolphins v. tuna problem
 Use Condition Management and VBID, by using CM
engagement to trigger drug cost incentive
Finding a Solution - CM Simulation
What drug classes should be subject to incentives?
How much benefit incentive did we need to provide?
What would the savings be from improved drug adherence?
Did we expect overall savings from adherence, minus the
cost of the incentives?
 How does the PBM provide the incentive?
 How will this be communicated?
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Clinical opportunity scenarios used
to model savings
CLINICAL RISK SCENARIOS
MEDICATIONS APPLICABLE
Related care considerations
CAD or Cerebrovascular disease or Peripheral arterial disease or Diabetes
Lipid-lowering agents (e.g., statins)
On RX but not in a specific clinical scenario
Related care considerations
Respiratory (Asthma, COPD)
Inhaled corticosteroids
Related care considerations
CAD or Cerebrovascular disease or peripheral arterial disease or Diabetes
CHF
ACE inhibitors or ARBs
Chronic kidney disease plus Hypertension
Refractory hypertension*
On RX but not in a specific clinical scenario
Related care considerations
CAD
CHF
Chronic kidney disease plus Hypertension
Beta-blockers
Refractory hypertension*
On RX but not in a specific clinical scenario
Related care considerations
Diabetes
Injectable, inhaled, and oral meds for diabetes
A Final Thought –
Health and Your Culture
Questions?