Transcript Living Well Program

Employer Perspectives Related to
the Expense of Behavioral Health,
and Substance Abuse
Behavioral Screening and Intervention
August 25, 2010
Jeff Kluever
[email protected]
About Journal Communications
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2800 employees, 1,000 pre-Medicare and
Medicare-eligible participants nationally.
Our strategic plan focuses on providing quality
benefits while maintaining shareholder value.
Like other employers, we struggle with
managing:
 Affordable coverage (employer and retiree)
 The impact of medical inflation on our budget
 The health status of medical plan participants
JOURNAL OUTCOMES
Impacting Medical Plan Trends
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Medical Per Member Per Month (PMPM)
increased 8.4% from 2008 – 2009
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Medical PMPM decreased 5.8% including
high cost claimants from 2009-2010
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Medical PMPM decreased 20.6% excluding
high cost claimants from 2009-2010
Prevalence of Behavioral Risk Factors
BRFSS, 2008 SAMHSA NSDUH 2006-2007
Our Experience 2006-2009
Behavioral Health
Pharmacy
Inpatient
Outpatient
Total Paid
2006
$301,456
$ 86,463
$184,245
$572,165
2007
$265,367
$ 73,857
$145,984
$485,208
2008
$247,945
$ 36,781
$136,652
$421,378
2009
$207,843
$ 21,214
$ 64,738
$293,795
Based on Plan Year April 1– March 31
Our Experience 2006-2009
Substance Abuse
Pharmacy
Inpatient
Outpatient
Total Paid
2006
$ 337
$ 3,670
$ 8,684
$12,691
2007
$1,086
$14,571
$16,820
$32,476
2008
$1,285
$16,946
$22,768
$40,999
2009
$
$47,009
$31,910
$78,919
0
Based on Plan Year April 1– March 31
Our Experience
Behavioral Health Net Paid PMPM
$9.00
$8.00
$8.03
$8.24
$7.99
$7.00
$6.48
PMPM
$6.00
$5.00
$4.23
$4.51
$4.70
$4.58
$4.00
$3.00
$2.00
$2.59
$1.21
$2.48
$2.59
$1.43
$1.25
$0.70
$1.00
$0.47
$2006
2007
2008
2009
Pharmacy
Inpatient
Outpatient
Total Paid
Strategy for all
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Offer medical plans requiring engagement;
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PCP – coaching opportunity
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Living Well – pharmacist coaching
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Reduce barriers;
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Give participants with chronic diseases tools and
support to manage their condition. Increase
compliance for disease-specific medications; and
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Provide wellness program that gives feedback
Coordination and Support for the Patient
Tools:
1. Employee Assistance
Plan – evaluation and
referral
2. Medical Benefits –
asses, medication and
treatment
3. Living Well Program face-to-face coaching and
medication management
4. Wellness Program –
telephonic or online
support for lifestyle
changes
Remove Barrier #1 – Benefit Limitations
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Implement behavioral health Parity
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Removed day/visit limits
Remove lifetime limits
Waive the HSA deductible for “preventive
prescriptions” as defined by the IRS
Remove Barrier #2 – Lack of Primary
Self-Care
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Provide preventive examinations at 100%
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Encourage relationship with PCP
Screening and early diagnosis of behavioral health
concerns, tobacco cessation, excessive drinking, and
drug use
Tobacco Cessation medications and coaching
covered at 100%
Increase reward for members who participate
in HumanaBeginnings for early diagnosis of
post-partum depression
Health Care Provider Form
13
Remove Barrier #3 – Complexity
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Integrated EAP (5 visits)
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Same network as Medical Plan
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Available to all employees, spouses and dependents
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PHQ9 administered by health coaches
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Connect STD and FMLA administration to
Medical
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Refer patients to Personal Nurse and Disease
Management
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Manage co-morbid health conditions
Behavioral health, tobacco use, excessive drinking
and drug abuse is costly to the workplace
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Lost Productivity
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Absenteeism
Presenteeism
Turnover and Training Costs
Co- morbidity with other Diseases
Overall Healthcare Costs
Disability
Worker’s Compensation Expense
Studies Show Treatment Improves Work
Performance
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Nearly 86% of employees treated with
depression with antidepressant medications
reported improved work performance.
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80% of those treated for mental illness report
“high levels of work efficacy and satisfaction.”
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Studies prove that treatment of depression
results about a 40-60% reduction in
absenteeism/presenteeism.
Source: Finkelstein SN et al: Improvement in Subjective Work Performance after Treatment of Chronic Depression: Psychopharmacology Bulletin, Vol 32,1996, pp 33-40.
Therapy in America 2004: Poll shows Mental Health Treatment Goes Mainstream. Dunlop, DD Am J Pub Health 2005. Wag, PS am J Psych 2004. Simon, GE Gen Hosp
Psych 2000, Claxton, AJ JOEM, 1999. Courtesy of Clare I Miller, Partnership for Workplace Mental Health.
Understanding Co-Morbidity
Implemented Living Well (Base on Asheville Project)
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Provide members with a personal health coach (from a
network of specially-trained pharmacists);
Coordinate with the patient’s physician or other healthcare
providers to help effectively manage their condition:
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Diabetes
High Blood Pressure
Cholesterol
Asthma
Depression
Provide medication and supplies without deductible and
reduced copays.
Address Co-morbidity with other diseases
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Individuals with depression consume two to four times the
healthcare resources of other enrollees.
Chronic medical illnesses increase prevalence of major
depression.
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45% of people with asthma and 27% of people with diabetes
have co-occurring depression
Individuals with depression are twice as likely to develop
CAD, twice as likely to have a stroke and more than four
times as likely to die within six months from a myocardial
infarction.
Many chronic medical conditions are adversely affected by
behavioral health conditions. Co-morbidity increases
impairment in functioning and decreases adherence to
prescribed regimens.
An employer’s Guide to Behavioral Health Services, National Business Group on Health December 2005.
Pincus HA. J Clin Psychiatry. 2001;62 Suppl 6:5-9; Schatzberg AF. J Clin Psychiatry. 2004;65 Suppl 12;3-4.
Sederer Li et al: Integrating Care for Medical and Mental Illnesses. Preventing Chronic Disease, April 2006.
Patient Incentives – Living Well Program
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Face-to-face coaching
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Improved reliability via direct observation
Interpersonal connection
Strengthens the patient-physician relationship
HSA Medical plan deductible waived for
preventive RX
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100% coverage diabetes medication, test strips and
supplies
Reduce copays by 50% for medication
 Cholesterol
 Blood Pressure
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 Asthma
 Depression
Free Glucometers & Insulin Pumps
Traditional Interventions are Limited
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Employees ride below the radar
EAP – most employees with behavioral
health, alcohol and drug disorders do not
receive services
Health Risk Assessments (HRA) – provide
promotions only to those that self-report an
issue or concern.
Supervisors are not trained to recognize the
symptoms or do not know how to approach.
The Bottom Line
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Behavioral health, excessive drinking,
tobacco and drug use is
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prevalent in working populations and
frequently co-morbid with other health conditions.
Treatment works.
Face-to-face coaching is cost effective.
Primary Care Physicians have the opportunity
to improve effectiveness of care.
Resources - Connections
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Center for Health Value Innovation
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LifeSync
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Grant Lee 469-759-4312, [email protected]
Piedmont Pharmaceutical Care Network
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Cyndy Nayer 314-422-4385, [email protected]
Larry S. Long RPh, 336-202-7146, [email protected]
Quality Health Solutions
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Brian J. Thomas, 888-747-0708 ext 102,
[email protected]
Questions?
Jeff Kluever
[email protected]
414-224-2702