Population Health is Good Business

1. Population Health is Good Business Anne Elwell, RN, MPH VP, Community Relations Qualidigm The Changing Healthcare Landscape HFMA CT Annual Meeting June 5, 2014

2. 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

3. Health Risk Behaviors

4. 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

5. 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

6. 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

7. National Security • Childhood obesity is a national security threat • One in four Americans are unfit for military service because they are too heavy

8. 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…

9. The Good News! • Addressing modifiable risk factors for chronic disease • Save lives and reduce economic impact by $11.9 billion in 2023

10. 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.”

11. 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

12. Absenteeism and “Presenteeism” • Absenteeism: largely due to chronic illness • Presenteeism: responsible for the largest share of lost economic output associated with chronic health problems

13. How can we turn this ship around?

14. 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.”

15. 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.

16. This Approach Requires • Coordination of different interventions • Health promotion • Prevention • Screening • Behavior change • Consumer education (self management, disease management, chronic care management)

17. Population Health • Eliminate healthcare disparities • Increase safety • Promote effective, equitable, ethical and access to care

18. 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

19. 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%

20. Wellness in Four Steps

21. You Don’t have to do it Alone

22. 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%

23. 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%

24. Connecticut’s Plan for Reducing Chronic Disease

25. Decreasing Readmissions

26. 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

27. 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

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

29. "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

30. Anne Elwell, RN, MPH VP, Community Relations Qualidigm Aelwell@qualidigm.org (860) 632-6322