Collaborating for Health & Productivity

William Molmen, JDGeneral Counsel and Co-founder

Integrated Benefits Institute

www.ibiweb.org

About IBI• National, not-for-profit membership

organization

• 460+ corporate sponsors

• Health & Productivity Programs

– Health & productivity research

– Measurement/modeling tools

– Benefit program Benchmarking

– Education/Forum

• Visit www.ibiweb.org

Patient Centered Medical Home• The Collaborative believes…the patient centered medical home will

improve the health of patients and the viability of the health care delivery system.

• Employers, consumers, patients, clinicians and payers agree that it is essential to support a better model of compensating clinicians.

• Compensation under the PCMH model would incorporate:– Enhanced access and communication– Improved coordination of care– Rewards for higher value– Expanded administrative and quality innovations and – Promote active patient and family involvement.

• PCMH will improve the quality of care delivered and help control the unsustainable rising costs of healthcare for both individuals and plan sponsors.

• Clinicians have agreed to the following Joint Principles for patient-centered primary care:

– Option to develop an ongoing relationship with a personal physician;– Physician-directed medical practice;– Whole person orientation;– Coordinated care across the health system;– Ongoing, voluntary pursuit of quality and safety;– Enhanced access to care; and– Payment recognizing the value added.

Value-based Insurance Design

• “Supply side” service delivery financing promotes fragmented visits to multiple providers

• A VBID approach targets people (including their co-morbid conditions)

• To provide “demand side” incentives for a coordinated system of targeted and effective treatments.

• VBID naturally aligns with initiatives such as the patient-centered medical home and electronic medical records.

Patient Centered Medical Home / Value-based Insurance Design

Shortcomings in traditional definitions – From employer/payor

viewpoint

Value-based Benefits Design

“VBID promotes the use of services when the clinical benefits exceed the cost…”

Source: Sipkoff, M. Value-Based Insurance Design: Spend a Little More on Selected Patients For Payoff Down the Line. Managed Care. August 2009.

Value-based Benefits Design

“VBID promotes the use of services when the clinical benefits exceed the cost...”

Total Medical, Pharma & Productivity-- per 1000/FTEs --

Hypertension

Other Chronic Pain

Other Cancer (vs Skin)

Allergy

GERD

Anxiety

Back/Neck Pain

Arthritis

Obesity

Depression

MedicalDrugAbsencePresenteeism

$300,000$100,000 $400,000

(HPBS – Phase 2 Employers)

$200,000

Source: “Health and Productivity as a Business Strategy,” JOEM. Vol. 51, No. 4, April 2009

Co-Morbidity and Lost Time

0

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10+

# of chronic conditions

Lo

st d

ays

Absence lost time Presenteeism lost time

1.7

11.9

4.9

12.7

7.8

19.5

26.529.4

37.4

14.2

Source: “Health and Productivity as a Business Strategy,” JOEM. Vol. 51, No. 4, April 2009

10

Value-Based Benefits:The Impact of Pharmacy Plan Design

Source: A Broader Reach for Pharmacy Plan Design, Integrated Benefits Institute, 2007

IBI Research - 2007

Results Attract Broad Media Attention

11

Savings in Lost Productivity Costs-- For No-Script Group --

$12.8$14.0

$17.2

$0

$5

$10

$15

$20

Baseline Reduced incidence

Reducedincidence +

duration

Lost

Pro

duct

ivity

Cos

ts ($

Mill

ions

)

-26%

12 Source: A Broader Reach for Pharmacy Plan Design, Integrated Benefits Institute, 2007

Health & Productivity Focus for Patient-centered Medical Home

• Recognize employers are a critical part of healthcare– Provide 60% of coverage/workplace funds 55% of total costs

• Demonstrate the nexus between the Physican, patient, employer funder, and “value,” broadly defined

• Patient-centric – not just medical needs– Quality of life Includes work/family life – healthy/active

• Clearly align PCMH / VBID with health-related productivity enhancement that’s truly important to Payor – support for better coverage – Demonstrates that medical care/prevention are an investment

in workers, not a cost to be avoided or shifted

• Huge long-term impacts on post-retirement medical costs and quality of life from focusing on obesity

Challenges to Health & Productivity

• Effective education/Information• Credible measurement/Shared

understanding• Speaking in C-Suite’s language• Showing it as a competitive edge

Strategic Health & Productivity Collaboration

• Collaborators: Integrated Benefits Institute (IBI); The American College of Occupational and Environmental Medicine (ACOEM); and the Center for Health Value Innovation (CHVI)

• Work together to better articulate the value of health and productivity management (HPM)

• Working together, we will:– create standardized data and result metrics for

value-based health & productivity management – Present educational HPM Clinics to educate and

inform employers, insurance brokers and industry consultants on their opportunities to enhance employer competitiveness and health in the community, and concurrently bend cost trends.

Center for Health Value Innovation

• CHVI – An information exchange for value-based design - dedicated to sharing the evidence of improved health and economic outcomes through value-based designs for sustainable health and financial improvement.

• www.vbhealth.org

Center for Health Value Innovation

Publishes white papers with evidence on sectors, innovation, outcomes

Center for Health Value Innovation

New book on Value-based Design – Goals, Benefits, Levers, and Plan

American College of Occupational and Environmental Medicine

• ACOEM is an organization of occupational and environmental physicians, to promote and protect the health of workers through preventive services, clinical care, research, and educational programs.

• www.acoem.org

American College of Occupational and Environmental Medicine

• HPM Clinic – Educational program with IBI

• HPM Toolkit

• Journal of Occupational & Environmental Medicine

• Blueprint for Health modeling tool

Integrated Benefits Institute

• IBI – programs include benefits performance research and analysis, measurement, practical solutions, and forums for information and education to advance understanding about the link between—and the impact of—health-related productivity on corporate America’s bottom line.

• www.ibiweb.org

Integrated Benefits Institute

• Health, productivity, absence and disability management research

• Absence/disability and lost-productivity modeling and measurement tools

• Education programs

IBI Research

• Recent publications– More than Health Promotion: How Employers Manage

Health & Productivity

– The Full Costs of Depression in the Workforce

– Health and Productivity as a Business Strategy

– Employer Incentives for Workforce Health and Productivity

• Upcoming Research– HPM and Corporate Measures of Success

– Health, Productivity, Employee Performance and Engagement

Programs in Progress

• ACOEM/CHVI/IBI – HPM Clinic for regional brokers and consultants around the country showing them how to bring a competitive edge to clients through health & productivity.

• ACOEM/IBI – upcoming meeting of self-reported health information tool developers and users to determine what’s useful about the tools and reports, what should be changed. First stage of subsequent efforts to standardize metrics and measures.

• ACOEM/IBI follow-on to JOEM study to assess the impact of drug adherence on health & productivity.

Program in Progress • IBI project with Mark Fendrick to develop a white

paper outlining the data and analytical requirements for next-step empirical work to connect VBID to health-related lost time (absence and presenteeism) and lost productivity.

• IBI/ACOEM/other thought leaders – Employee health and productivity on the balance sheet. Initial meeting with employers, analysts, consultants, associations to map out a strategy and determine how to proceed.

• IBI – Research with John Riedel on how employers are using the variety of self-reported health information tools – how are the tools used, what information is useful, what are the challenges and how may they be avoided.

To Contact IBI

Bill Molmen

wmolmen@ibiweb.org

www.ibiweb.org