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Strengthen EmployeeEngagement Through a New

World WorkThe Total Rewards Association

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A case study about a Floridaschool district’s approach to

maintain health and wellness amongits employees under the pressure of arapidly growing community anda tight budget.

Fasco County is located just north ofthe Tampa-St. Petersburg metropolitanregion and is the state’s 12th mostpopulous county. From 2000 to 2010,the county population increased 34.8percent from 344,768 to 464,697, theU.S. Census reports. This growth wasfueled by increases in housing andjobs north of the Interstate 275 andInterstate 75 intersection along thestate roads 52, 54, and 56. It’s esti¬mated that the population is expected

By Dan Ross, Med-Vision, John Watson, CrowneClinics and Katherine Macrone, Deerwalk Inc.

9 October 2015 workspan | 51

Ifo tk& 2009-2010 the school boardcreated an Insurance Committee to meet withconsultants and identify programs to reduce health-carespending and increase employee health and wellness.

to increase to 479,078 and to 527,000by 2030. As more families move intothe county, increased service pres¬sure is exerted on all governmentservices including schools.

Twenty-five percent of Pasco resi¬dents are between the ages of 25-44and another 26 percent betweenthe ages of 45-64. Families make up67 percent of the population with anaverage household of 2.7 persons.

The District School Board of PascoCounty (DSBPC) was, and continues tobe, the largest employer in the countywith 9,350 employees in 2010-2011and rising to over 9,500 by 2015. Highschool graduation rates have increasedfrom the baseline of 73.4 percent set

TV* Tuuire*What is missing in medicine todayis a holistic approach authoredby consultants, employers andled by physician-directed healthcenters. In this model, doctorsare salaried and only worry abouttheir patient’s health, outcomesand future good health.

“There are more than 9,000 billing codes for individualprocedures and units of care. But there is not a single billingcode for patient adherence or improvement, or for helpingpatients stay well.”— Clayton M. Christensen, “The Innovator’s Prescription: A Disruptive

Solution for Health Care."

in 2007 to 81.9 percent in 2010 toover 90 percent by 2015.

County growth and demographictrends are shifting from a ruralcommunity to a more suburbanpopulation with increased demandsfor housing, schools, roads, entertain¬ment, retail and other services. Withthe collapse of the housing market in2007-2008 and resulting recession, thecounty saw a net property tax revenuedecrease over the same time period asthe population was increasing.

The annual budget of $519 millionspends 94 percent on direct studentservices. Within this context ofincreasing enrollment and flat budgetincreases, it became imperative forthe district to review all expendi¬tures that were not directly relatedto student services. Faced with thedouble hit of decreasing tax revenueand increasing population, the DSBPCneeded to find a way to reduceadministrative expenses while main¬taining student expenditures.

Starting in 2008, the DSBPC targetedthe annual trend of 10-12 percentincrease in its health care spending,a major target for cost reduction.As with all health insurance plans,every dollar spent on claims wasa dollar less to spend on otheradministrative areas such as facilities,staffing, technology and pay.

Without broker involvement where commissions and fees may, andin most cases have, become a primary driver of recommendationsfor programs, the partnership between the employer, health andwellness centers, and consultants can and will lower spend,improve health, and save employees and employer’s money. Dataanalytics are now available to pinpoint inefficiencies and excesswaste in health-care costs, and opportunities abound for both costsavings to employers and employees as well as future good healthand quality of life.

Team-Based ApproachIn the 2009-2010 year, the schoolboard created an Insurance Committeeto meet with consultants and iden¬tify programs to reduce health-carespending and increase employeehealth and wellness. The groupconsisted of Med-Vision LLC, Care-Here Crowne, LLC, the school districtsuperintendent, and the school district

52 | workspan October 2015

Insurance Committee. Med-Vision is thedata analytics company that compilesand then analyzes an organization’shealth and pharmacy claims data inorder to identify areas and activitieswhere excess spending can be reduced.CareHere Crowne was formed as part¬nership between The Crowne Group andCareHere LLC and it administered theemployee health and wellness centersfor the district. The following areaswere identified where excess spendingcould be addressed through a programof wellness, big data and physician-directed health centers:1 | Moving pharmaceutical drug

spending from higher-cost brandnames to lower-cost generics

2| Engaging members with chronicconditions such as high bloodpressure, high cholesterol anddiabetes in active manage¬ment of those conditions

3| Identifying the mix of claim dollarsbetween preventive and reactivepayments for existing disease and

Claims data are taken direct into theMed-Vision system and analyzed in aneasy to read and understand reportingformat. The platform utilizes the Deer-walk Plan Analytics platform, whichuses the practice of Big Data analysiswhere information is stored in data“lakes” and can be searched and reportedon in real time, much like Internetsearch engine’s return information. Inaddition, data from over 18 millionlives is benchmarked against the datafrom the organization based upon theorganization demographics in order tocompare organization results againststatistically validated norms.

The team was able to identify keyaction items to reduce spend andincrease member engagement in well¬ness. Team members then then usedthose parameters to develop a programdriven by employer-sponsored on-sitehealth centers and real-time dataanalysis feedback on the results:1 | Implement on-site physi¬

cian directed health andwellness centers for employeeand their dependents (members)medical and pharmacy use.

2 | In exchange for no co-paysfor medical and lower to nocost for many pharmaceu¬ticals, member blood workand biometric data feedinto the clinical systems sothat data analytics are ableidentify high-cost expenseand high-risk population.

3| By identifying theseemployees who were eithercurrently high cost or atrisk of becoming high cost,steps are taken to reduce riskby driving these employeesto manage their conditionsthrough on-site physicianand health teams coach.

4| Move pharmacy benefitmanagement (PBM) from atraditional PBM model to atransparent PBM that operateson a pass-though pricing model.

AWarJi/AccotaJeÿ &During 2014, Healthiest Employers, the

leader in employee health analytics best

practices and benchmark data, inductedthe District School Board of Pasco County

into the 2014 Healthiest 100 Workplaces

in America. The district school board

was also designated by the American

Heart Association as the Platinum Fit

Friendly Workplace.

In 2013 the Tampa Bay Business Journal

named the District School Board of Pasco

County as the healthiest employer in the

1500+ employee category and secondplace overall winner out of 27 finalists

from the Tampa Bay area.

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October 2015 workspan | 53

Physician Directed Healthand Wellness CentersThe health and wellness center modeloffers medical visits with $0 co-payand prescriptions that are often $0or much lower cost than through themember health plan. By running allclaims from the health plan and theemployee health and wellness centersthrough its data model, Med-Visionis able to analyze the components ofsavings and health from the healthcenter versus the health plan participa¬tion in order to document savings andtarget additional areas for savings.

As a physician-directed program,every health center is staffed by aboard-certified medical doctor who isa salaried employee of the company.Each health center medical staffer isable to spend 20-30 minutes withthe member, unlike most practiceswhere time is often limited to 5 or 10minutes. In addition, there is a phar¬macy doctor on staff to review andmonitor all prescriptions.

Since the health center inceptionin 2011, employee participation hasgrown to where currently 96 percentof eligible employees use some typeof health and wellness center service.Total appointment utilization increased

132 percent per member per yearsince inception. Growth has beenrobust that over the past four years atotal of five health centers have beenopened as of May 2015.

In 2014, 46,000 appointments weremade for medical treatment with60-70 percent of these treating achronic condition and 30-40 percentacute care. Ten thousand visits werewellness based. Participation istrending at 5,000 visits a month forboth wellness and medical visits.

Employee and MemberWellness ProgramThe centers provide a critical link tosupport the organization’s health andwellness initiatives. After the initiallaunch and strategic plan design,teams were assigned to specificgoals and held accountable to imple¬ment tactics, monitor results, assessand evaluate programs and providefeedback for program success usingdata-driven analysis. Four strategicinitiatives were targeted:1 | Communications — engage

all members2| Wellness — physical, emotional,

financial, social, spiritual3| Weight Loss — care health team4| Diabetes Management — medi¬

cation compliance, close caregaps, reversal of disease

The wellness committee consists ofassociates from all parts of the orga¬nization —human resources, boardmembers, union members, teachers,EAP specialists, school nurses, healthcenter employees and other admin¬istrative employees. All membersof the health plan are part of thewellness program, not just employees,thus engaging all stakeholdersin wellness programs.

Cost Savings Medical,Pharmaceutical, andWorkers CompensationSince inception in 2011, medical andprescription plan cost exclusive of thehealth center expense has trendedupward only 0.5 percent over thefour-year time frame (essentially a


rFigure 2 | Health Plan Utilization: Inpatient Facility

A

350

300

250

200

150

100

50

0

ALOS:3.5

Pre-EmployeeHealth Center

Opening

Jan10-Dec10 Jan11-Dec11 Jan12-Dec12 Jan13-Dec13 Jan14-Dec14

Inpatient Days/1,000 Members

908070605040302010

0

81 79

Pre-EmployeeHealth Center

Opening


Inpatient Admissions/1,000 Members‘Includes run-out medical claims

v j

( i ' \Figure 3 | Health Plan Utilization: Outpatient Facility

1000

800

600

400

200

0

0 percent trend). Contrast this withaverage 4 percent to 12 percentyear-over-year trend and annual costincrease over same timeframe forbenchmark organizations.

Facility Utilization TrendInpatient facility utilization decreased15 percent since inception from 83per 1,000 members to 70 per 1,000members over a four-year period.Outpatient facility visits decreased10 percent since inception from902 per 1,000 members to 816 per1,000 members in the same timeframe. In addition, medical claimsper member per year decreased 10percent over the four-year period.Total number of claims processed bythe health plan dropped 16 percentin the same timeframe.

Prescription TrendPrescription drug utilization throughthe health plan has decreased17 percent since inception of thehealth center pharmaceutical program.As the employee health and well¬ness center dispenses its drugs ata much lower cost than the healthplan, this drives savings for both theemployee and the employer.


Outpatient Visits/1,000

The number of outpatient visits has decreased 10 percent since inception.

V

Workers’ Compensation TrendThe centers also manage all firstreports of injury workers’ compensa¬tion claims since after the first yearopening. Expense from workers

October 2015 workspan | 55

compensation and occupationalclaims have dropped 60 percent overthe reporting frame.

District and EmployeeSavings Three-Year ResultsOver the reporting period, the valueof the shifted utilization for thedistrict totals $24 million. Once theemployee health and wellness centeroperating costs are included, savingsare $9.2 million over the timeframe.

Employee Savings Year ResultsOver the past four years, membershave saved a total of $4.2 million inmedical and prescription co-pays alone

Figure 4 | Prescription Utilization: EH&WC and Health Plan(Per Member Per Year)

A

Utilization through the Plan has decreased


Number of EHC Rx PMPY Number of Health Plan Rx PMPY

Figure 5 | District Savings(Analysis by Health Plan Utilization Change)

Market Costof Medical

ClaimsAvoided

Market Costof Rx Claims

Avoided

Total MarketValue forShifted

Utilization

EH&WCOperational

Costs‘excludes facilityrelated charges Net Savings

2011 $6,914,248$1,171,000

($75.69 x 15,471)$8,085,248 $3,856,189

2012 $4,579,215$901,239

($37.63 x 23,950)$5,480,454 $5,258,482

2013 $9,343,680$1,062,987

($38.15x27,942)$10,409,667 $5,612,988

Total $20,837,143 $3,138,226 $23,975,369 $14,727,659 $9,247,710

Despite High Cost Claimants in 2012, ROI = $1.63 : $1

by using the employee health and well¬ness centers instead of the health plan.

The district is a large group withover 9,000 members and the baselinedata set included three years ofclaims information, which translatesto over 340,000 member months.These data sets are large enoughso results are considered statisti¬cally significant (within 2-3 percentof margin of error).

Future TrendsMedical claims costs are being drivenprimarily by high-cost claimantsin areas like cancer and multiplesclerosis, along with a few cases oftrauma or premature birth. Pharmacyclaims costs are most recently beingdriven by specialty medications totreat conditions like Hepatitis C,multiple sclerosis and cancer. Alsolower-cost/lower-risk members arebeing moved out of the plan andusing the company plan as a singlecoverage. Or, they are using programsunder the Patient Protection andAffordable Care Act or Medicareor Medicaid programs. Concernsregarding adverse selection ariseif only the sickest members areremaining in the plan. TO?

Dan K. Ross is president of Med-Vision LLC/

Med-View LLC in Tampa, Fla. He can becontacted at [email protected].

John Watson is director of strategic

development at CareHere Crowne LLC. He can

be contacted at [email protected].

Katherine Macrone is a client manager

at Deerwalk Inc in Tampa, Fla. She can becontacted at [email protected] in

central Florida.

resources plusFor more information, books andeducation related to this topic, logon to www.worldatwork.org anduse any or all of these keywords:

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