Health Plans and Population Health Management

© 2012 Health Fitness Corporation

1© 2011 Health Fitness Corporation 1© 2012 Health Fitness Corporation 1

A Partnership Checklist for Population HealthJune 14, 2012

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Today’s Discussion

1. The health plan landscape

2. Why population health management?

3. Health Plan Top 10 Checklist

4. Q&A


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The Health Plan LandscapeHow is the market respondingto regulation?


4© 2012 Health Fitness Corporation

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Changing landscape, health plan evolution

Regulatory Drivers Market Response

ACA--Increasing the number of insured consumers B-to-C shift in insurance marketing

Medical Loss RatioDesign quality improvement activities that can be measured and verified.

Accountable Care Organizations Collaborate as conveners, participants, value-based payers

Comprehensive Primary Care Multi-purchaser initiative for com-prehensive, accountable care

Health Insurance Exchanges (HIX) Design consumer-focused plans

Mergers and acquisitions High level of activity in both horizontal and vertical directions



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ACA: Increasing the number of insured consumers

• Consumer-centric products and services

• Low-or-no cost preventive care services

• Wellness services—health risk assessments, biometric screening, health coaching, reimbursement for smoking cessation, chronic care management



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Regulatory Drivers Drivers—Affordable Care Act Market Response

Medical Loss Ratio • Measured and verified• Can include:

- Population health/wellness- Care management- Case management- Chronic care management



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Accountable Care Organizations

Collaborate as conveners, participants, value-based payers• CMS Pioneer ACOs• Medicare Shared

Savings Program• Commercial ACOs



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Comprehensive Primary Care Multi-purchaser initiative for comprehensive, accountable primary care

Apr 2012CMS released selected markets

May 2012Health plan payersapply to participate

Aug 2012Practicesannounced

Sep 2012Project launch



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Regulatory Drivers—Affordable Care Act Market Response

Health Insurance Exchanges (HIX)

$1B

Design consumer-focused plans• Supreme Court ruling in ACA

(June 2012)• Est. 26M to 67M to enroll (Rand)• Customer mix:

- High risk only? - Employees of small/medium

size companies with lean policies

- Large employer groups• Bronze, Silver, Gold and

Platinum plans



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Federal HIX Establishment Grants

Source: Healthcare.gov fact sheet



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Regulatory Drivers—Affordable Care Act

Market Response

Mergers and acquisitions High level of activity in both directions--horizontal & vertical


Hospital Hospital

Health Plan Hospital Practice

Health Plan

Hospitals

Practices

Data/ AnalyticsPHM

Hospital Practice

Hospital Practice


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Why Population Health Management?



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Why engage in a population health management strategy?• Decades-long record with large employers as demand-

side strategy to reduce claims costs• Right side of the MLR equation• Health risk data gathered BEFORE claims filed• Retain traditional customers (large/medium employers)• Attract new customers (new consumer marketplace)

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Consumer Trust

Core Business

Experience Readiness

Health plan-based PHM vs. partnership


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The Health Plan Top 10 Checklist


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10Single source

On-site program delivery

Proven experience

People

Recognition

Stable, scalable

Customized, flexible

Accountability

Outcomes & science-based

Technology & data


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EXPERIENCE• Scale• Complex client needs• Implementation

PERSONALIZATION• Client customization • Unique client needs • Participant experience

ENGAGEMENT• Intrinsic behavior change

For comprehensive, integrated health management programming

• Centralized accountability—one contract, one management structure, one bill

• Simplicity in integrating data to measure performance

• Optimum program delivery—no finger-pointing• Member experience--One phone number, one portal,

warm transfers

Single source


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On-site program delivery capabilities

• Choose a vendor who can bring services to the doorstep of multiple, diverse employer-clients of your plan

• On-site screenings bring more to the employer-client bottom line—better participation, less time away from the job

• Company-owned screeners vs. rent-a-nurse• On-site health improvement classes• On-site program administration

On-site program delivery


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Proven experience and expertise

• Consultative partnership resources• Ability to gauge health trends across different

employer-client types—manufacturing, service, high-tech, public employee, etc.

• What engagement activities really work in different settings? Focus groups, data mining resources

Experience & expertise


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Technology is a good tool, but people turn the key on engagement

Layers of support: • Customer service• Program development experts• Implementation experts• Behavioral science experts• Outcomes experts• Data and technology experts• Occupational health, health advising, health risk

assessment, medical oversight, etc.

Experience & expertise


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EXPERIENCE• Scale• Complex client n• eeds• Implementation


Recognition and references

• PHM partner name recognition• Client testimonials• Third-party recognition for PHM excellence

• Award-winning clients

Innovations in Prevention Award

Recognition & references


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Stable, scalable and national in scope

• Proven track record and financial stability• Ability to provide services in multiple locations at

the same time—geographic and resource reach• Ready to grow as you grow

Stable & scalable


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Customized, flexible, consultative approach

• Comprehensive, integrated program• Modular approach to fit with plan’s own programs• Customizable templates– Incentives– Service options—Coaching? Occupational health?

Wellness classes? Screenings?– Program needs and preferences—telephonic,

on-site, web-based, all of the above– Portal platform

• Complete customization and client branding• Expert adviceCustomized & flexible


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Pricing and performance—accountability

• Pricing—based on utilization of services• Performance—outcomes based measurement• Measurement, verification of participation and

outcomes essential in more transparent environment (ACOs, HIX)

Accountability


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Outcomes methodology and science-based approach

Look for REAL gains, not what-ifs• Lower claims costs• Change in risk factors from high to low• Can your partner demonstrate the value of the

program with clear, unambiguous data?

Outcomes-, science-based


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ROI Claims Analysis MethodologyMeasurement

Pre-Program Year Program YearMeasurement

Post-Program Year

Participants Baseline

Characteristics

Participants - Measure

Difference in Claims Spend

Participants Receive Services

Matching

Process

Reference Baseline

Characteristics

Reference - Measure

Difference in Claims Spend

Compare

T1 to T2

Outcomes-, science-based


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Technology and data capabilities

• Data sharing needed for accountability in reform efforts—ACOs, PCMHs, HIX

• Data transfer• Integrating data from disparate sources• Engagement factor• eHealth portal with your branding• Personalized consumer environment

Technology & data


28© 2011 Health Fitness Corporation 28© 2012 Health Fitness Corporation 28

Question & Answer SessionGLENN LEARYVice President, Business Development HealthFitnesswww.HealthFitness.com

Health & Medicine

Health Plans and Population Health Management