Better Care, Better Health and Lower Cost James E. Pope, MD, FACC Chief Science Officer, Healthways September 16, 2010
Apr 02, 2015
Better Care, Better Health and Lower Cost
James E. Pope, MD, FACC
Chief Science Officer, Healthways
September 16, 2010
WWW.HEALTHWAYS.COM
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What is Driving Cost
Mozaffarian, Wilson and Kannel, Circulation 2008
$$$$$
Chronic Disease is driving increasing morbidity and cost…
…. and then you die.
But good news: There are treatments!
Bruckert ,E Eur Heart J Suppl 2005;7:L16-L20© The European Society of Cardiology 2005.
Relative odds reduction according to number of years in trial and reduction in LDL-c
Meta-analysis of 49 Clinical TrialsIschemic Heart Disease Risk Reduction
Lifestyle Changes and Risk Reduction
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“Exercise, exercise, exercise.
It's the only wonder drug we
have.”
Adults who are physically
active not only have a lower
risk of disease, depression and
chronic pain from conditions
like arthritis and back pain but
are also less vulnerable to
dementia than their inactive
peers.
-- Dr. Rosanne Leipzig, vice chair of the department of geriatrics at Mount Sinai School of Medicine - Time Magazine, June 22, 2009
It’s All About Prevention
Proven Solutions
Silver Sneakers Senior Fitness Solution• Lower total health care costs
• Lower hospitalization rate
• Cost & hospitalization rates lower for individuals participating > once a week
• Newly diagnosed depression lower in individuals participating > once a week
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Nguyen, H.Q., Ackermann, R.T., Maciejewski, M., Berke, E., Patrick, M., Williams, B., LoGerfo, J.P. (2008). Managed-Medicare Health Club Benefit and Reduced Health Care Costs Among Older Adults. Preventing Chronic Disease, 5(1), 1-10. http://www.cdc.gov/pcd/issues/2008/jan/07_0148.htm
Huong, H.Q., Maciejewski, M.L., Gao, S., Lin, E,Williams, B., & LeGerfo, J.P. (2008). Health Care Use and Costs Associated with Use of a Health Club Membership Benefit in Older Adults with Diabetes. Diabetes Care, 31(8), 1562-1567. http://care.diabetesjournals.org/content/vol31/issue8.
Huong, N.Q., Koepsell, T., Unuetzer, J., Larson, E.,& LoGerfo, J.P. (2008). Depression and Use of a Health Plan-Sponsored Physical Activity Program by Older Adults. American Journal of Preventive Medicine 35(2), 111-117. http://www.ajpm-online.net/article/S07493797(08)00381-4/abstract
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10% Risk Reduction$434 BILLION
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The Call to Action
Actuarial model that can score the value of health risk reduction
Demonstrates the potential savings from:
PreventionHealth PromotionChronic Care Management
Enormous value to be gained by• Helping Medicare beneficiaries stay
healthy and/or progress more slowly in disease severity
• Getting people to Medicare entry in a better health status
Source: Center for Health Research, Ingenix Consulting Analysis (2009)Medicare Beneficiaries starting number as of May 2010 (Kaiser Family Foundation)
10% Risk Reduction$652 BILLION
Chronic Disease Driving Cost
0%
20%
40%
60%
80%
100%
None 1 2 3 4 5+
26
40
68
90
6
15
42
72
0%
20%
40%
60%
80%
100%
0-19 20-44 45-64 65+
1 or more chronic conditions 2 or more chronic conditions
Percent of U.S. population with chronic conditionsby age group
Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
Percent of Medicare expenses by beneficiarychronic condition status
Number of chronic conditions
Prevalence increases w
ith age
Cost increases w
ith Prevalence
Medicare Health Support (MHS) Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)1
Few Key Points• Three year randomized controlled studies of chronic care
management• Beneficiaries with diabetes and / or heart failure
• Selection of sicker individuals than average FFS Medicare• HCC2 score of 1.35 or greater (actual range 2.2 – 2.5)
• Eight pilots, assigned specific geographies• Different approaches selected to maximize learning
• Allowed to modify program design based on learning
• Participants needed to consent to receive program interventions• Lag time between program start and engagement of population
1 Title VII – Sec. 721 Under Traditional Fee for Service, Subtitle C – Voluntary Chronic Care Improvement2 Hierarchical Condition Code
Population Attributes
• PBPM Cost per beneficiary per month 3 X
• Hospital Admission Rate 2.5 X
• Hospital Bed-Days 2.5 X
• Skilled Nursing Facilities SNF admit rate 1.5 X
MHS vs. FFS Medicare
• Older, sicker, higher mortality• Seeing ~ 7-10 physicians on average
• Take ~10-20 medications at any point in time
• About 1% dying each monthSource: Healthways MHS program experience
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CMS FindingsGovernment Reports on Healthways MHS Performance
Source: Final Liability for Performance Monitoring Report; Mathematica Policy Research Submission to CMS (April 2009)Final Reconciliation for Healthways Medicare Health Support Program; Actuarial Research Corporation Submission to CMS (April 2009)Evaluation of Phase I of Medicare Health Support Pilot Program Under Traditional Fee-for-Service Medicare, McCall et al. Report to Congress (October 2008)Evaluation of Phase I of the Medicare Health Support Pilot Program Under Traditional Fee-for-Service Medicare: 18-Month Interim Analysis Report to Congress (June 2007)
Process of Care• Improvement in all 5 process of care measures:
Engagement• Consent rate of 89%• 65% continuous participation after consent
Physician support• All randomly-selected community-based
physicians reported that program could benefit beneficiaries with chronic conditions
Improved key clinical metrics
Gross savings created in both 1st and 2nd clinical cohorts
Net cost savings created in 2nd cohort
94% beneficiary satisfaction
CMS Scorecards on Healthways Reports to Congress (re Healthways)
• Help people adopt and maintain healthy lifestyle• Help reduce and where possible, eliminate health
risk• Optimize care for people with chronic conditions
Three Simple Aims
How NotTo EndUp Here
Prevalence of Chronic Disease
WWW.HEALTHWAYS.COM
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Center for Health Research
701 Cool Springs Blvd
Franklin, TN 37067
1414
Engagement Reduces Hospital Readmissions
The Impact of Post-Discharge Telephonic Follow-Up on Hospital Readmissions
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Accepted
(in press)
Harrison,P; The Impact of Post-Discharge Telephonic Follow-Up on Hospital Readmissions, 2010 Submitted Population Health Management
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Emory Study: Analysis of the Treatment EffectGreater Impact Observed for Active Participants
“… statistically significant decrease in spending
among those who fully participated in the program.
Total annual Medicare costs were 15% lower in 2007
for active participants, controlling for age, gender,
race and baseline risk. ”
Atherly, AJ, Thorpe, KE; Analysis of the Treatment Effect of Healthways’ Medicare Health Support Phase I Pilot ; Submitted Health Affairs, Jun 2010
DRAFT
Submitted
Journal of Population Health Management
“The Healthways study offers more proof that we know what works, and have the
ability to improve health and lower costs by engaging people and providing them with the support they need."
Kenneth E. Thorpe, PhD
Chair, Department of Health Policy and Management
Emory University Rollins School of Public Health
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MHS Outcomes in Important SubgroupsImpact of Predictive Model–Directed End-of-Life
Randomized control with treatment & control cohorts per CMS design
Focused on those in greatest need
Based on predictive model Top 10% death rate: 333 per 1000 Bottom 70% death rate 7 per 1000
Demonstrated statistically significant savings in the last 6 months of life for a total savings of
$5.95 million.
Hamlet, K; Am J Manag Care. 2010;16(5):379-384
Impact of Predictive Model–Directed End-of-Life Counseling for Medicare Beneficiaries