THR Keynote Feb 2011

8/7/2019 THR Keynote Feb 2011

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Accountable HealthcareUtilizing Your Programs toInfluence Cultural Change

Presented by: Jeff StreseDirector of Human Resources

Southern Methodist University


2/13

Southern Methodist UniversityA private university of 11,000 students near the center of Dallas, SMU offers

strong undergraduate, graduate, and professional programs through seven

schools in the humanities and sciences; business; the performing, visual,

and communication arts; engineering; education and human development;

law; and theology.

Locations: Dallas campus, SMU-in-Plano, SMU-in-Taos Benefit Eligible Groups: Faculty & Staff, Early Retirees and Retirees

Faculty/Staff

2,287 benefit eligible, 2,092 enrolled in health plan

Blue Cross Blue Shield of Texas (since 2005)

Retirees

417 enrolled in retiree health plan

Emeriti Retiree Health Solutions (since 2008)

2


3/13

Cultural Challenges

Higher Education demands Best Practicebenefits approach

Different needs of faculty & staff population

Strategic decisions need buy-in from FacultySenate, Benefits Council, etc.

Aging demographic

Average employee age is 47

2 year large claim spike

3


4/13

Health Risk Identification

Health Risk

Assessment

Lab Values:Biometrics

Cost Analysis:Claims Data

Continued Risk

Claim & Clinical

Management

Intervention

TobaccoMetabolic

Syndrome

Clinical

Stress

Musculo-

skeletal

Reversed Risk

Ongoing

Monitoring

Trend Elimination Strategy

Keep theHealthy,Healthy

2011 Trajectory Health, LLC


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Employers must view

patient accountability astheir risk management

responsibility

Patients dont want to

be engaged in insurance

Disease production anddestruction cannot be

slowed with patient

compliance

High degree of variability

in provider quality andmedical outcomes

High degree price

variability even within a

network

Lack of integration in mosthealthcare delivery

systems

Focused gatekeeper

initiatives work

Accountabilityin Healthcare is Coming

Confidential-Not for Distribution2011 Trajectory Health, LLC


6/13

Accountable Healthcare at SMU

Developed and launched organizational initiative in 2010 based on

healthcare inflation and reform

More aggressive levers in plan design for 2011 Eliminated lower deductible participants migrating to higher

deductibles

Incentivize mail order and generics

Implemented consumer driven, pre-procedure analysis Compass

All age appropriate screenings are at no cost to the participant

Increased stakeholder outreach awareness building for change

management reasons


7/13

Who is REALLY Incurring Claims?

Intervention Challenge:

Who is going to move to

Red and Yellow next,

and how do you keep them

from getting there?

Healthy Status

Episodic Status

Catastrophic

Paid Claims

$0 - $999

7%

$1,000 - $9,99943%

> $10,00050%

# of Claimants> $10,000

5%

$0 - $99955%$1,000 - $9,999

40%


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Impacting Claim PatternsDisease & Pre-Disease Management

Disease Management Pre-Disease Management

Naturally Slim/Healthy Lifestyles

10-Week Clinical Intervention

Program Metabolic Syndrome Education

Pre and Post Program Biometric

Screenings

Health Coach

Online Wellness Community

NS Town

Healthy Status

Episodic Status

Catastrophic

Employee Wellness Program Wellpower Wellness Web Site On-site Biometric Screenings Annual Preventive & Diagnostic

Care Special Beginnings for Expectant

Mothers 24-Hour Nurseline Flu Shots

# of Claimants> $10,000

5%

$0 - $999

55%$1,000 - $9,99940%


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Metabolic Syndrome Improvement

All SMU Participants Benchmark

100%

47.1%

-53%

0%

10%

20%30%

40%

50%

60%

70%

80%

90%

100%

% of Population with MetS

Pre

Post

Change

932018

100%

54.8%

-45%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% of Population with MetS

Pre

Post

Change


10/13

Clinical Lab Improvement

N = 154

71%

45%

56% 57%53%51%

23%

59%

32%

23%

-28% -50% 6% -43% -56%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Elevated WaistCircumference

ElevatedTriglycerides

Reduced HDL["good

cholesterol"]

Elevated BloodPressure

Elevated FastingGlucose

Percentage of Participants

Prevalence of Specific Risk Factors

Pre

Post

Change


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Weight Loss

6

14

20

25

12 12

13

0

5

10

15

20

25

30

Gained 0 to

5

5 to

10

10 to

15

15 to

20

20 to

25

25 to

30

30+

CountofParticipants

Pounds Lost During Program

MetS Participants WeightLoss

N=93

Average Weight Loss: 12.7 pounds

Total Pounds Lost: 1177.4 pounds

Average Weight Loss: 11.8 pounds

Total Pounds Lost: 1823.9 pounds

11

25

31

40

2319

2 3

0

5

10

15

20

25

30

35

40

45

Gained 0 to5 5 to10 10 to15 15 to20 20 to25 25 to30 30+

Count of Participants

Pounds Lost During Program

All Participants WeightLoss

N=154

Count of Participants


12/13

Next Steps at SMU

Implement more cost saving levers in 2012 plan

design Cost goal: $70 (SMU)/$30 (Employee)

Phase in more incentives for healthy

Lay the groundwork for cost penalties forunaccountable participants (unhealthy)

Targeted communication and education (increase

generics, mail order, screenings)

Increase organizational outreach to penetrate faculty

culture


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Questions?

THR Keynote Feb 2011

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