✯
✯
2003 National Health Policy ✯Conference
January 22-23, 2003
J.W. Marriott
Washington, D.C.
Health Plan-based
Health Promotion Strategies
Rationale, Products and Services
Nico Pronk, Ph.D.
Vice President, Center for Health Promotion
Research Investigator, HealthPartners Research Foundation
Why Health Promotion and
Disease Prevention?
“A society that spends so much on health care that
it cannot or will not spend adequately on other
health enhancing activities may actually be
reducing the health of its population.”
-- Evans and Stoddart (1994)
Consider the likelihood that the same is true
for health plans, employers, …
Disease as well as Prevalence
Drives Health Care Costs
™
™
™
™
Stratified random sample of health plan members ages 40+
Survey data: PA, BMI, smoking status, chronic disease
status, age, gender (85% response rate)
We estimate the individual cost of care attributable to PA
and overweight/obesity from multiple regression analysis
controlling for age, gender, smoking status, chronic disease
status
Next, we estimate the portion of total expenditures
attributable to PA and overweight/obesity for segments of
the health plan by disease status
Estimated Annual Health Care Costs Attributable to Physical
Inactivity and/or BMI among Health Plan Members Age 40+
Membership
Prevalence
(Age 40+)
Mean Cost for
Group
Mean Cost
attributable to
PA and BMI
Total Health
Plan Cost
($1,000s)*
Total Cost
attributable to
PA and BMI
($1,000s)*
Diabetes
5.8%
12,264
2,983
142,261
34,604
Heart Dis.
8.2%
14,781
2,678
242,408
43,918
Both
2.4%
32,753
8,149
157,215
39,114
Neither
83.6%
4,734
802
791,456
134,029
Total
100%
6,667
1,258
1,333,340
251,666
* Assuming a health plan with 200,000 members ages 40+
18.9%
The Business Case For Health Promotion:
A Proactive View -- Preventing New “Cases”
Chronic Disease
Major Events
Acute Disease
Major Illness
Ability to identify “high-risk cases”
is critical to effectively prevent new “disease
cases” through behavior change programs
Our
Approach:
• HRA-based algorithms identify those at high-risk for diabetes and heart disease
• 6-fold higher risk for disease diagnosis over the next 2.5 years
• Modifiable risk factors drive the algorithm score--prevention opportunity
Health Assessment-based Aggregate Risk Picture
Employer size: 798 employees and dependents
Health Assessment response rate: 94%
257
Lower Risk
34.2%
95
Elevated
Risk 12.6%
364
High Risk
48.6%
35
Active
Diabetes/CAD
4.6%
Lower risk = 3 or fewer risk factors for diabetes & 2 or fewer risk factors for CAD
Elevated risk = 1 point below high risk category for heart disease, diabetes or both diseases.
High risk = 4 or more risk factors for CAD or 5 or more risk factors for Diabetes
HealthPartners Health Promotion
Programs and Services
™
™
™
™
™
™
™
Designed to prevent new diagnoses of (chronic) disease
and support self-management of diagnosed disease
Evaluated for effectiveness, scalability and sustainability
Implemented with capacity to reach large populations
Intervention intensity aligned with health risk levels
Intervention platform integrated with clinical care—
medical, behavioral health, pharmacy
Topics include weight management, tobacco cessation,
physical activity, low back pain, diabetes prevention,
diabetes and heart disease self-management, and others
Most participants reached by telephone or Internet
Health Risk Segmentation
Systematic Targeted Outreach Integrated with Medical Care
Low-Risk
Assign
level of
health
risk
HA
Based on
N=1,000
completers
Source: Pronk. HealthPartners CHP, 2001.
n=63%
High-Risk
n=30%
Active Disease
n=7%
Proactive outreach to engage
in risk reduction programs
Prevention
Programs
Care
Management
Reduce Incidence
Reduce Disease
Burden
HealthPartners
Health Investment Program
™
Packaging HealthPartners products,
health assessment, health improvement
and medical management programs with
incentives for employers and employees
to engage.
Health Investment Incentives
™
Employer incentives
™
™
™
Employee incentives
™
™
™
1% reduction in trend in the following year
Applies when Health Assessment response rate ≥80%
Require HA Completion as part of medical plan
eligibility OR
Offers a financial or other reward for taking the health
assessment and/or participating in health improvement
programs
HIP can also be implemented without incentives
Repeat in Subsequent Year
Combining Product Design, Incentives and
Health Improvement Programs
HealthPartners Health Investment Program
Employer establishes
incentives to complete
health assessment and
to participate in health
improvement programs
Participant
completes activity
and earns “health
shares” toward
year- end rewards
Employer
provides
annual
rewards
for shares
earned
HealthPartners
tracks
participation,
assigns shares,
and reports
progress to
employer
On
- line
Health
Assessment
Completed
Eligible for Health
Investment Account
Participant enrolls in
HealthPartners
health improvement
programs
Proactive, systematic health plan
follow-up
Identification, outreach, and -2 year
follow
- up for high
- risk (pre
diagnosis) individuals and individuals
with diagnosed heart disease or
diabetes
Automatic referrals to Case
Management
Automatic referrals to Behavioral
Health
Automatic referrals to Pharmacy
Integration of data into patient
medical record
Tailored individual report with
personalized health improvement
plan
Conclusions
™
™
™
Strong financial rationale exists to implement
health promotion and disease prevention
programs
Programs with known effectiveness, scalability
and sustainability can successfully promote
health, prevent and manage disease
Programs integrated with clinical care, utilizing
appropriate incentives, and supported by multiple
stakeholders (e.g., health plan and employers)
can reach the right individuals and enjoy high
participation