Better Care, Better Health and Lower Cost
James E. Pope, MD, FACC
Chief Science Officer, Healthways
September 16, 2010
What is Driving Cost
Chronic Disease is driving increasing morbidity and cost…
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…. and then you die.
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But good news: There are treatments!
Mozaffarian, Wilson and Kannel, Circulation 2008
WWW.HEALTHWAYS.COM
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$$$$$
Meta-analysis of 49 Clinical Trials
Ischemic Heart Disease Risk Reduction
Relative odds reduction according to number of years in trial and reduction in LDL-c
Bruckert ,E Eur Heart J Suppl 2005;7:L16-L20
© The European Society of Cardiology 2005.
Lifestyle Changes and Risk Reduction
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It’s All About Prevention
“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
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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The Call to Action
Actuarial model that can score the value
of health risk reduction
Demonstrates the potential savings from:
Prevention
Health Promotion
Chronic Care Management
Enormous value to be gained by
10% Risk Reduction
$434 BILLION
• Helping Medicare beneficiaries stay
healthy and/or progress more slowly in
disease severity
• Getting people to Medicare entry in a
better health status
10% Risk Reduction
$652 BILLION
Source: Center for Health Research, Ingenix Consulting Analysis (2009)
Medicare Beneficiaries starting number as of May 2010 (Kaiser Family Foundation)
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Chronic Disease Driving Cost
Percent of U.S. population with chronic conditions
by age group
Percent of Medicare expenses by beneficiary
chronic condition status
100%
100%
90
80%
72
68
80%
60%
60%
42
40
40%
40%
26
20%
20%
15
6
0%
0%
0-19
20-44
45-64
65+
None
1
2
3
4
Number of chronic conditions
1 or more chronic conditions
2 or more chronic conditions
Anderson, G. Chronic Conditions: Making the case for ongoing care. Johns Hopkins University. November 2007.
5+
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
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Beneficiaries with diabetes and / or heart failure
• Selection of sicker individuals than average FFS Medicare
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HCC2 score of 1.35 or greater (actual range 2.2 – 2.5)
• Eight pilots, assigned specific geographies
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Different approaches selected to maximize learning
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Allowed to modify program design based on learning
• Participants needed to consent to receive program interventions
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1
2
Lag time between program start and engagement of population
Title VII – Sec. 721 Under Traditional Fee for Service, Subtitle C – Voluntary Chronic Care Improvement
Hierarchical Condition Code
Population Attributes
MHS vs. FFS Medicare
• PBPM Cost per beneficiary per month
3X
• Hospital Admission Rate
2.5 X
• Hospital Bed-Days
2.5 X
• Skilled Nursing Facilities SNF admit rate
1.5 X
• Older, sicker, higher mortality
• Seeing ~ 7-10 physicians on average
• Take ~10-20 medications at any point in time
• About 1% dying each month
Source: Healthways MHS program experience
CMS Findings
Government Reports on Healthways MHS Performance
CMS Scorecards on Healthways
 Improved key clinical metrics
Reports to Congress (re Healthways)
 Process of Care
• Improvement in all 5 process of care measures:
 Gross savings created in both
1st and 2nd clinical cohorts
 Net cost savings created in 2nd
cohort
 94% beneficiary satisfaction
 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
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)
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Three Simple Aims
•
•
•
Help people adopt and maintain healthy lifestyle
Help reduce and where possible, eliminate health risk
Optimize care for people with chronic conditions
Prevalence of Chronic Disease
How Not
To End
Up Here
Center for Health Research
701 Cool Springs Blvd
Franklin, TN 37067
research@healthways.com
WWW.HEALTHWAYS.COM
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Engagement Reduces Hospital Readmissions
The Impact of Post-Discharge Telephonic
Follow-Up on Hospital Readmissions
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 Effect
Greater 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. ”
“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
Atherly, AJ, Thorpe, KE; Analysis of the Treatment Effect of Healthways’ Medicare Health Support Phase I Pilot ; Submitted Health Affairs, Jun 2010
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MHS Outcomes in Important Subgroups
Impact of Predictive Model–Directed End-of-Life
Impact of Predictive Model–Directed End-of-Life
Counseling for Medicare Beneficiaries
 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
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