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Accountable Healthcare

Utilizing Your Programs to


Influence Cultural Change

Presented by: Jeff Strese


Director of Human Resources
Southern Methodist University
Southern Methodist University
A 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
Cultural Challenges
 Higher Education demands “Best Practice”
benefits approach
 Different needs of faculty & staff population
 Strategic decisions need buy-in from Faculty
Senate, Benefits Council, etc.
 Aging demographic
– Average employee age is 47
– 2 year large claim spike

3
Trend Elimination Strategy
Health Risk Identification
Health Risk Lab Values: Cost Analysis:
Assessment Biometrics Claims Data

Keep the
Metabolic Clinical Musculo-
Tobacco Healthy,
Syndrome Stress skeletal
“Healthy”
Intervention

Reversed Risk Continued Risk

Ongoing Claim & Clinical


Monitoring Management

©2011 Trajectory Health, LLC


Accountability in Healthcare is Coming

 High degree of variability  Employers must view


in provider quality and patient accountability as
medical outcomes their risk management
 High degree price responsibility
variability even within a  Patients don’t want to
network be engaged in insurance
 Lack of integration in most  Disease production and
healthcare delivery destruction cannot be
systems slowed with patient
 Focused “gatekeeper” compliance
initiatives work
Confidential-Not
©2011 for Distribution
Trajectory Health, LLC
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
Who is REALLY Incurring Claims?
Healthy Status
Episodic Status
Catastrophic
# of Claimants
> $10,000
5%

Paid Claims
$0 - $999
$0 - $999 $1,000 - $9,999 55%
> $10,000 40%
50% 7%

Intervention Challenge:
Who is going to move to
“Red” and “Yellow” next,
and how do you keep them
from getting there?
$1,000 - $9,999
43%
Impacting Claim Patterns
Disease & Pre-Disease Management
> $10,000
# of Claimants
5%

Healthy Status
Episodic Status
Catastrophic

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


40% 55%

Disease Management Pre-Disease Management


Naturally Slim/Healthy Lifestyles Employee Wellness Program
 10-Week Clinical Intervention  Wellpower Wellness Web Site
Program  On-site Biometric Screenings
 Metabolic Syndrome Education  Annual Preventive & Diagnostic

 Pre and Post Program Biometric


Care
 Special Beginnings for Expectant
Screenings Mothers
 Health Coach  24-Hour Nurseline
 Online Wellness Community  Flu Shots
“NS Town”
Metabolic Syndrome Improvement

All SMU Participants Benchmark


% of Population with MetS % of Population with MetS

100%
100% 100%
100%
93
90%
90% 2018
80% 80%
-45%
-53% 70%
70%

60% Pre 60% 54.8% Pre


47.1% Post 50% Post
50%
Change Change
40% 40%

30% 30%

20% 20%

10% 10%

0% 0%
Clinical Lab Improvement
Prevalence of Specific Risk Factors
N = 154
80%
71% Percentage of Participants
70%
59% 57%
60% 56%
51% 53%
50% 45%
Pre
40%
32%
Post
30% 23%
23%
Change
20%

10% -28% -50% 6% -43% -56%


0%
Elevated Waist Elevated Reduced HDL Elevated Blood Elevated Fasting
Circumference Triglycerides ["good Pressure Glucose
cholesterol"]
Weight Loss
Average Weight Loss: 11.8 pounds Average Weight Loss: 12.7 pounds
Total Pounds Lost: 1823.9 pounds Total Pounds Lost: 1177.4 pounds

All Participants Weight MetS Participants Weight


Loss Loss
N=154 N=93

45 40 30
40 25

Count of Participants
25
35 31 20
30 20
25
25 23 14
19 15 12 12
20
15 11 10
6
10 3
3 5
5 2 1
0
Count of Participants 0
Count of Participants
Gained 0 to 5 to 10 to 15 to 20 to 25 to 30+ Gained 0 to 5 to 10 to 15 to 20 to 25 to 30+
5 10 15 20 25 30 5 10 15 20 25 30

Pounds Lost During Program Pounds Lost During Program


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 for
unaccountable participants (unhealthy)
 Targeted communication and education (increase
generics, mail order, screenings)
 Increase organizational outreach to penetrate faculty
culture
Questions?