Leah Malof is a principal in Mercers Employee Health amp Benefits business as well as a consultant in Mercers national Analytic and Measurement specialty practice Leah brings practicality to her consulting engaging all the influential parties within the health care ecosystem toward ID: 661687
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Leah c. malofprincipal
Leah Malof is a principal in Mercer’s Employee Health & Benefits business, as well as a consultant in Mercer’s national Analytic and Measurement specialty practice. Leah brings practicality to her consulting, engaging all the influential parties within the health care ecosystem toward common goals that centers around her clients. Leah uses a variety of data sets and systems in her client work, transforming data to actionable strategy and driving high-integrity, objective decision making. Specific experience includes: utilization and complex and catastrophic case management, disability management, wellness and chronic disease management, medical claims management, centers of excellence program selection and implementation, incentive design and communications.
Her consulting work further includes leveraging data to answer fundamental questions such as what unique factors exist that can drive a specific and measurable strategy, such as the influence of generation, access, and culture. She has coordinated and led focus groups, vendor summits, and collaborated with communication resources to develop highly customized multi-media health promotion content. She leverages her data and broad healthcare experience to develop partnerships with vendors and client centered performance guarantees. And finally, Leah has a particularly strength in tying health and performance to the impact it has on her client’s business objectives.
Leah has more than 25 years of experience within the health care industry. Prior to joining Mercer, she was the Practice Leader for Buck Consultants’ Center of Excellence for Health Analytics and Interventions. She managed national consulting teams providing services that ranged from custom data dashboard development and analytics, to multi-functional audits, and population health and wellness consulting. Leah played an instrumental role in the development and ongoing operations of Buck’s private exchange solution, and also served as the interim Health and Productivity Practice Leader in the UK.
Leah’s health care industry experience also includes her work as a clinician, specializing in brain injury rehabilitation, with a specific focus on metacognition and assisting professionals and college students in returning to work and school. She leverages her clinical expertise in human behavior and decision making to help drive meaningful change in her consulting work. Leah also served as a director of various outpatient facilities and was a senior executive of a third-party administrator directly responsible for comprehensive medical operations to support claims administration and a full continuum of integrated care management programs and services.
Leah has a Masters in speech pathology specializing in neurology from Indiana University and a BA in psychology from Emory University. Slide2
Is Wellness Working?
How to make the most from the deluge of data
May 8, 2017Slide3
Wellness is….
“the active process through which people become aware of and make choices toward a
successful existence” -National Institute of Wellness
© MERCER
2017Slide4
Is health a business issue?
3
Source:
Mercer's Inside Employees' Minds Survey,
2015; Journal of Occupational and Environmental Medicine, January 2016
© MERCER
2017Slide5
Smoking
Pregnancy
/ Family
Condition
Mgmt.
Behavioral
Health
Weight /
Nutrition
Sleep
Financial
Wellbeing
Physical
Activity/Wellness
Medical
Devices
Pharmacy
Transparency
TeleHealth
Advocacy
Employer-Sponsored/Exchange
Communications
Incentives/Challenges
Navigation
Member
Assessments/Testing
Focus
Broad
Narrow
Narrow
Population
Big Data Analytics
2
nd
Opinion
Care
Coordination
Onsite/
Near-site
Provider
Networks
Healthy Habits
Is health a business?
© MERCER
2017Slide6
How is the business doing?
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2017Slide7
How is the business doing?
O
ne in three babies born in the US in the year 2000 will be diabetic
© MERCER
2017Slide8
Is Wellness working?
How to make the most of the deluge of dataSlide9
Five Primary Challenges
Too much / too little / not the right dataData that doesn’t tell a story or answer fundamental questionsData that is repetitive and shows what is already known
Not enough evidence of value or effectiveness or proofThe “now what”? is not evident
Action
© MERCER
2017Slide10
Four primary questions
Do we have the
information
we need to answer our questions? Based on the
information
we have, what
insight
s can we glean?
Based on the
insights
what
action
should we take?
Is there anything else we need to know or
should consider
when deciding on what
action
to take?
© MERCER
2017Slide11
Measurement Strategy
VALUE
BASIC
DATA WAREHOUSE
VENDOR PARTNERS
ADVANCED
DATA WAREHOUSE
Where’s the data?
Direct or
Delegated
© MERCER
2017Slide12
Build a measurement strategy
TEXT
What questions
do we want
the data to
answer?
How do we define success?
What data do we have, what do we need, where will we get it and what’s our budget?
What actions do you expect the audience(s) to take based on the data?
Who is or are the
Recipient(s) of
the information?
What format will tell the story best to each recipient?
What metrics will answer our questions?
What frequency is needed
?
© MERCER
2017Slide13
Strategic Formula
Influencers
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2017Slide14
Define Desired Success or Change
Clinical
Adherence
Operational
Financial
Behavior
Utilization
Prevalence
Biometrics
Illness Burden or population risk
Evidence Based Medicine
Safety and Other Policies
Contracts
Plan Design
Compliance
Claims Processing
Recruitment
Retention
Cost
Productivity Business Performance
Personal finance
Perceptions
Culture
Values
Generational or other meaningful segmentation
Choice
Participation
Human Capital Optimization
Physical, Financial and Emotional Well Being
Wellness
Total Well
Being
Promotion
Human Performance
Maintenance Sustainability
© MERCER
2017Slide15
sample
Define Change
Success
Increase diabetics medication possession ratio with retail/mail order to
reach
benchmarks
Increase utilization of HPN designated providers where available to 50%
Improve or achieve “healthy” biometric values for 80% of engaged diabetics
Less inpatient admissions, readmissions and emergency rooms visits
when
comparing engaged
to non engaged
Lower overall medical and pharmacy costs than non engaged diabetics
Define Resources,
Programs,
Interventions &
Messages
CURRENT
Resources
: Disease Management Program – multi modality and 24/7 access;
In network high performance providers available
Incentives
: engaged participants receive free generic maintenance medication
and free glucometer and test strips and $100 gift card; pay for performance for primary care providers ACTIONS NEEDEDClearly define engaged for the purposes of reporting on success criteria
Verify coaches can identify HPN providers and promote steerage Align performance guarantees with diabetes vendor
Consider Incentives & Motivation to Drive Action
© MERCER 2017Slide16
Build a measurement strategy
TEXT
What questions
do we want
the data to
answer?
How do we define success?
What data do we have, what do we need, where will we get it and what’s our budget?
What actions do you expect the audience(s) to take based on the data?
Who is or are the
Recipient(s) of
the information?
What format will tell the story best to each recipient?
What metrics will answer our questions?
What frequency is needed
?
© MERCER
2017Slide17
“If we give everyone the right amount of nutrition and exercise, not too little and not too much, we would have found the safest way to health”
- ???
© MERCER
2017Slide18
Questions and answers
Mercer Local Consulting Team
Ann Thomas Rob Benda Sean Liedtke Krystle Hilbig
801-533-3669 801-533-3631 801-533-3621 801-533-3657
© MERCER
2017Slide19
© MERCER
2017Slide20
Is Wellness Working?
A Case Study
May 9, 2017Slide21
Your Worksheet
QuestionHow will and/or how does your client define success? See slide from the 5-8-17 presentation
What questions do you have?Can your questions be defined objectively?
Do you have the data you need? Who is the audience for
the information?
How will you display it to tell a story?
What frequency is
needed?
What action
do you expect to take based on this information?
© MERCER
2017Slide22
The process of design
IS WELLNESS WORKING?
FINANCIAL
Lower
Claim
Expense
ADHERENCE
Fewer
Gaps
in
Care
UTILIZATION
Less
Utilization
of
High
Cost Services
ACTION
Leverage results to enhance program effectiveness and identify other opportunities
CLINICAL
Maintain and/or
Improve Biometric Health
Wellness Program
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2017Slide23
MEASUREMENT STRATEGY
VALUE
BASIC
DATA WAREHOUSE
VENDOR PARTNERS
ADVANCED
DATA WAREHOUSE
Access to Data
DIRECT OR DELEGATEDSlide24
Definitions and Terms
Participant
Non-Participant
Medical Plan
Enrollment
Three consecutive year
s of enrollment
Relationship
Employees and Spouses
Health Risk Assessment/
Biometric Results
Three years of HRA/Biometric participation
None
Medical and Pharmacy Claims
Experience
36
months of consecutive incurred claims experience (2013, 2014, 2015)
Member Count
1,182
480
Plan
No
consideration given to plan design. Consumer directed plan added in 2014 with minimal enrollment
© MERCER
2017Slide25
Allowed PMPY: With and Without HCC
On a PMPY basis, Participant healthcare costs were less than Non-Participants in two of the three years and essentially the same in Year 3
When high cost claims (HCC), defined as $50,000 or greater, are removed, the Participant PMPY allowed amount was less than Non-Participants in all three years
© MERCER 2017
Incurred Aug 2013 – July 2014 (Year 1), Aug 2014 – July 2015 (Year 2) and Aug 2015 – July 2016 (Year 3)
FINANCIAL
Lower
Claim
ExpenseSlide26
Inpatient admissions
Participants had lower IP/1000 than Non-Participants in all three years and are 29 percentage points further below benchmark than the Non-Participant group
© MERCER
2017
Incurred claims from Aug 2013 – July 2014 (Year 1), Aug 2014 – July 2015 (Year 2) and Aug 2015 – July 2016 (Year 3)
UTILIZATION
Less
Utilization
of
High
Cost ServicesSlide27
Emergency room
Participants had lower Emergency Room (ER) Visits/1000 than Non-Participants in all three years The Participants has a lower percentage of ER visits classified as non-emergent in all but the first year of the analysis
© MERCER
2017
Incurred claims from Aug 2013 – July 2014 (Year 1), Aug 2014 – July 2015 (Year 2) and Aug 2015 – July 2016 (Year 3)
UTILIZATION
Less
Utilization
of
High
Cost ServicesSlide28
Preventive Care Screening Rates
© MERCER
2017
Incurred claims from Aug 2013 – July 2014 (Year 1), Aug 2014 – July 2015 (Year 2) and Aug 2015 – July 2016 (Year 3)
ADHERENCE
Fewer
Gaps
in
CareSlide29
The rate of compliance or adherence to evidenced based medicine for asthma, coronary artery disease (CAD) and diabetes was higher for Participants than Non-Participants
Chronic disease compliance rates
© MERCER 2017
Incurred claims from Aug 2014 – July 2015 (Year 2) and Aug 2015 – July 2016 (Year 3)
ADHERENCE
Fewer
Gaps
in
CareSlide30
Average
Illness Burden powered by truven
Diagnostic Cost Groups (DCGs)
is a research-based and broadly used methodology that combines age, gender and diagnoses into a score (assigned to each person) that is shown to be highly predictive of current and future costs
The average illness burden has improved in the Participant group with each year and is consistently lower than the Non-Participant group.
The Non-Participant average illness burden increased with each year
© MERCER
2017
Average illness burden derived from DCG time periods (incurred claims) from July 2013 – June 2014 (Year 1), July 2014 – June 2015 (Year 2), & July 2015 – June 2016 (Year 3)
CLINICAL
Maintain and/or
Improve Biometric HealthSlide31
Risks and Cost – Participants only
The higher the number of risks, the higher the PMPY medical and pharmacy costs
While the PMPY value varied from year to year, the higher the number of risks was consistently associated with higher costs
© MERCER
2017
Risk factor count from 2015 Bravo data and PMPY derived from incurred claims from Sept 2015 – Aug 2016 (Employees Only)
CLINICAL
Maintain and/or
Improve Biometric Health
FINANCIAL
Lower
Claim
ExpenseSlide32
PMPY*
(Allow Med/Rx)
Number of
Risk Factors
2009 Cohort
Risk Strat.
Est. C
ost Based on
No Change in Risk Profile
2017 Cohort Risk Strat.
Est. Cost Based on Updated
Risk Profile
$3,401
0
251
$853,651
313
$1,064,513
$5,725
1
175
$1,001,875
179
$1,024,775
$7,959
2
97
$772,023
41
$326,319
$30,750
3
12
$369,000
2
$61,500
n/a
4
0
n/a
0
n/a
n/a
5
0
n/a
0
n/a
n/a
Total
535
$2,996,549
535
$2,477,107
*Allowed (Med/Rx) PMPY based on Mercer's Cohort (2015 Bravo Risk Factors & Incurred Sep 2015 - Aug 2016)
31
Bravo Cohort
2009-2017 Migration by Risk Number
The total allowable based on the 2009 risk stratification = $2.9M
Based on the change in risk stratification the updated total allowable = $2.4M
Total estimated savings $0.5M
CLINICAL
Maintain and/or
Improve Biometric Health
FINANCIAL
Lower
Claim
Expense
© MERCER 2017Slide33
The process of design
IS WELLNESS WORKING?
FINANCIAL
Lower
Claim
Expense
ADHERENCE
Fewer
Gaps
in
Care
UTILIZATION
Less
Utilization
of
High
Cost Services
Results
CLINICAL
Maintain and/or
Improve Biometric Health
© MERCER
2017
WELLNESS PERFORMANCE
REVIEW
Yes
Yes
Yes
YesSlide34
Your Worksheet
QuestionHow will and/or how does your client define success? See slide 12 from the 5-8-17 presentation
What questions do you have?Can your questions be defined objectively?
Do you have the data you need? Who is the audience for
the information?
How will you display it to tell a story?
What frequency is
needed?
What action
do you expect to take based on this information?
© MERCER
2017Slide35
Questions and answers
Mercer Local Consulting Team
Ann Thomas Rob Benda Sean Liedtke Krystle Hilbig
801-533-3669 801-533-3631 801-533-3621 801-533-3657
© MERCER
2017Slide36
© MERCER
2017