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This report highlights the results and findings of HealthQuest's 2017 outcome reporting, focusing on experience, clinical and financial data, as well as risk assessment. Key areas of focus include chronic condition spend, standards, evidence-based medicine, integration, and potential cost savings through onsite pharmacy. The report also provides an analysis of chronic condition risk categories, service types, clinical benchmarks, and financial outcomes.
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HealthQuest Plan Year 2017
Outcome Reporting Results – Experience, Clinical and Financial Data and Risk Assessment Predictive Consultation Experience Condition Risk • $34M+ is potential of inefficient “preventable” chronic condition spend • $4,319 to $4,594 annual per claimant is trending well to the 2017 private insurance baseline of $6,040 • Focus on Standards • Evidence based medicine • Integration in key workflows and culture • Direct replacement costs through potential onsite pharmacy 8 of 9 chronic condition risk category reduction in claimant count Service Type Risk 5 of 6 service type category reduction in claimant count ED Admitted has risen 2.7% in claimants and 15.3% in spend Clinical 17 of 30 benchmarks ahead of State & National levels 9 of 30 benchmarks average 4 of 30 benchmarks below average Clinical Risk Financial 8.5% decrease in aggregate total paid per claimant 10 of 10 chronic condition category reduction in Total Spend
Claimant Service Type (with exclusions applied) 8.5% decrease in total paid per claimant Delivery of Care 2017 2016
Trending: *Y-o-Y Chronic Condition Costs *Claimant Count and Average Cost Per Claimant pulled using 12 months as of 12/31/2017 with 60 days claim runout. Standard Exclusion Criteria Applied.
Top Risks Hypertension Delivery of Care (Hypertension Claimant Group) $79.3M Medical Total Paid 8% decrease in claimant count 9% decrease in total paid per claimant 2017 Wellness Identified Risk: Moderate risk 2,593 High (Stage 1) 9,262 High (Stage 2) 2,494 14,349 wellness identified, 841 (7.2%) coached Risk Level Behavioral Environment Top locations (High Risk) Kansas State University (1,170 / 41%) Parsons State Hospital & Training Center (112 / 63%) University of Kansas (1,075 / 42%) Department of Transportation (736 / 60%) Direct Care and Treatment Lifestyle and Nutrition Programs Medication Adherence Targeted Communication Client best practice example to be discussed.
Top Risks EarlyHeart Disease and Hyperlipidemia Delivery of Care (Hyperlipidemia Claimant Group) $59.5M Medical Total Paid 17% decrease in claimant count 9% decrease in total paid per claimant 2017 Wellness Identified Risk: Moderate risk 9,328 High risk 11,061 20,389 wellness identified, 843 (7.6%) coached Risk Level Behavioral Environment Top locations (High Risk) Kansas State University (1,154 / 41%) Department of Revenue (299 / 55%) University of Kansas (892 / 35%) 4 way tie - Department of Transportation (639 / 52%) Direct Care and Treatment Lifestyle and Nutrition Programs Medication Adherence Targeted Communication Client best practice example to be discussed.
Top Risks Obesity Delivery of Care (Obesity Claimant Group) $38.3M Medical Total Paid ≤1% change in claimant count 14% decrease in total paid per claimant 2017 Wellness Identified Risk: Moderate risk 7,747 High risk 9,088 16,835 wellness identified, 679 (7.5%) coached Risk Level Behavioral Environment Top locations (High Risk) Kansas State University (789 / 28%) Parsons State Hospital & Training Center (94 / 53%) Department for Children and Families (667 / 49%) Department for Children and Families (667 / 49%) Direct Care and Treatment Lifestyle and Nutrition Programs Medication Adherence Targeted Communication Client best practice example to be discussed.
Top Risks Diabetes Delivery of Care (Diabetes Claimant Group) $34.8M Medical Total Paid 7% decrease in claimant count 5% decrease in total paid per claimant 2017 Wellness Identified Risk: Moderate risk 4,187 High risk 879 5,066 wellness identified, 77 (8.8%) coached Risk Level Behavioral Environment Top locations (High Risk) Department for Children and Families (77 / 6%) Kansas State University (54 / 2%) 3 way tie - Department of Revenue (28 / 5%) Direct Care and Treatment Lifestyle and Nutrition Programs Medication Adherence Targeted Communication Client best practice example to be discussed.
Average Claims Spend by Condition Identified through Wellness ProgramSource: Participating members in PHA, Wellness Screenings, and Medical Claims (22,246 members total) Analysis based on all employees who completed PHA and Screening, and exclusion criteria $3,900 baseline cost of a Healthy and Fit member Members at high risk for Heart Disease have the highest incremental cost followed by COPD and Diabetes Hypertension has the lowest incremental cost Hypertension and Hyperlipidemia have the highest count of members Health Risks
Excess Cost Due from RiskSource: Participating members in PHA, Wellness Screenings, and Medical Claims (22,246 members total) Progression is linear here, which is not typical Doubling of health spend typically happens around 3 comorbidities. In the State of KS it is closer to 4 (which is good) $34M is what is on the table of “preventable” type spend Costs from Risks
