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Sutter Health Partners

Sutter Health Partners. THE HERO Forum “Develop Corporate Responsibility and Personal Accountability” September 18-19, 2006. Margaret Sabin, CEO Sutter Health Partners. Today’s Agenda. Sutter Health Partners Overview SHP Lifestyle Management Program Model

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Sutter Health Partners

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  1. Sutter Health Partners THE HERO Forum “Develop Corporate Responsibility and Personal Accountability” September 18-19, 2006 Margaret Sabin, CEO Sutter Health Partners

  2. Today’s Agenda • Sutter Health Partners Overview • SHP Lifestyle Management Program Model • Train the Trainer for Healthcare Systems • Summary • Your Questions • Next Steps

  3. Sutter Health – Our Vital Statistics Serving more than 100 cities and towns in Northern CA • 26 acute care hospitals • 3,400 physicians (7 physician medical foundations) • Approximately 43,000 employees • Home health & hospice, and long-term care services • Medical research and medical education/training

  4. Sutter Health’s Self Funded Migration Timeline

  5. Health Insurance Landscape • Employees/patients have become uninformed users of the healthcare system as they receive little information about the costs insurance companies pay when an employee or their dependents access the healthcare system • Symptom of the HMO Era • As a result of sky-rocketing costs and increased utilization, companies are experiencing 30% increases in rates for the 2007 budget cycle

  6. What is SHP ? • SHP is an administrator that manages self-funded, ERISA-compliant healthcare benefits programs • SHP has developed and provides a unique lifestyle management program • SHP integrates lifestyle, disease, medical, pharmacy, and behavioral health management into a single product

  7. This is Accomplished Through… • Excellent customer service • Accurate and timely claims administration • Proactive risk identification (health risk appraisal) • Lifestyle management – “high touch” coaching • Use of member empowerment tools (24/7 NAL, Audio Library) • Disease management programs • Pharmacy Management • Behavioral Health Management • Linkage to community resources • Employee/member Incentives (financial)

  8. What SHP Brings to the Table… • What we can do for your organization: • help control/moderate escalating health care costs • take single sourceaccountability for management and administration to provide excellent customer service • Work with you to maximize participation and results in your Lifestyle Management Program

  9. What Can We Provide? • Matched/Enhanced benefits (e.g., LM) depending upon your goals • A robust LM Program with focused incentives to maximize participation levels and achieve results (clinical and financial)

  10. Optimal Intervention Timefor Greatest Cost Savings

  11. Reinsurance Actuarial Analysis BH Management LM, DM, FMM PharmacyBenefitsManager Network Eligibility / Claims Vision & Dental Flexibility of the SHP Model : Putting the Pieces Together… SHP MANAGEMENT • Key: One Stop Shopping

  12. Why Is Lifestyle Management (LM) Important?… (I) 72% of all disease is preventable • Smoking results in $3391(per smoker) of additional claim costs annually • Smoking increases the risk of CVD by 30% • Obese patients expend 77% more than non-obese patients on medications • Diabetics costs per patient exceed $13K compared with $2500 for non-diabetics (14% of total US healthcare costs - $132B annually)

  13. What’s Wrong With This Picture? • We spend 97% of available healthcare dollars for restoration/illness, but… • We spend only 3% of the available healthcare dollars on prevention

  14. Costs Follow Risks… • 19 year study of 10,245 men at Cooper Clinic*: average cost of “fit” men was 53% less than “unfit” men • Average cost of an overweight female is 22.6% more than a healthy weight woman** *Med. & Science in Sports & Exercise; Sept., 2005 **JAMA, September, 2005

  15. Healthy Lifestyle Characteristics Among US Adults – 2000* • Healthy lifestyle defined as combination of 4 healthy lifestyle characteristics (HLCs) • Non-smoking • Healthy Weight (BMI<25) • 5 fruits and vegetables/day • Regular physical activity • Overall prevalence of adult US population who met above criteria: 3% *Arch Intern Med.2005;165:854-857

  16. Education & Empowerment Active Patient Involvement Shared Decision Making In Contrast: SHP Fosters Partnerships with MD’s In Contrast: SHP Fosters Partnerships with MD’s Physician Patient “Partnership” Lifestyle and DM Framework “Collaborative Care”

  17. The Role of Lifestyle Management (LM) • LM is either the first intervention or a major component of the management of: • Abnormal lipid profile • Coronary artery disease • Hypertension • Diabetes • Asthma • Obesity/metabolic syndrome • These diseases account for >75% of healthcare expenditures

  18. The SHP Lifestyle Management Program • LM Coaches “close the loop” using PWP’s to modify identified risk factors • Reports sent to individual’s physician for joint treatment planning and goal- setting • Professional clinical oversight & ongoing education of LM Coaches “Back End”LM Coaches • Statistically valid & confidential health risk appraisal • Completed via hard copy or on-line • Personal risk factor identification “Front End”Personal Wellness Profile (PWP)

  19. LM Coaches Explained… • Healthcare professionals with variety of training/degrees/expertise credentialed in related fields e.g.) ACE Certified (fitness trainers); RN, Master Level Kinesiology, Certified Coach • Do not practice medicine • Do not interrupt/interfere with MD’s workflow – “physician-extenders” • Do help members set and achieve realistic lifestyle-related goals including stress, work-life balance – Behavior Modification

  20. LM Coaching Explained… LM Coaching helps members: • Recognize/understand impact of lifestyle choices related to their health status • Understand benefits of change • Identify barriers to change • Build skills and provide tools for behavioral change (self-efficacy) • Increase motivation

  21. LM Coaches – Member “Load” • Based on risk stratification (HRA, predictive modeling) • Current ratios: • 1:100 (for high risk members) • 1:200 –250 (for moderate risk members) • 1:300 or > (for low risk members)

  22. Actual Case Summary Self Reported Data • 61 year old male hospital worker • On no medications • Reports health status as “good” • Has not seen his physician for 7 years • Family history of diabetes • Walks daily for at least 30 minutes • Reports 6-8 alcoholic beverages/week

  23. Actual Case Summary Coach Validated • Smokes 1 PPD for 30 years • Biometrics: • BP 203/113 initial reading; 192/110 second reading • BMI – 25.5 (Ht. 70”; Wt. 170#) • Lipids, Glucose – pending • Patient “oblivious” to current health status

  24. Actual Case Summary Corrective Action • Advised to make appointment with a physician immediately; risk factors of smoking and alcohol discussed with Lifestyle Coach • Patient heeded advice; saw physician and was started on anti-hypertensive medication • BP within 5 days was 157/78 • Started smoking cessation program, purchased BP machine and is monitoring BP 2X/day • Initiated exercise program with physician’s clearance

  25. Actual Examples of High End ClaimsLargely Impacted by Lifestyle • Morbid Obesity – Average $75,000 • High $116,000 • Low $52,000 • Alcoholic Cirrhosis of the Liver • One case $295,500 Based on 2006 Sutter Health actual claims data

  26. Prevalent Disease Categories # of Claimants Dollars Spent Percent of $$ Spent PMPM Disease/Case Management Circulatory - Hyperlipidemia - Hypertension - CHF 925 544 300 22 $3.2 M $1.2 M $928,000 $290,000 30% $290 Yes Diabetes 265 $1.25 M 11.5% $394 Yes Neoplasms - Breast - Bone, CT,Skin - Male GU - Colo-Rectal - Respiratory - Lip/Oral Cavity 97 $1.25 M 11.5% $1,073 CM Picture in Picture:Predictive Modeling-Based Focused Outreach* * Based on paid claims 7/1/04 – 6/30/05

  27. Prevalent Disease Categories # of Claimants Dollars Spent Percent of $$ Spent PMPM FH DM Program/CD Mental Disorders - Depressive Disorders 157 151 $700,000 6.4% $368 UBH Musculo-Skeletal - Joint/CT - Musculo-Skeletal Symptoms - Sprains/Strains/Back 138 $750,000 6.8% $449 Yes Respiratory - Asthma - COPD 115 $480,000 4.4% $348 Yes Picture in Picture:Predictive Modeling-Based Focused Outreach* Picture in Picture:Predictive Modeling-Based Focused Outreach* *Based on paid claims 7/1/04-6/30/05

  28. Actual Examples of High End ClaimsLargely Impacted by Lifestyle • Morbid Obesity – Average $75,000 • High $116,000 • Low $52,000 • Alcoholic Cirrhosis of the Liver • One case $295,500 Based on 2006 Sutter Health actual claims data

  29. John Q. Health Active Patient Involvement – The PWP Individual Report (I) John Q. Health

  30. John Q Health Active Patient Involvement: The PWP Individual Report (II)

  31. Non-Intrusive MD Actionable Data: The Physician Summary Report Non-Intrusive MD Actionable Data: The Physician Summary Report

  32. For Affiliates: Executive Level Reporting For Affiliates: Executive Level Reporting

  33. % of people interested in each topic For Affiliates Group Level Reporting For Affiliates Group Level Reporting

  34. Driving LM Participation: Pay Members to Get and Stay Healthy… LM Program Participation Rates Due to application of incentives

  35. $200 $300 Max PARTICIPATION COMPLETION Current Incentive Program Structure Current Incentive Program Structure Goal: Drive participation in Lifestyle Management Program $500 $ • HRA completion • LM Coach meeting • Joint goal-setting • Basic Screening • All criteria is met • At least one goal has been attained • Attendance at programs/activities And/Or Maintain normal clinical parameters For 12 months+Activity Class/Program

  36. $200 $100 Max/Q PARTICIPATION COMPLETION Progressive Sequential Incentives: An Example (Starting in ’06)… Goal: Drive participation in Lifestyle Management Program Through Ongoing Incentives $500 Q1 Q 2-4 $ • HRA completion • LM Coach meeting • Joint goal-setting • Basic Screening • All criteria is met • At least one goal has been attained • Attendance at quarterly programs/activities Or Maintain normal clinical parameters For 12 months+Activity Class/Program

  37. Momentum Builds Over Time… Momentum Builds Over Time… Sutter Health Partners Lifestyle Management Program Participation Levels – Affiliate A 2004 2005 2006 Participation Level

  38. Sutter Health Affiliate Results: Affiliate “A” 9/05-12/05

  39. Prevalent Disease Categories # of Claimants Dollars Spent Percent of $$ Spent PMPM Disease/Case Management Circulatory - Hyperlipidemia - Hypertension - CHF 925 544 300 22 $3.2 M $1.2 M $928,000 $290,000 30% $290 Yes Diabetes 265 $1.25 M 11.5% $394 Yes Neoplasms - Breast - Bone, CT,Skin - Male GU - Colo-Rectal - Respiratory - Lip/Oral Cavity 97 $1.25 M 11.5% $1,073 CM Picture in Picture:Predictive Modeling-Based Focused Outreach* * Based on paid claims 7/1/04 – 6/30/05

  40. Prevalent Disease Categories # of Claimants Dollars Spent Percent of $$ Spent PMPM FH DM Program/CD Mental Disorders - Depressive Disorders 157 151 $700,000 6.4% $368 UBH Musculo-Skeletal - Joint/CT - Musculo-Skeletal Symptoms - Sprains/Strains/Back 138 $750,000 6.8% $449 Yes Respiratory - Asthma - COPD 115 $480,000 4.4% $348 Yes Picture in Picture:Predictive Modeling-Based Focused Outreach* Picture in Picture:Predictive Modeling-Based Focused Outreach* *Based on paid claims 7/1/04-6/30/05

  41. What Have Been our Results: FinancialMGH/NCH Premium Increase Moderation** Note: $2.15 M added to WC reserves * Includes Medical and Pharmacy ** Additional BH benefits added

  42. What Have Been Our Results? Member Satisfaction Survey* • Overall Satisfaction: • 89% rated their experience good to excellent • 92% indicated they would recommend to a family member or friend • 96% would re-enroll • Lifestyle Management Program • 93% rated their experience as good to excellent • 93% reported that they had reached their goals as a result of the LM program • 96% rated advice about remaining healthy/avoiding illness as good-excellent

  43. What Do the Economic Return Studies Show? What Do the Economic Return Studies Show? Meta-Evaluation of Worksite Health Promotion 2005 Update By Larry S. Chapman, MPH “The summary evidence is very strong for average reductions in sick leave, health plan costs and workers’ compensation and disability costs of slightly more than 25%.” Source: The Art of Health Promotion, July/August 2005

  44. Health System Employer Strategy • Internal initiative builds platform, establishes credibility and competence • Hospitals must become trusted partner for health and disease prevention • If health plans fill this niche (demand): • The Role of the Hospital is further diminished • Opportunities for Commercial Growth decrease significantly

  45. Sutter Health 2005-07 Strategic Plan:Build New Relationships with Employers Sutter Health Partners will: • Develop employer relationships • Provide data • health risk • competitive • Increase commercial business • Increase consumer brand loyalty • Creates foundation for partnerships

  46. SHP’s “Living In Balance” ProgramTargets External Employers Flexible Product Offerings • Comprehensive* LM Program • Target: Employers in Northern CA through local SH affiliates • Consultative/Train the Trainer Program • Target: Healthcare systems outside the SH Northern CA marketplace *Other Models Available

  47. Marketplace Price Points

  48. In Summary: Why do this? • Provides effective tools to control cost escalation over time • “Win-win” proposition for organization and employees • Improves recruitment, retention • Reduces workers comp costs, absenteeism, presenteeism • Improves productivity • Flexible platform for future expansion • Aligns incentives with the employer community

  49. Q A & Your questions please…

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