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WhitePaper-CoreSource-and-Verisk-Health-2016
- 1. Managing the Health ofthe Highest-Cost Employees Now and in the Future: The Value of YourCare
- 2. Managing the Healthof the Highest- Cost Employees Now and in the Future: The Value of YourCare Healthy workers are critical to a business’s bottom line, but taking care of one’s health isn’t always a top priority for employees. Lack of time, knowledge, and motivation can lead to poor health outcomes for employees and high healthcare costs for employers. Productivity losses related to family and personal health problems cost U.S. employers $225.8 billion each year, or $1,685 per employee1 . CoreSource launched YourCare in 2007 to help employees take better care of themselves. The program focuses on the most common, high-cost diseases and determines when patients or their providers are not following evidence-based standards of care. That triggers an intervention from YourCare—a letter, email, or phone call—to remind, coach, or invite members to work more closely with YourCare staff to ensure they understand their conditions and they get the care they need. CoreSource engaged Verisk Health, an independent healthcare analytics company, to compare healthcare costs and utilization for employers who offer YourCare to those that do not. The results showed that YourCare encourages employees to access the care they need, when they need it, resulting in improved health and lower costs for employers. Key findings included: • The population with access to YourCare had improved preventive care – with fewer care gaps, more frequent physician visits, and higher medication usage. • Patients with access to YourCare were hospitalized less frequently, reducing the number of high-cost claimants. • As a result, employers offering YourCare had lower costs than those who did not offer the program. 02 1 Center for Disease Control and Prevention
- 3. HowYourCare Works YourCare ispowered by sophisticated analytics that enable healthcare staff to target the right people with the right interventions. The analytics use patient data—pulled from claims, health risk assessment questionnaires, and biometric screenings—to create a holistic picture of members’ health status, risks, and gaps in care. Members missing preventive care such as mammograms, blood tests, or colonoscopies are reminded to access these screenings. Those who are high risk but have not yet incurred cost for care are targeted for more extensive involvement. They receive phone calls from a nurse-educator who teaches them how to manage their chronic disease or referral to a health coach to help with lifestyle changes (for example, improving diet and adopting an exercise routine). YourCare also offers member interactions with Health Advisors and Wellness coaches to support lifestyle behavioral changes. In addition, there are curricula for on-site educational programs on topics like smoking cessation, as well as webinars on a variety of health-related topics. Members can also take advantage of online, self-directed coaching in areas such as nutrition and weight loss. Bottom line: YourCare helps members change their behavior and access the care they need before their conditions deteriorate and become more costly. 03 The Study The study looked at medical care—everything from emergency room visits to hospitalizations, prescriptions filled to primary care visits—between October 2013 and September 2014. A total of 278,520 patients were studied: 124,986 of those people were in the YourCare group and 153,534 were in the non- YourCare group. About 190 CoreSource employer groups were examined, representing industries ranging from healthcare to energy to transportation to the public sector. 278,520 Patients 124,986 Patients YourCare Group 153,534 Patients Non-YourCare Group Most prevalent chronic conditions among patients enrolled in YourCare Asthma Chronic Obstructive Pulmonary Disease Coronary Artery Disease Congestive Heart Failure Diabetes Hypertension Hyperlipidemia
- 4. 04 Digging into theNumbers Given the focus of YourCare on chronic condition management, the study evaluated the evidence as to whether the YourCare program improves member compliance with preventive care measures, keeps members healthy and out of the hospital, and lowers costs for the patients and plan sponsors. First, the findings showed that members eligible for the YourCare program visited their doctor 6 percent more, and filled 14 percent more prescriptions – both hallmarks of effective primary care. The findings also demonstrated fewer care gaps — patients not taking their medications, not visiting their primary care doctor, or not getting needed preventive treatment and screenings— were lower in YourCare patients for six out of seven chronic conditions. For example, the YourCare population had improved compliance across all standard diabetes quality measures. The only condition where the YourCare population had more care gaps was asthma, which was due to pediatric patients who were not eligible for the program. Utilization of acute medical services by the YourCare group was lower as well: Hospital admissions were 12 percent lower and emergency department visits were 1 percent lower after adjusting for risk. The reduction in inpatient utilization was particularly notable, given the broader CoreSource client population had 12 percent lower inpatient utilization than observed in Verisk Health’s Commercial Norm benchmark of 46 million people. 12% Lower Hospital Admissions 1%Lower Emergency Department Visits Lower in 6 of 7 Chronic Conditions Risk Adjustment in a Nutshell Highly sophisticated statistical models enable Verisk Health to assign what’s called a relative risk score to each patient. A person who is an average user of medical services would be assigned a risk score of 1. By contrast, someone expected to spend twice as much (because he has some serious health problems) would have a risk score of 2. Verisk Health’s statistical models base their calculations on age, gender, and patients’ medical conditions. Using these risk scores, analysts are then able to accurately determine whether patients are well-managed from medical and cost perspectives. Risk Adjustment If some patients are sicker or at higher risk than others to begin with, how can a fair comparison of costs be made? For example, a 59 year-old male with diabetes and hypertension is more likely to have a “high-cost” event like a heart attack than a 25 year-old male with no chronic conditions. Similarly, 32-year old men are likely to have lower medical bills than 32-year-old females because the woman are in their prime child-bearing years. To enable an “apples-to-apples” comparison, Verisk Health applied a proven clinically-driven methodology called risk adjustment to the YourCare data. Using statistical models, analysts factored these differences in demographics and disease burden into their evaluation of cost and utilization. 0 20 40 60 80 100 Visited Their Doctors 6% more Filled 14% More Prescriptions
- 5. 05 Ultimately, this reductionin hospital admissions translated into lower costs that outweighed cost increases associated with more frequent usage of primary care. Once analysts risk-adjusted the YourCare patient group, their total costs were 6 percent lower than the non-YourCare group. The biggest difference in costs between the two groups was found among a subset of CoreSource patients who are among the sickest and have chronic diseases that are complex to manage. For an employer providing coverage to 1,000 members, these differences would represent a $360,000 savings per year, even after accounting for higher costs due to increases in preventive care and medication usage. Implications for Employers Offering YourCare The Verisk Health analysis demonstrated that YourCare helps employers successfully manage their high-risk employees and lower their overall costs by encouraging members to: • comply with evidence-based care standards to manage their chronic conditions • use primary care and medications more routinely to take care of their health, thereby avoiding expensive hospitalizations • stay engaged by participating in wellness programs, utilizing online tools, and more As people age, their chronic conditions often worsen or turn into even more serious diseases, especially if neglected. Effective programs for chronic condition management like YourCare are essential to control longer-term medical cost trends. A longer-term study of YourCare members would be expected to reveal even more dramatic differences in costs and utilization of services between employees managed by YourCare and those who are not. Going forward, CoreSource is applying the findings of the study to help continue to improve the YourCare program. For example, given the strong results demonstrated in reducing hospitalizations, there may be opportunity to develop targeted interventions to further reduce emergency department utilization.
- 6. CoreSource solutions ACTIONABLE DATA TAILORED PL ANS ENGAGEDEM PLOYEES ©2016 CoreSource R450-999 3-16 CoreSource is a wholly owned subsidiary of Trustmark Mutual Holding Company. www.coresource.com | 800.832.3332 About CoreSource CoreSource, a Trustmark company, is one of the nation’s leading health plan administrators, delivering integrated, customized employee benefit solutions to self-funded employers. CoreSource maintains claims and customer service offices in Baltimore; Charlotte, N.C.; Chicago; Columbus, Ohio; Detroit; Kansas City, Kan.; Des Moines, Iowa; Lancaster, Penn.; Tucson, Ariz.; and Little Rock, Ark. The Trustmark companies provide a full spectrum of employee benefits to improve well-being through better health and greater financial security. Visit www.coresource.com. About Verisk Health A co-author of this paper, Verisk Health is an independent healthcare analytics company that works with employers, providers, brokers, and payers to reduce risk across all domains of healthcare. Visit www.veriskhealth.com