The Business Case for Supporting the

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The Business Case for Supporting the

• Wyoming Business Coalition on Health

Anne Ladd 307-262-2550 anneladd_at_bresnan.net
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National Health Expenditure
Clinton becomes President Hillary heads
healthcare reform effort 1993
Dollars in Billions
1973 Nixon and HEW Sec. Caspar Weinberger call
for a National Health Strategy
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Source http//www.cms.hhs.gov/NationalHealthExpen
dData/downloads/tables.pdf - 1-25-08
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National Health Expenditure will DOUBLE in less
than 10 years
Dollars in TRILLIONS
Source Poisal et al, Health Spending Expected
to Double by 2016 Health Affairs Web Exclusive,
February 21, 2007 http//content.healthaffairs.org
/cgi/content/abstract/hlthaff.26.2.w242 Exhibit 1
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NHE as of GDP
Clinton
Nixon
Percent of GDP
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Source http//www.cms.hhs.gov/NationalHealthExpen
dData/downloads/tables.pdf - 1-15-08
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NHE will be 20 of our GDP in less than 10 years
Source Poisal et al, Health Spending Expected
to Double by 2016 Health Affairs Web Exclusive,
February 21, 2007 http//content.healthaffairs.org
/cgi/content/abstract/hlthaff.26.2.w242 Exhibit 1
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NHE Per Capita
Dollars
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Source http//www.cms.hhs.gov/NationalHealthExpen
dData/downloads/tables.pdf - 1-15-08
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The Healthcare Cost Explosion
Between 1999-2004, Health Care Premiums Grew
2.3x As Fast As Business Revenues 4.0x As Fast As
Workers Earnings 5.5x As Fast As Products and
Services
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Source Brian Klepper Center for Practical
Healthcare Reform
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US Other Developed Countries
National Health Expenditure as a Percent of GDP
(2003)
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Source http//www.who.int/nha/country/en
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US Other Developed Countries
Per Capita Health Expenditure (2003)
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Source http//www.who.int/nha/country/en
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Outcomes US not the Best
Life Expectancy at Birth (2004)
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Source http//www.who.int/nha/country/en
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Outcomes US not the Best
Infant Mortality / 1000 births (2004)
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Source http//www.who.int/nha/country/en
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Bottom LineIts the Cost(and lack of
significantly better outcomes) Stupid!
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How Much Does Wyoming Spend on Healthcare?

• Assume a population of 515,004(US census 2006
  estimate)
• Use 2006 per capita expenditure of 7,026
• Wyoming spends 3,618,418,104 or over
• 3.6 BILLION
• Per Year!
• The State of Wyoming Budget General Fund spending
  for the 2009-2010 biennium is 3.6 Billion

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Wyoming Data

• Overall healthcare costs increased 12 in the
  last year in Wyoming now over 4.05 Billion
• Wyoming employers are absorbing the majority of
  the cost increases

Source Mountain States Employer Council 2008
Health and Welfare Plans Survey
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Employers are the Solution

• Political will is non-existant
• CEOs - who do not have to get elected - have the
  power to change the system.
• Employers are the ultimate payer and can demand
  transparency and accountability.

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WyBCH Vision

• An accountable healthcare system that achieves
  better care, healthier people and competitive
  costs.

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WyBCH Mission

• To promote leadership, collaboration and
  knowledge among employers to make available
  comparative cost and quality information on
  healthcare treatments and providers in order to
  continually improve healthcare quality and value.

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WyBCH Board Members

• Mike McCraken Wyoming Tribune Eagle
• Joe Coyne - CANDO
• George Bryce Lincoln Financial Advisors
• Ken Cochran ARCH Coal
• DL Lobb Peabody Energy
• T. Chris Muirhead Porter, Muirhead, Corina and
  Howard
• Jim Roden Crum Electric
• Tom Scott First Interstate Bank
• Linda Vosika Bonneville Transportation
• Jana Cheetham NERD Technology

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Goals of our first project

• Provide measurable and meaningful results for
  employers
• Improve the health of the workforce
• Help WyBCH get the attention of the healthcare
  delivery system
• Help attract new members to WyBCH

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HealthMapRx - overview

• Diabetics
• CardioVascular
• High blood pressure
• High cholesterol
• Depression
• Asthma

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Classic Healthcare Pareto Analysis
109,170
n100,723 Total Cost 511,624,850 Average Cost
5,079
Average cost per person
47,973
25,385
9,949
1,228
n84,000 82
n10,000 10.2
n4,000 4
n2,200 2.1
n900 0.9
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HealthMapRx - overview

• Trained Personal Coaches
• Eliminate co-pays for insulin, test strips,
  meters, etc...

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Asheville, NC

• It is a real place and these are real results

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Diabetes in Wyoming

• Wyoming has a 6 prevalence rate or about 30,900
  residents with Diabetes.
• Diabetes cost in Wyoming were 258 Million in
  2006
• 170 Million in direct medical expenses
• 88 Million in lost productivity
• Known diabetes average health expenditure is
  11,744 per year.
• 30 to 40 of diabetics do not know they have
  the disease

Source Centers for Disease Control and the
American Diabetes Association
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Diabetes in Wyoming

• Wyoming has a 6 prevalence rate or about 30,900
  residents with Diabetes.
• Diabetes cost in Wyoming were 258 Million in
  2006
• 170 Million in direct medical expenses
• 88 Million in lost productivity
• Known diabetes average health expenditure is
  11,744 per year.
• 30 to 40 of diabetics do not know they have
  the disease

Source Centers for Disease Control and the
American Diabetes Association
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Total Healthcare Costs Rx and Medical - Mission
Hospital and City of Ashville
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The Asheville Project Today

• Over 1500 patients from 10 employers enrolled for
  diabetes, asthma, hypertension, lipid therapy
  management, and depression
• Patients realize improved outcomes increased
  medication adherence
• 50 reduction in sick days
• Zero workers comp claims in the City diabetes
  group over 6 years
• Average net savings of 1,600-3,200 per person
  with diabetes each year from year 2 on
• Employers saved over 5,000,000 in healthcare
  costs

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Other test sites around the country
HealthMapRx Sites 2007 21HealthMapRx Employers
80
Manitowoc, WI
Eugene, OR
Philadelphia, PA
Flint, MI
Milwaukee, WI
Lancaster, PA
Chicago, IL
Honolulu, HI
Cumberland, MD
Pittsburgh
Quincy, IL
Colorado Springs, CO
Greensboro Eden NC
Asheville
Western North Carolina
City of Rocky Mount and Fayetteville, NC
Charleston, SC
NW GA
Arizona Counties
Los Angeles, CA
Dublin GA
Monroeville, AL
Tampa, FL
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BRiDGE Participant A1c Results
Initial (n42) Most recent visit
Average A1c 8.1 7.4
lt 7.0 (ADA) 38 58
lt 9.0 (HEDIS) 74 83
for 42 participants with documented visits and
at least one A1C recorded.
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BRiDGE documented Flu, Foot and Eye Exams
Initial Most recent
with current Flu Shot 62 88
with current Foot Exam 55 98
with current Eye Exam 69 93
for 42 participants who met inclusion criteria
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Average Total Health Care Costs for Participants
in the Lancaster PA BRiDGE ProjectBaseline
and Year 1 Actual and Projected Costs
Projected Yr 1 21,961
Average Cost Savings Per Patient 5,812
TOTAL 19,318
13,506
For 39 patients that met inclusion criteria
assumes 13 inflation rate.
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Summary of Year 1 Results

• There has been significant improvement in key
  clinical indicators The A1C and LDL have both
  trended down, with patients at highest risk (A1C
  gt9) decreasing from 26 to 17. Also, the number
  of patients with an LDL lt100 (the ADA goal)
  increased from 38 to 67.
• Participant satisfaction with overall diabetes
  care has improved and satisfaction with
  pharmacist care was very high.
• Economics data indicated a significant return on
  investment for employers with an average saving
  per participant in the evaluation group of 5,812
  per year.

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Sample Cost/Benefit Projection Employer A
(2,000 covered lives)
Year 1 Year 2 Year 3
Projected of Diabetics Enrolled 60 79 90
Annual Yearly Investment 153,600 176,320 193,160
Waived co-pays/incentives 36,000 47,520 54,000
Medication adherence 30,000 39,600 45,000
Laboratory costs 5,400 7,128 8,100
Diabetes supplies 21,600 28,512 32,400
ADA Diabetes Education sessions 15,000 4,800 2,700
Pharmacist Reimbursements 36,000 38,520 42,120
Administrative Fees 9,600 10,240 8,840
Annual Yearly Savings Reduced Hospitalization Costs 205,200 547,200 615,600
Net Annual Savings in total healthcare costs 51,600 370,880 422,440
The projected costs/savings are based on
analyses conducted during program pilot in
Asheville, NC. Note that a more accurate
analysis will be conducted for employers using
actual costs.
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Proprietary and Confidential
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Challenges to Implementation in Wyoming

• Amassing critical number of covered lives
• Geographic distribution of those lives
• Coordination of diverse employers involved in the
  project
• Training and coordination of coaches
• Financial support to get the project going

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Work with us

• Anne Ladd
• 307-262-2550
• anneladd_at_bresnan.net