optimizing health care delivery by integrating workplaces...

Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities / Ron Loeppke MD, MPH "

Western Occupational Health Conference: September 25 – 28, 2013 / Sheraton Waikiki, Honolulu, Hawaii

Ron Loeppke MD, MPH, FACOEM, FACPM President

American College of Occupational and Environmental Medicine

Optimizing Health Care Delivery by Integrating Workplaces, Homes and Communities

How Occupational and Environmental Medicine

can serve as a vital connecting link between Accountable Care Organizations and the Patient Centered Medical Home

Content Attestation and Disclosure

I am an employee and shareholder of U.S. Preventive Medicine and the content in my presentation, is unbiased,

and to the extent possible, evidence-based.

Today’s Session

Discuss OEM opportunities/roles ACOs/PCMH initiatives:   ACOEM’s Position Statement paper in April issue of JOEM on ACOs/PCMH/OEM

  How OEM physicians can help ignite employer centered ACO and PCMH deployment

  The unique role of Occupational and Environmental Medicine (OEM) in prevention, care delivery and population health management

  How OEM can help transform our “Sick Care” system to a true Health system



ACOEM Position Statement on Occ Health in ACOs/PCMHs

ACOs/PCMH Definitions

•  Accountable Care Organizations (ACOs) •  Care model that makes physicians and hospitals more accountable •  Outcomes oriented, performance-based with aligned incentives •  Goal: improve value of health services, control costs, improve quality •  ACOs share in a portion of any savings gained

•  Patient Centered Medical Home (PCMH) •  “Whole-person” and “Whole Population” orientation •  Integrated and Coordinated Care •  More emphasis on quality, safety, better access to physicians •  Aligned incentives for improving health as well as better clinical outcomes Population Health Management: Better Health, Better Healthcare at Lower Cost

ACOs/PCMH and the Workplace

•  Employer communities/workplaces are impacted –  Large percentage of Americans receive health benefits at work

•  137 million employees in the U.S. •  Retirees and families of employees extend impact even further

–  Employers increasingly attuned to health of employees and dependents •  Strong evidence base showing that improving health improves productivity

and lowers total health related costs

•  Including workplace in ACO/PCMH development is logical –  Work impacts health and health impacts work –  Workplace is organically connected to home as personal health risks aren’t left

at home just as occupational risks aren’t left at work… –  Employers have unique infrastructure advantages that could help ACO/PCMH

initiatives.



•  Occupational Health Providers are an important resource –  Nation’s specialists in workforce/workplace health and wellness –  Critical link to nation’s workers and their dependents –  An Occ Health Provider/Workplace Wellness Program yearly impact w/

employees = Hundreds of hours; a primary care physician yearly contact w/patient only minutes.

•  Occupational Health relevance and sphere of influence is expanding –  Workplace health and wellness initiatives now reach millions of workers –  Unique training and skills in both individual health and population health

management –  Clinical guidelines and scientific research base increasingly relevant –  Emphasis on Prevention is fundamental to Occupational Health as well as

ACOs/PCMH

Unique Advantages of Workplace Wellness and Occupational Health

Why are these concepts getting so much attention by employers?   The Cost Crisis has been largely driven by the Health Crisis

  Employer’s goal is a healthier, more productive workforce at lower total costs

  ACOs/PCMH initiatives align incentives for better population health on the supply side (providers) and employers align incentives on the demand side (consumers)

Background: ACOs/PCMH

Of the $2 trillion spent on U.S. health care

The Cost Crisis due to the Health Crisis

In public programs, treatment of chronic diseases constitute an even higher portion of spending:

More than 96 cents in

Medicare… …and 83 cents in Medicaid

Of every dollar spent…

…75 cents went towards treating patients with one or more chronic diseases

“The United States cannot effec0vely address escala0ng health care costs without addressing the problem of chronic diseases.”

-‐-‐ Centers for Disease Control and Preven2on



•  133 Million Americans have one or more chronic conditions

•  79 million Americans have pre-diabetes (yet, < 7% are aware of it)

•  67% of the increase in health care spending is due to increased prevalence of treated chronic disease

•  27% of rise in healthcare costs associated with the increase in

obesity rates (‘Waist Line impacts the Bottom Line’)

Source: K.E. Thorpe, Health Affairs 24, no.6 (2005): 1436-1445; and K.E. Thorpe et al., Health Affairs 23, no. 6 (2004): 480-486.

The Problem

The Bigger Problem: The Full Cost of Poor Health

Iceberg of Full Costs from Poor Health on Employers

Sources: Loeppke, R., et al., "Health and Produc2vity as a Business Strategy: A Mul2-‐Employer Study", JOEM.2009; 51(4):411-‐428. and Edington DW, Burton WN. Health and Produc2vity. In McCunney RJ, Editor. A Prac2cal Approach to Occupa2onal and Environmental Medicine. 3rd edi2on. Philadelphia, PA. LippincoY, Williams and Wilkens; 2003: 40-‐152

Personal Health Costs Medical Care Pharmaceu/cal costs

Produc2vity Costs Absenteeism Short-‐term Disability Long-‐term Disability

Presenteeism Over/me Turnover Temporary Staffing Administra/ve Costs Replacement Training Off-‐Site Travel for Care Customer Dissa/sfac/on Variable Product Quality

Top 10 Health Conditions by Full Costs For Employers (Med + RX + Absenteeism + Presenteeism) Costs/1000 FTEs

$0 $50,000

$100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000

Depression Obesity Arthritis Back/Neck Pain Anxiety GERD Allergy Other Cancer Other Chronic Pain

Hypertension

Presenteeism Absenteeism Drug Medical

Loeppke, R., et al., "Health and Produc2vity as a Business Strategy: A Mul2-‐Employer Study“. JOEM. 2009;51(4):411-‐428.



As Health Risks go so go Health Costs

Dr. Dee Edington

Zero Trends

$0

$3,000

$6,000

$9,000

$12,000

19-34 35-44 45-54 55-64 65-74 75+

$1,776 $2,193 $2,740

$3,734 $4,613 $5,756

0

$2,565 $3,353

$4,620

$6,625

$7,989 $8,927

$5,114 $5,710

$7,991

$10,785 $11,909 $11,965

Annual Medical Costs

Age Range

Edington. AJHP. 15(5):341-349, 2001

Low Med Risk

High

Which Matters More on Costs: Age or Health Risk?

Health Risks Impact Productivity

% of Workplace Produc2vity Loss

0-‐2 risks 3-‐4 risks 5+ risks

14.7%

20.9%

26.9%

6.4 Days

9.3 Days

12.6 Days

1 risk 3 risks 4+ risks

Work days lost / Person / Year

STD Days / Year

0-‐1 risks

2-‐ 3 risks

4+ risks

2.4 Days 5.3

Days

13.1 Days

Sources: Burton, et al, JOEM: Vol. 47. No. 8, August, 2005; Wayne Burton, MD, IHPM North American Summit Mee/ng 2000; also Tsai, et al. JOEM: Vol. 47, No. 8, August, 2005



The Solution

Shi`ing Costs

Actual Cost Decrease

Reducing the burden of health risks and illness leads to a healthier popula/on and measurable TOTAL COST DECREASES.

Current system focus on the financial transac/ons of healthcare has not lowered total costs — it only shiYed them.

Prevention is a Key Solution

Centers for Disease Control and Prevention has found that:   80% of Heart Disease and Type II Diabetes as well as   40% of Cancer are Preventable

–  if people just: » stopped smoking, » ate healthy and » exercised



Whole Population Health Management

Total Population

Medium Risk Low Risk High Risk

DM Risk LS Risk

Population of One

21

Population Health Risk Transitions after 2 Years on a personalized Prevention Plan

N = 7,804 Par2cipants

Loeppke, R; Edington,, et.al. “The Associa2on of Technology in a Workplace Wellness Program with Health Risk Factor Reduc2on” Journal of Occupa2onal and Environmental Medicine: March, 2013



498

2291

5531 4666

Significant Overall Reduction in Health Risk of Population

Net Movement of Health Risk Levels in Cohort Baseline vs Year 2 on Prevention Plan

1775 847

N = 7,804

Low Moderate High

60%

11%

6%

29% 23%

71%

Loeppke, R; Edington, etal. “The Associa2on of Technology in a Workplace Wellness Program with Health Risk Factor Reduc2on” Journal of Occupa2onal and Environmental Medicine: March, 2013

$215 Risk/Year

Costs

Increased

Costs

Redu

ced

Reduced Risk à Reduced Cost

Source: Edington, Zero Trends, 2009 and Edington, AJHP. 15(5):341-‐349, 2001.

$800

$400

$200

$0

<$200>

<$400>

<$800>

-‐3 -‐2 -‐1 0 1 2 3

Risks Reduced Risks Increased

Average Saving (per Risk Reduced per person per year)

$950 Risk/Year

% of Produc2vity

Change

Reduced Risk à Improved Productivity

6% 4% 2% 0% -‐2%

# of Health Risk Changes

Source: Burton, W. et. al. The Associa2on of Health Risk Change and Presenteeism Change. JOEM. Volume 48, Number 3, March 2006, pp 252-‐263.

Average Productivity Savings (per Risk Reduced per person per year)



Wellness Works and Prevention Pays

Average ROI

$3.27 + $2.73 Med/Rx Absenteeism

Savings Savings

$6.00 saved for every $1.00 invested

In Comprehensive Wellness

Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Affairs (Millwood). 2010; 29(2).

OEM Roles Expanding

Occupational Medicine

• Urgent care focus • Physical exams • Workers’ Comp. • On Site Clinics • Primary Care • Pre-placement,

periodic, medical surveillance exams

• Hazardous/toxic evals • Hearing conservation •  regulatory compliance • Case/Disability

management • Efficient SAW/RTW

Occupational Health

• Workplace Wellness

• Health Protection (safety ) and Health Promotion

• Ergonomics •  Individual Health

Risk Assessment • Organizational

health assessment

Population Health

Integration of: • Health management • Disease

management • Disability/Absence

management • Medication

management • Value (quality/cost)

management • Managing the health

assets and human capital of workforces and populations

Loeppke, R. Prevention and Managed Care: The Next Generation. Journal of Occupational and Environmental Medicine. 1995 37(5):558-562.

Vision for the Future

  Permission to Drs & Pts   Misaligned Incen/ves for Sick   Fragmented/Uncoordinated   Preven/on a Cost to Jus/fy

  Benefits Paid for Poor Health   EEs “Use it or Lose it”   Pa/ents Passive Recipients   “Pay for Quan/ty/Volume”

  “Sick Care” System   Quan/ty/Cost of Service   Illness & Injury   Health “Benefit” as a Cost

  Empowerment of Drs & Pts   Aligned Incen/ves for Health   Integra/on / Coordina/on   Preven/on as an Investment

  Rewards Paid for Befer Health   EEs “Use Wisely & Save”   Consumers Ac/ve Par/cipants   “Buy Quality/Value” of H&P

  True “Health” System   Quality/Value of Service  Well-‐being and Produc/vity   Value and Benefits of Health

Focus

Approach

Results

Current Way New Way



We Can Start Integrating OEM with ACOs/PCMH Now

•  Employer sponsored ACOs/PCMHs for workers and their families •  Financial opportunities to support health behavior change •  “Whole person” and “whole population” integrated health services •  Primary, Secondary and Tertiary Prevention services •  Work fitness and disability prevention and management •  Onsite OEM clinics or full-service primary care clinics •  Evidence Based Medical Practice guidelines (clinical & functional)

Key Point: INDIVIDUAL and POPULATION HEALTH MANAGEMENT is a fundamental building block of ACO/PCMH models and OEM physicians

have unique training and expertise with proven results

The Time to Engage is Now

Good Health

is Good Business

The Bottom Line

optimizing health care delivery by integrating workplaces...

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