1. health and fitness

2014 Managed Care Symposium
Search for Tomorrow:
A Guiding Light
for Managed Care
November 20, 2014
1
Table of Contents
Schedule of Events ………………………………………………………………………..….…3
2013 – 2014 MHPA Board of Directors……………………………………….…………….….4
2014 Symposium Planning Committee……………………………………………..……….….5
Speaker Bios…………………………………………………………………………...…… 6 - 18
Sponsors…………………………………………………………………………..…….….19 – 22
Exhibitor List & Booth Layout…………………………………………………………...23 – 24
Another World: Striving For Success In A Diversifying Medical Marketplace………..26 - 45
Jeffrey C. Bauer, Ph.D., Independent Health Futurist and Medical Economist
Dynasty: “The Next Generation” ……………………………………………………………………..46
Karen Atwood, President, Blue Cross Blue Shield of Illinois
William Snyder, Market Vice President, IL, Humana
Michael Phillips, President, Midwest Markets, Cigna
The Young and the Restless: Elevate Your Benefits Program with the Enterprise
Healthcare Cloud………………………………………………………………………………..…47 – 55
Dr. Howard Wilson, Senior Director, Solutions Consulting, Castlight
All My Children: Employer and Employee Perspectives on Healthcare…………..……56 – 64
Andy Rix, Midwest Region Market Leader, Aon Hewitt
Mitch Santiago, Senior Vice President, Aon Hewitt
Moment of Truth: Engaging Your Patients……………………………………………..........65 – 75
Ann Grill, Patient Experience Advisor, Enterprise Division, Press Ganey, Associates (66 – 70)
Theresa Larsen, MPH, CPHQ, Director of Quality Improvement, Meridian Health Plan (71– 75)
2
TIME & LOCATION
8:00 a.m. -8:45 a.m.
Brook and Oak Rooms
TOPIC/SEGMENT
Registration/Continental Breakfast and
Exhibitor Review
8:45 a.m. -9:00 a.m.
Welcome
SPEAKER
John Wyrostek
Director, Managed Care
Cadence Medical Partners
Terrace Room
Dr. Gary Wainer, FAAFP
Medical Director
Cadence Medical Partners
Session 1: Another World
9:00 a.m. -10:00 a.m.
Terrace Room
10:00 a.m. -10:30 a.m.
Keynote: Striving for Success in a
Diversifying Medical Marketplace
Break/Exhibitor Review
Jeffrey C. Bauer, Ph.D.
Independent Health Futurist and
Medical Economist
Brook and Oak Rooms
Karen Atwood
President
Blue Cross and Blue Shield of Illinois
10:30 a.m. -11:30 a.m.
Session 2: Dynasty
Terrace Room
“The Next Generation”
William Snyder
Market Vice President, IL
Humana
Mike Phillips
President, Midwest Markets
Cigna
11:30 a.m. -1:00 p.m.
Venetian 1
Lunch
These Are The Days of Our Lives
(whether we like it or not)
Jen Bosworth
Writer and Performer
Session 3: The Young & The Restless
1:00 p.m. -1:45 p.m.
Terrace Room
Elevate Your Benefits Program with the
Enterprise Healthcare Cloud
Session 4: All My Children
1:45 p.m. -2:30 p.m.
Employer and Employee Perspectives on
HealthCare
Terrace Room
Dr. Howard Wilson
Senior Director, Solutions Consulting
Castlight Health
Mitch Santiago
Senior Vice President
Aon Hewitt
Andy Rix
Midwest Region Market Leader
Aon Hewitt
2:30 p.m. -3:00 p.m.
Brook and Oak Rooms
Break/Exhibitor Review
3:00 p.m. -3:45 p.m.
Session 5: Fear Factor
Terrace Room
Update: Illinois Insurance Exchanges
Anne Grill
Patient Experience Advisor, Enterprise Division
Press Ganey, Associates
Theresa Larsen, MPH, CPHQ
Director of Quality Improvement
Meridian Health Plan
3:45 p.m. -5:00 p.m.
Grand Ballroom Foyer
Reception: The Edge of the Night
Prize Raffles & Cocktail Hour
3
MHPA BOARD OF DIRECTORS 2013—2014
President Vice President Treasurer Secretary COO/Director Board Members Cheryl Perrin VP Risk Adjustment and Quality, NAMM of Illinois John Wyrostek Director, Managed Care, Cadence Health Vacant Kim Neverouski Director of Operations, Fox Valley Medicine, Ltd. Debra Ryan Vice President, Kaufman Hall Jill Rock Director of External Affairs & Marketing, Union Health Service, Inc. Meg Kresach Director, Managed Care, Silver Cross Hospital Lynn Philipson President, Ingalls Provider Group Bridget Morehouse VP Payer Relations, ATI Physical Therapy Tammy Wald Executive Director, Clinical Services, DuPage Medical Group 4
2014 MHPA SYMPOSIUM PLANNING COMMITTEE
Maureen Conway
Director of Health Plans and Payor Markets
Quest Diagnostics
Teresa Djukic
Director of Credentialing & Quality Improvement
Fox Valley Medicine, Ltd.
Melissa Dunne
Senior Manager Network Management
Family Health Network
Evan Freund
Evan Freund Managed Healthcare Consulting
Kristen Keeley
Director, Hospital/Ancillary Contracting
Cigna-HealthSpring
Bridget Morehouse
VP Payer Relations
ATI Physical Therapy
Jill Rock
Director of External Affairs and Marketing
Union Health Service, Inc.
Debra Ryan
Vice President
Kaufman Hall
Alma Stanton
Network Management
Family Health Network, Inc.
Jeff Turner
VP Network Services
MED3000/McKesson
Tammy Wald
Executive Director, Clinical Services
DuPage Medical Group, Ltd.
John Wyrostek
Director, Managed Care
Cadence Health
5
Speaker Bios
6
John Wyrostek
Director, Managed Care
Cadence Health
_____________________________________________________________________________
John Wyrostek is the Director of Managed Care for Cadence Health, now part of Northwestern
Medicine. Previously, he had been the System Director of Managed Care at Presence Health,
Regional Director of Managed Care for Surgical Care Affiliates as well as Director of
Managed Care for Centegra Health System . He is a member of insurance and reimbursement
task force for the Illinois Hospital Association and Vice President of the Managed Healthcare
Providers Association Board. He has a Bachelor’s degree in management and an MBA in
Marketing and Finance from the University of Illinois at Chicago.
7
Dr. Gary Wainer, FAAFP
Medical Director
Cadence Medical Partners
_____________________________________________________________________________
Dr. Wainer is a graduate of Chicago College of Osteopathic Medicine and the MacNeal
Hospital Family Medicine Residency Program. After residency he established Primary Care
Associates, a 6 physician primary care practice in Berwyn. Illinois. He has served on numerous
MacNeal Hospital Committees including Medical Executive, Credentials, and Utilization
Management Committees. He has acted as Chief Medical Officer and VP of Operations at
MacNeal Hospital. In 2007 he became the Chief Medical Officer for Chicago Health System,
the population health and managed care organization there and most recently was its Executive
Director and President of its MSSP ACO. In April Dr. Wainer moved to Cadence Health in
Winfield Illinois to take on similar population health and managed care initiatives with
Cadence Medical Partners.
8
Jeffrey C. Bauer, Ph. D
Independent Health Futurist and Medical Economist
_____________________________________________________________________________
Dr. Bauer is an internationally recognized health futurist and medical economist. As an independent industry thought leader, he forecasts the evolution of health care and develops practical
approaches to improving the medical sector of the American economy. He is widely known for
his specific proposals to create an efficient and effective health care delivery system through
multi-stakeholder partnerships and other initiatives focused in the private sector.
Dr. Bauer has published more than 250 articles, books, Web pages, and videos on health care
delivery. He speaks frequently to national and international audiences about key trends in
health care, medical science, technology, information systems, reimbursement, public policy,
health reform, and creative problem-solving. Dr. Bauer is quoted often in the national press and
writes regularly for professional journals that cover the business of health care.
His latest book is Upgrading Leadership’s Crystal Ball: Five Reasons Why Forecasting Must
Replace Predicting and How to Make the Strategic Change in Business and Public Policy
(Taylor & Francis, 2014). Previous books include Paradox and Imperatives in Health Care:
How Efficiency, Effectiveness, and E-Transformation Can Conquer Waste and Optimize Quality (Productivity Press, 2008) and Statistical Analysis for Health Care Decision-Makers (CRC
Press, 2009). His two previous books are Telemedicine and the Reinvention of Health Care:
The Seventh Revolution in Medicine (McGraw-Hill, 1999) and Not What the Doctor Ordered
(McGraw-Hill, 1998).
As a consultant, he has assisted hundreds of provider, purchaser, and payer organizations with
strategic planning and performance improvement. He served as Vice President for Health Care
Forecasting and Strategy for ACS, a Xerox Company, from 1999 to 2010. His previous consulting firm, The Bauer Group, specialized in consumer-focused strategic planning and development of clinical affiliation agreements for multi-hospital networks from 1984 to 1992.
In addition, Dr. Bauer has extensive academic experience. He was a full-time teacher and administrator at the University of Colorado Health Sciences Center in Denver from 1973 to 1984,
where he held appointments as associate professor and as Assistant Chancellor for Planning and
Program Development. He also served concurrently for four years as Health Policy Adviser to
Colorado Governor Richard D. Lamm. From 1992 to 1998, Dr. Bauer was a visiting professor
in Administrative Medicine at the Medical School of the University of Wisconsin-Madison,
where he taught physician leaders how to evaluate research reports and other published studies.
Prior to his career in health care, he worked on meteorology projects for the National Center for
Atmospheric Research.
He received his Ph.D. in economics from the University of Colorado-Boulder. He graduated
from Colorado College in Colorado Springs with a B.A. in economics and completed a certificate in political studies at the University of Paris (France). During his academic career, he was
a Boettcher Scholar, a Ford Foundation Independent Scholar, a Fulbright Scholar (Switzerland),
and a Kellogg Foundation National Fellow. He is an elected member of the Association of
Managers of Innovation and of the Institute of Medicine of Chicago. Dr. Bauer lives in Chicago, where he occasionally displays his paintings in local art galleries. He is an avid fan of 9
music and member of the Governing Board of the Chicago Symphony Association.
Karen Atwood
President
Blue Cross and Blue Shield of Illinois
_____________________________________________________________________________
Karen Atwood is president of Blue Cross and Blue Shield of Illinois (BCBSIL). In this role,
she oversees all of BCBSIL’s sales and marketing activities; its extensive health, wellness and
medical management programs; its health care provider networks and relationships; and its government, public and community relations activities across Illinois.
Karen joined BCBSIL in 1979. Prior to becoming BCBSIL president, she served as divisional
senior vice president of the company’s National Division, which manages more than 350 major
national, municipal and labor accounts, representing nearly four million members. Prior to that,
she served as Health Care Service Corporation’s (HCSC) chief underwriter and held positions
in financial operations, cost and budgets and financial reporting. HCSC operates BCBSIL.
Karen received her master’s degree in Business Administration from DePaul University in 1982
and her bachelor’s degree in Finance from the University of Illinois, Champaign/Urbana, in
1978. She is a Certified Public Accountant.
Karen is a member of the board of directors of the Chicagoland Chamber of Commerce and the
Civic Federation, as well as a member of the Board of Governors of the Metropolitan Planning
Council. She also serves on the board of directors for DePaul University.
She and her husband Mike live in Chicago.
10
William Snyder
Market Vice President, IL
Humana
_____________________________________________________________________________
In his ninth year at Humana, Bill has worked in various sales leadership and account
management roles, including Midwest Regional Business Executive for Humana’s Well-being
& Productivity Solutions team.
Bill earned a Masters in Business Administration from Northwestern's Kellogg School of
Management and a bachelor’s degree in Economics and Political Science from Vanderbilt
University.
11
Michael Phillips
President, Midwest Markets
Cigna
_____________________________________________________________________________
Mike Phillips joins CIGNA HealthCare as the President & General Manager for the Midwest
Markets which include Illinois, Indiana, Michigan, Minnesota and Wisconsin.
Prior to joining CIGNA, Mike served as a National Health Care Strategist for Aon Hewitt. He
was responsible for identifying and confirming the issues and challenges that clients face and
constructing unique and compelling value propositions that solve those challenges.
Mike also held several positions with Aetna. While Head of Business Engagement & Specialty
he was responsible for developing new ideas, enhancing products, strengthening customer and
consultant relationships and growing all specialty lines.
Mike has over 25 years of industry experience. He is a graduate of Michigan State University
and resides with his family in Chicago.
12
Jen Bosworth
Writer & Performer
_____________________________________________________________________________
Jen Bosworth is an actress and storyteller from Evanston, Illinois. She is a graduate of the
Theatre School at DePaul University and has appeared on numerous television shows as well as
on some of Chicago's most well known stages. Jen is a mainstay of Chicago's thriving
storytelling community and her one woman show, "Why Not Me…Love, Cancer and Jack
White" has enjoyed sold out runs in both Chicago and New York City.
13
Dr. Howard Wilson
Senior Director, Solutions Consulting
Castlight Health
_____________________________________________________________________________
Dr. Willson is a Senior Director as Castlight Health and works primarily with prospective
enterprise customers to help them understand the opportunity for better value in their members'
healthcare spend. Formerly, he led Castlight’s work with health care providers, and has also
been the clinical lead on some of Castlight's most successful products. Prior to joining
Castlight, Dr. Willson was the Department Chief of Emergency Medicine at Swedish Medical
Center in Seattle, the largest nonprofit health care facility in the Greater Seattle area. He
received a BA from Dartmouth, an MD from the University of Illinois College of Medicine, and
an MBA from Wharton.
14
Mitch Santiago
Senior vice President
Aon Hewitt
_____________________________________________________________________________
Mitch is a Senior Vice President in Aon Hewitt’s Health and Benefits Practice in Chicago,
Illinois. He is responsible for health and benefits sales to large and mid-size employers of all
industries. Prior joining Aon Hewitt, he was the local health care and group benefits practice
leader for another international consulting firm.
Mitch has over 20 years of consulting experience. He has served as the client lead and strategist for several healthcare organizations. His experience includes providing advice and support
across all aspects of health and welfare benefits including multi-year strategy development,
program design, cost management, compliance, measurement and analytics, annual renewals,
vendor evaluation, network development, health management program design and ongoing
performance management. He has also worked with a number of entities related to the development of prospective Accountable Care Organizations.
Mitch has a BA in Psychology from Syracuse University and a JD from The
Cleveland-Marshall College of Law. He is a member of the International Society of Certified
Employee Benefits.
15
Andy Rix
Midwest Region Market Leader
Aon Hewitt
_____________________________________________________________________________
Andy is the Midwest Market Leader and a strategic communications consultant in Aon’s
Communication Practice based in Chicago, Illinois. He works on a wide range of
communication projects with prospective Accountable Care Organizations and Corporations in
the fields of health and benefit communications and employee research.
Andy works with his clients to leverage Aon’s research in employee segmentation, their
perceptions of their own health, what they value in healthcare generally and how they act as
consumers of healthcare to design and implement communication strategies that market benefit
plans effectively and provide decision support for employees making healthcare choices.
Andy has been with Aon Hewitt for ten years in a range of change management and
communication roles in our outsourcing and consulting businesses. Prior to joining Aon Hewitt,
Andy worked at PricewaterhouseCoopers in the Global Human Resource Solutions Practice,
also in change management and communication roles.
Born in the UK and now resident in the US for fourteen years, Andy holds a Political Science
degree from Warwick University and a Master’s degree in Human Resource Management from
Middlesex University.
16
Anne Grill
Patient Experience Advisor, Enterprise Division
Press Ganey, Associates
_____________________________________________________________________________
As a Patient Experience Advisor with Press Ganey Associates, the leading provider of health
care performance improvement solutions, Anne Grill brings a dynamic approach to partnering
with facilities on the implementation of improvement initiatives. She has a diverse
background, with experience in Public Relations, Business Development, Marketing,
Communications, Consulting and Customer Service.
In her role as an Advisor, Ms. Grill is responsible for assisting her clients throughout each step
of the patient satisfaction process. As hospitals charge their employees with responsibility for
patient satisfaction, Anne is charged with guiding the improvement efforts of her clients.
Working with large hospitals and health systems spread throughout the Midwest, she provides
direction for goal- setting, action planning and change management, along with assisting
systems in creating and maintaining consistency in service across their locations.
In her five-year tenure at Press Ganey, Anne has developed her own methods persuading an
audience, overcoming objections, and demonstrating the value of her partnerships. She has
presented the Press Ganey message to hospitals and medical practices in over 20 states, hosted
numerous webinars open to large audiences, and been invited to present to outside
organizations such as the Healthcare Financial Management Association and the Iowa
Pharmacy Association. Ms. Grill has also served as a speaker for Press Ganey’s 2013,
Regional Education Symposiums, designed service excellence programs that have demonstrated
a return on investment, and has been ranked above the 90th percentile as a consultant for the
past 2 years.
Before joining Press Ganey, Anne was involved in Public Relations in the utility industry.
Some of her responsibilities included public speaking engagements, open forums with
consumers, the education of customers and staff on energy related issues, and a monthly
column dedicated to energy advice published in a national magazine. She has traveled
extensively and lived outside the US, been involved in numerous community Chambers of
Commerce, and is a former board member of the Cass County Economic Development
Corporation as well as the Michigan Geothermal Energy Association.
Anne obtained her Bachelor of Arts degree in Communications from Michigan State University
in 2002, is certified in several public speaking courses such as Dale Carnegie and RogenSI, and
is a certified Lean Six Sigma Yellow Belt.
17
Theresa Larsen, MPH, CPHQ
Director of Quality Improvement
Meridian Health Plan
_____________________________________________________________________________
Ms. Larsen is the Director of Quality at Meridian Health Plan, a Medicaid-Medicare HMO that
has realized top quality scores in Illinois for the last three years. With over fifteen years of
experience in patient advocacy, service excellence, and quality improvement, Ms. Larsen is
responsible for all quality and community outreach activities for the Meridian Health Plan
Illinois market.
18
THANK YOU
TO OUR 2014
SYMPOSIUM
SPONSORS!
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Platinum Sponsors:
20
Gold Sponsors:
21
Silver Sponsors:
22
THANK YOU
TO OUR 2014
SYMPOSIUM
EXHIBITORS!
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EXHIBIT BOOTH LAYOUT
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24 25 26
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Beverag
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36
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Beverag
Food Service
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BOOTH NUMBER—COMPANY 8
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2
Food Service
Grand Ballroom Foyer
1
General Sessions
01 ‐ Ungaretti & Harris LLP 02 ‐ MedVision, Inc. 03 ‐ Blue Cross Blue Shield of Illinois ‐ Platinum Sponsor 04 ‐ Advanced Resources 05 ‐ First Recovery Group 06 ‐ McKesson Patient Care Solutions 07 ‐ Humana ‐ Platinum Sponsor 08 ‐ VITAS Innovative Hospice 10 ‐ Harmony/WellCare 11 ‐ Chicago Ambulance Alliance 12 ‐ HFN, Inc. 13 ‐ Hanger Prosthetics & Orthotics 14 ‐ Medline Industries, Inc. 15 ‐ Health Technology Resources 16 ‐ Edgepark Medical Supplies 17 ‐ Coram CVS Specialty Infusion 18 ‐ CCPA Purchasing Partners 19 ‐ IlliniCare Health Plan ‐ Gold Sponsor 20 ‐ Valence Health ‐ Silver Sponsor 21 ‐ Managed Care Staffers 22 ‐ DataWing Software® 23 ‐ Cigna‐HealthSpring ‐ Silver Sponsor 24 ‐ Accelerated Physical Therapy ‐ Gold Sponsor 25 ‐ Chicago Health System 26 ‐ PBC Advisors, LLC 27 ‐ Land of Lincoln Health 28 ‐ Private Home Care/Pri‐Med Infusion/Home Staff Inc. ‐ Silver Sponsor 29 ‐ ContextMedia: Health 30 ‐ Seasons Hospice & Palliative Care 31 ‐ Premier Medical Products, Inc. 32 ‐ Total Home Health 33 ‐ Medix Staffing Solutions 34 ‐ Midwest Dental Sleep Center 35 ‐ Sleep Case Management 36 ‐ TapCloud LLC 37 ‐ Citra Health Solutions Special Thank You to ATI Physical Therapy ‐ Silver Sponsor 24
Session
Information
25
John Wyrostek
Vice President
MHPA
“Welcome”
Dr. Gary Wainer, FAAFP
Medical Director
Cadence Medical Partners
26
Jeffrey C. Bauer, Ph. D
Independent Health Futurist and
Medical Economist
Another World
“Striving for Success in a
Diversifying Medical Marketplace”
27
The 13th Annual Managed Care Symposium
Oak Brook Terrace, Illinois; November 20, 2014
Striving for Success in a
Diversifying Medical Marketplace
Jeffrey C. Bauer, Ph.D.
Health Futurist and Medical Economist
© 2014 Jeffrey C. Bauer
•
•
•
•
•
Set in mythical Bay City
Known for addressing taboo subjects
Built on crossover character Mike Bauer
Created spinoff show For Richer, For Poorer
Started with epigram “We do no live in this
world alone, but in a thousand other worlds
which represent the difference between the
world we live in and the world of feelings and
dreams that we strive for.”
Disclaimers
• My
comments do not necessarily represent positions of
MHPA or any other organization
• My
criticism of one faction’s positions on health reform
does not imply support for any other faction’s positions
•
After 40+ years in health care, I believe American
enterprise can create the world’s best health system
28
For the Premium Pricing are We Getting Higher Quality?
Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).
Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey
of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High
Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009
(Paris: OECD, Nov. 2009).
Do we really have the world’s best health system?
• Our ranking on national health scales is very low for
comparable countries
#34 (OECD) and #39 (WHO)
•
Yet the world’s top-ranked systems are American
Mayo, Cleveland, Kaiser, Geisinger, etc.
Our world-class systems are highly diverse
All manage care scrupulously
They are constantly changing
29
STRATEGY
Strategy - purposeful
response to anticipated
change, consistent with
mission and values
How can leaders in managed care
identify the possibilities for doing
the right things?
TACTICS
See all factors as variable
See all factors as fixed
Identify possibilities
Meet goals
Make tough choices
Make best decisions
Do the right things
Do things right
Reading health care journals
Copying competitors’ responses
Attending professional meetings
Implementing the ACA (ObamaCare) Predicting based on trend analysis
Forecasting based on the possibilities
30
Are predicting and forecasting the same?
The Science of Predicting
Forecasting is about predicting the future as accurately
as
possible.
Rob J. Hyndman; Business Forecasting Methods (2009)
Forecasting is a strategy used in different fields to predict
the
future based upon the past.
Forecastingmethods.net (2013)
An economic forecast is a prediction of what future
periods of economic activity will be in various categories.
Investment Contrarians (2/26/2013)
A prediction is a specific
estimate of the expected
value of a key variable at a
future point in time
Economists are forecasting the same steady, if
unspectacular, growth this year they were expecting in
2012.
Last year’s predictions proved too optimistic.
Wall Street Journal (2/8/2013, p. A)
The Science of Predicting
• Specify
independent explanatory variables
for the analytical model
• Collect
historical data on the variables
• Determine
“best fit” mathematical
relationship
• Extrapolate
trend line to future values
31
The Science of Predicting
Health Care Example
The Science of Predicting
Useful predictions can be made when
the quantifiable relationships that
represented how things worked in the
past will continue to work the same
way in the future, assuming good data
and good methodological practice
Five fatal flaws of predicting when how
things work is changing...
1.Discontinuities in system dynamics
2.Violations of model assumptions
3.Deficiencies of available data
4.Failures of previous predictions
5.Diversions from strategic innovation 32
“Surely, we will end up where we are headed if we
do not change direction.”
The Art of Forecasting
The future of health care is
unpredictable!
Q: So how can the leaders
purposefully anticipate change?
A forecast is an estimate
of the probabilities of
possibilities for a key
variable at a future point
in time
A: The Art of Forecasting
33
The Art of Forecasting
•
Identify explanatory variables (weather: water,
temperature, pressure, wind)
•
Collect historical data on the variables
•
Categorize different outcomes for similar
combinations of variable •
Assign probabilities to the different outcomes
•
Update model whenever the climate changes
My forecast for health care as % of GDP: 2015-2019
•
15% chance of growth •
40% chance of stagnation
•
45% chance of decline
34
My forecast for health care providers: 2015-2019
•
35% will cease to exist as organized
•
40% will continue to exist as organized...
precariously
•
25% will thrive by fixing the way care is
delivered
The Art of Forecasting
Climate is the set of fixed factors that
define interaction of the variables
Climate is what you expect…
weather is what you get.
The climate is changing dramatically
in weather...and health care!
Health Care’s New Climate
•
New Climate
(Realm of Possibilities)
A revolution in medical science is shifting providers’
core function from acute care to disease management
•
Information & communications technologies are transforming
business models, production processes, and sites of care •
End of growth in health care spending is restructuring
the provider-patient relationship
•
Problems with government-driven reform are compelling
providers and their business partners to develop successful
futures on their own
Political
Reforms
Honoré Daumier (1858)
35
A revolution in biological sciences is shifting providers’
core function from acute care to disease management
• The “one-size-fits-all” clinical paradigm is being replaced
by precision medicine (personalized/predictive/preventive)
MARCH 29, 2009
I don’t think of myself predicting things. I’m
expressing possibilities. Things that could
happen. To a large extent it’s a question of
how badly people want them to happen. The
purpose of thinking about the future is not to
predict it but to raise people’s hopes.
•
Diseases long seen as single entities are now recognized as
different conditions with a range of biological instructions •
Cost-effective care will be achieved as therapies are matched
to each patient’s specific disease characteristics & epigenetics
•
Population health will be significantly enhanced by managing
patients’ diseases to prevent the need for acute care
•
Patient-centered care teams (physicians + qualified nonphysician practitioners) will become the best-practice model
-- Freeman Dyson
Eugene Richards for The New York Times
Freeman Dyson
JAMA November 5, 2014: 1779
Information & communications technologies are transforming
business models, production processes, and site of care • Robust
ICT networks will be the necessary foundation of
good medical practice (“hot-spotting,” disease management)
•
Integrated electronic record systems will be essential for
least-cost production of medical services
•
Telemedicine (virtual visits) will replace a substantial
portion of hands-on care
•
Virtual networks will be the foundation of successful
population-based care management models 36
Information & communications technologies are transforming
business models, production processes, and site of care 10% of all Medicare beneficiaries
accounted for 64% of the cost
Information & communications technologies are transforming
business models, production processes, and site of care Five percent of patients
accounted for 50% of all
health care expenditures.
By contrast, the bottom
50% of patients accounted
for just 2.8% of spending…
37
End of growth in health spending will restructure
provider-patient relationships
•
Governments and employers have reached the limits of
their ability and willingness to spend more on health care •
The market must shift from fee-for-service reimbursement
(quantity) to value-based payment (overall quality)
•
Demand will change significantly as patients are expected
to pay an increasing share of the costs of care
•
Patients will not have disposable income to pay more for
care, forcing providers to change delivery and pricing
End of growth in health spending will restructure
provider-patient relationships
End of growth in health spending will restructure
provider-patient relationships
End of growth in health spending will restructure
provider-patient relationships
Actuarial ratio: % of an average patient’s expected costs of care
that will be paid by health insurance
Average actuarial ratio for all health plans, 1970-2010: 80%
Statutory actuarial ratio for minimum ACA-mandated plan: 60%
Average patient out-of-pocket obligation is doubled by the ACA
38
End of growth in health spending will restructure
provider-patient relationships
End of growth in health spending will restructure
provider-patient relationships
39
End of growth in health spending will restructure
provider-patient relationships
Problems with government-driven reform will compel
providers to develop successful futures on their own
•
Rushed legislative sessions produced flawed laws that are
unlikely to be approved by amendments •
Legal challenges create an uncertain environment for
meeting the legislated mandates •
Neither the administration nor Congress has adequate
resources to complete all tasks delegated by the laws
•
DHHS has responded to the challenges of implementation
with waivers, delays, and program cancellations
•
Responsibility for implementation has been delegated to
states with wide variations in commitment and capacity
17%
40
“It is time for medicine to reinvent itself…to
form strategic partnerships and to embrace the
goal of exponentially increasing medicine’s value.
[Providers] need to become part of the solution
in the US health care system. The system’s
problems should not be addressed by politicians,
who are virtually powerless to effect meaningful
change in health care until [providers] fix the
way care is delivered.” JAMA; 20 April 2011:1589
Fix the way care is delivered!
delivered
Fix the way care is delivered!
All health care enterprises must adopt better ways of doing
business with performance improvement tools (Lean, Six Sigma,
etc.) that ensure care is delivered correctly all the time, as
inexpensively as possible
•
Efficiency is maximizing output for a fixed budget or
minimizing costs for a fixed output (i.e., no economic waste)
•
Effectiveness is a measure of relative compliance with
JAMA, April 11, 2012
objective specifications of expected performance (i.e., no
unexplained variation)
Waste as % of Total Spending
Low
Midpoint
High
21%
34%
47%
41
Fix the way care is delivered!
Fix the way care is delivered!
JAMA, April 11, 2012
Fix the way care is delivered!
Fix the way care is delivered!
•
•
•
•
•
Replace traditional care models with systems
customized to local marketplace (no “one size fits all”)
Shift significant resources from acute care to disease
management to optimize health of population served
Provide health care right all the time — quality — as
inexpensively and as close to home as possible
Develop payment/revenue mechanisms that reward
efficiency and effectiveness (accelerating end of FFS)
Create long-term (>5-year), multi-stakeholder
partnerships to fix the way care is delivered for
maximizing population health
42
Traditional Response: Health System Integration
Ideal marketplace response: Multi-stakeholder partnerships
Vertical
Purchasers
Payers
Practitioners
Providers
(Government & Employers)
(Insurers & Health Plans)
(Health Professionals)
(Hospitals & Clinics)
Horizontal
Ideal marketplace response: Multi-stakeholder partnerships
Purchasers
Payers
(Government & Employers)
(Insurers & Health Plans)
Practitioners
(Health Professionals)
Providers
(Hospitals & Clinics)
New marketplace response: Multi-stakeholder partnerships
Remember the First Law of Parasitism:
And remember the Corollary…
Don’t kill the host that feeds you.
If you are not at the table,
you are on the menu.
(No element of society can survive at the
expense of other elements.)
43
Critical success factors: Managing care for population health
• Analytics
to prioritize care for greatest return in health
•
Decision support to optimize individual patient care
•
Focus on managing chronic disease
•
Measurement of changes in population health status
•
Focus on overlap with traditional public health
•
Increased reliance on ambulatory, outpatient care
•
Data-based accountability
•
Shared responsibility (risk of loss, gain of profit)
•
Bottom line: “best bang for the buck” = Value!
“We do no live in this world
alone, but in a thousand other
worlds which represent the
difference between the world
we live in and the world of
feelings and dreams that we
strive for.”
RENÉ MAGRITTE - “LA CLAIRVOYANCE”
44
Jeffrey C. (Jeff) Bauer, Ph.D.
Health Futurist and Medical Economist
636 West Schubert Avenue, #A
Chicago, IL 60614
Telephone: 773-477-9339
Mobile: 970-396-3280
E-mail: jeffbauer@mindspring.com
Web: www.jeffbauerphd.com
45
Karen Atwood
President
Blue Cross and Blue Shield
of Illinois
William Snyder
Market Vice President, IL
Humana
Michael Phillips
President, Midwest Markets
Cigna
DYNASTY
“The Next Generation”
This Presentation Does not have
slides or any presentation material
46
Dr. Howard Wilson
Senior Director, Solutions
Consulting
Castlight
The Young and the Restless
“Elevate Your Benefits Program
with the Enterprise Healthcare
Cloud ”
47
Driving Value in
Healthcare – The Role
of Transparency for
Providers
MHPA Discussion
November 20th, 2014
Agenda
Overview of Castlight Health
Role of Transparency for Providers
Q&A
Castlight
empowers
businesses to costeffectively manage their
healthcare spend and
empower employees and
their families to make
informed choices with a
clear understanding of
costs and likely outcomes
Overview of
Castlight Health
US enterprises spend more than
$620B
per year on healthcare
It’s a top 3 business cost that rises
5–10%
per year
30%
of American healthcare
spend is wasted
Confidential
48
4
No correlation of cost with quality
High variation in healthcare pricing
Cost vs. Quality: Pregnancy & Delivery (Chicago)
Healthcare “commodity” pricing varies up to 7x
$18,000
Cost variation by service: Single health plan, single geography
Service
Price
$17,000
$16,000
Variance
$14,000
Colonoscopy
$563
Primary care1
$85
Spine X-Ray2
$38
$3,967
7x
$12,000
$10,000
$270
3x
$8,000
$6,000
$162
4x
$4,000
Source: Castlight claims analysis
visit for an adult 2For three images
1First
Confidential
$5,325
Below Average
Delivery Quality
Above Average
Sources: Pricing Data from Castlight Claims; Quality Data from Leapfrog Group
5
Confidential
6
Consumer-friendly healthcare shopping
Success with Leading Companies
130+
Customers
25+
Fortune 500
customers
25
1
of lives across all 50 states
3
in engaging all their employees
in a prescriptive way
Confidential
Search box with
“smart text” entry
and commonly used
terms
2. 
Personalized plan
update with user’s
current phase &
deductible
3. 
Alerts to higher
value choices based
on personal claims
4. 
Spotlights on
special offerings
2
Industries
Millions Success
1. 
4
7
Confidential
49
8
We have evolved from Transparency to a robust
Healthcare Management suite
Enabling high-value care selection
2
1
3
1. 
Filters to select
search results
based upon
preferred criteria
2. 
Expanded medical
transparency
Search results with
Total & out-of-pocket
prices
-  Provider price and
quality info
- 
3. 
Basic medical
transparency
Clinical Education
Additional links to
- 
- 
Castlight Connect
Castlight Insights
Castlight Care
Castlight Controls
Full Engagement Support
Educational content
Employer programs
24 months ago
Pilot programs:
COE, Rewards, RX, RBB,
Analytics, Program
integration
Enterprise Healthcare Cloud
12 months ago
Confidential
9
Castlight: A Strategic Platform for Transformation
Care
  Medical, Pharmacy
  Dental (coming soon)
Controls
  Quality
Confidential
10
The Castlight Enterprise Healthcare Cloud
  Advanced Plan Design
  Rewards
  Price
  In-Network, In-System
  Education/Care Mgt
  Tiered Networks, Narrow
Network, COEs
  Personalized
Today
Castlight
Castlight
Insights
Insights
Castlight
Controls
Castlight
Connect
Castlight
Care
  Convenience
  Family Access
Creating Healthcare Consumers
  One-stop
Connect
  Onsite Clinic
Castlight
Enterprise
Healthcare
Cloud
  DM/Wellness
  HSA/HRA Balance
  2nd Opinion
  EAP
  Concierge/Advocacy
Driving Utilization of all Health Programs
Powering Strategic Benefits Designs
Ins
Insights
  Actionable Analytics
  Real-Time Reporting
Castlight
Castlight
Care
Controls
Analytics
Personalization
Incentives
Castlight Enterprise
Engine
Engine
Engine
Healthcare Cloud
Platform
Enterprise Healthcare Database
Castlight
  Population Health
Management
Connect
Castlight Data Interchange
  Future Strategies
  Custom Analytics
Actionable Decision Support
Confidential
11
Confidential
50
12
Searchers spend less for common services
On average, Castlight searchers spent…
labs
13% less
on labs
Role of transparency for
providers
MRIs
14% less
on advanced imaging
JAMA. 2014;312(16):1670-1676. doi:10.1001/jama.2014.13373
Confidential
13
There are four key ACA healthcare trends
affecting providers today
Providers are adjusting to the “new normal” of
healthcare with different strategies
Key trends
Value-based
1
reimbursement
2
Shift in types of
health plans
Vertical and
horizontal
consolidation
  Fee-for-service to value-based reimbursement
  Providers required to manage clinical utilization and risk
  598 M&A’s in
2013 $52.7
billion value1
  More government insurance & less employer insurance
Novel policies
-  Market share &
negotiating
power
-  Manage
population
health
liabilities
  Higher insurance rate but less stable patient mix
4
Promotion of
Consumerism
  34% have
health plan
  20% intend
by 20182
  Rise in high deductible plans & narrow networks
  New regulations: e.g., higher Balance After Insurance
3
Launching a
health plan
  Demand for price transparency and access to “shopping”
  High deductibles and more scrutiny in healthcare choice
Confidential
-  Promotion of
own network
-  Manage risk for
novel
reimbursement
models
New
reimbursement
& delivery
Developing new
revenue streams
  500 physicianor hospital-led
ACOs
  2nd opinion,
telemedicine,
travel-benefit
medicine
-  Competitive
edge by playing
to strengths
-  Access to
implementation
grants
-  New volume for
select services
-  Increase
commercial
revenue
All strategies can be strengthened or enabled with
healthcare IT-based transparency
15
1. Becker’s Hospital Review, 2013 2. Advisory Board report 2013; 3. Leavitt Partners Center for Accountable Care
Intelligence, 2014;
51
Confidential
16
Benefit and transparency platforms present
opportunities for providers
From…
1
Provider
employees
2
Selfinsured
employers
3
Patients
1
…to
Challenges with rising
costs and domestic
leakage
Transparency as
“learning lab” for
behavioral change
No employer relationship
and network exclusion
Direct employer
engagement to enable
long-term success
No ability to engage
patients on price or
quality
Novel delivery models to
drive more efficiency &
patient volume
Confidential
1
Providence Health System
  Washington State’s largest health
system with 44,000 employees
Goals in new transparency market
Employer goals:
  Reduce inappropriate use
  Address gaps in care
Provider goals:
  Enhance online presence
  Validate pricing
  Drive domestic use by employees
  Improve high value service lines
A
B
C
Domestic facility use
“Right pocket, left
pocket”
Health plan strategy
  Employee use of
own facilities a
strategic priority to
increase volume
and occupancy
  Reduced utilization
saves costs BUT
also reduces
revenue
  Incentive to
maintain high
quality AND low
cost referrals
  Payments on
domestic use may
be higher for their
own employees
than CMS patients
  Must balance
employee vs. health
plan customer
demand to ensure
new customers
  Employee trust in
“home institution”
crucial for
reputation
17
Castlight has experience with large provider
systems
Indiana University Health
  State’s largest hospital network with
25,000 employees
Providers need to balance benefits strategy
with their business strategy
Confidential
2
Castlight solutions
  ID inappropriate use
like non-emergent ER
While employers express four major unmet
needs with providers on population health…
Unmet needs
Employer quotes
High quality, innetwork referrals
“Providers refer patients to their golf buddies for surgery
because that is who they know. They don’t review quality
data or check if they are in-network.”
Outcomesaligned
incentives
“People with high cholesterol are told to eat Cheerios and
oatmeal and do it again when nothing has improved… …
we must change how we incent providers.”
-Benefits Director, Fortune 500 grocery chain
Non-threatening
patientexperience
“We set up a mobile mammogram – cost over $100,000.
You believe or don’t believe it saves money. But women
are now engaged with their care.”
-Global Benefits Director, Fortune 500 food manufacturer
More access to
quality data
“I struggle with quality data. I know providers can share
more data but it should be validated by a 3rd-party so
providers are not grading themselves.”
-Health Director, Fortune 50 retail pharmacy chain
-Corporate Benefits Director, Fortune 50 media company
  Alert gaps in care
  Submitted rates
  In-network search
results only
  Additional, shared
quality data
  Castlight Reviews
  “Self-cleaning
oven” to improve
Confidential
18
19
Source: Castlight Market Analysis (2014)
Confidential
52
20
2
…they are already starting to innovate
programs and employ solutions on their own
Narrow networks /
COEs
Reference-based
benefit
  Not always done
with health plans
  Customized to
cost or quality
  Enabled by
transparency tools
  Regional
benchmarks
  Expanding to
more services
  Proven to reduce
costs
2nd opinion
services
2
Health guides
Employer
segment:
  Individual coaches
to steer patients
to high value care
Telehealth / 2nd
opinion services
Employers vary in desired approach with
providers
Onsite clinics
Employer
type:
Source: Castlight Market Analysis (2014)
3
Confidential
Willing to explore
partnership
Unsure of direct
provider relations
  Providers who
- are willing to
take full risk
- customize
services
- simplify HR
benefits
  Pilot COEs
  Need specialty
pharma solution
  Will discuss
bundled
payments or
RBB
  Will not deny
employee
choice of MD
  Carriers to drive
payment reform
  Want quality/
cost data
  Manufacturing,
manual laborers
  Rural locations
  Few provider
choices
  Manual & white
collar employees
  National spread
  Various provider
access by region
  Educated, techsavvy employees
  Urban locations
  Many provider
choices
Source: Castlight Market Analysis (2014)
21
Spot pricing benefits both patients and
providers…
Different prices for services based
on time or location
Want direct-toprovider relations
3
Confidential
22
…while patient reported outcomes improve
quality data and the shopping experience
Potential impact for stakeholders
Patient
Lower co-payment
Provider
More off-peak volume
Outcomes
California Medical – Main Campus
Price Depends on
Time of Day
$372
4pm – 8pm
$295
8pm – 12am
$250
Learn more
Knee Replacement
Hip Replacement
ACL Repair
Patient Reported Outcomes after Hip Replacement Surgery (5 patients)
MRI of lower back
8am – 4pm
Surgical Outcomes
Employer
Lengthen employee
deductible phase
55% of patients reported that their health was improved after surgery
Much
Worse
Greatly
Improved
Overall Health
Ability to do daily activities
Payer
Pain
Minimal (if any)
Fatigue
95% of patients recommend Dr. Workman for this surgery
For providers: Can also ensure premium revenue for a provider’s highest
quality services or optimize employee domestic utilization patterns
Note: future product concept and not available today
Confidential
Note: future
product concept
and not yet
available today
23
Confidential
53
24
Product concepts: Providers have repeatedly
requested solutions to address other needs
Third party
access
  Physician or caregiver access to Castlight
  Enables clinician to “shop” for patient
  Enables provider to manage value of all referrals in
risk sharing, ACO, or health-plan models
Provider
reports
  Analytics on pricing, consumer behavior, or other
  Reports to develop strategy, and execution plan to
drive pricing, market campaign, or innovation
  Insight on relative position in marketplace
Referral
pattern
analysis
  Analysis of out-of-network referral & utilization
  View of location, referring physician, and extent of
out-of-network use for enhanced benefit design
  ID lowest value areas & ways to improve
Note: all are future product concepts and not available today
Confidential
25
List of Quality Sources - Physicians
Bridges to Excellence (Source: Bridges to Excellence Program)
•  Medical Home Recognition Program
•  Physician Office Systems Recognition Program
•  Asthma Care Recognition Program
•  Cardiac Care Recognition Program
•  Chronic Obstructive Pulmonary Disease (COPD) Care Recognition Program
•  Congestive Heart Failure Recognition Program
•  Coronary Artery Disease Care Recognition Program
•  Depression Care Recognition Program
•  Diabetes Care Recognition Program
•  Hypertension Care Recognition Program
Appendix
•  Spine Care Recognition Program
Regional Collaboratives
•  Minnesota Community Measurement
•  The Health Collaborative of Greater Cincinnati
•  WI Collaborative for Healthcare Quality
•  MA Healthcare Quality Partners
•  Others – in several advanced discussions
Minimally Invasive Procedure (Source: Ethicon Endo Surgery)
Patient Experience Castlight users and multiple sources (e.g., Angie’s List)
Confidential
54
28
Complete List of Quality Sources - Hospitals
Surgical Safety Outcomes (Source: CMS Hospital Compare)
Based on relatively rare events that should never happen including:
•  Serious complications
•  Hospital acquired conditions
•  Healthcare associated conditions
Medical Condition (source: CMS Hospital Compare)
Based on mortality and readmissions for:
•  Heart attack; Heart failure; Pneumonia
Procedure volumes (Source: CMS Hospital Compare)
• 
• 
• 
• 
• 
Hip/knee replacement
Coronary Artery Bypass
Heart Valve Replacement
Disc surgery
Spinal fusion
Imaging Appropriate Utilization (Source: CMS Hospital Compare)
•  CT Scan of the chest and abdomen
•  MRI for low back pain
•  Mammography follow-up
Maternity (Source: LeapFrog)
•  Appropriate delivery – gestational age and method
•  Care of high risk babies
Child Asthma Care (Source: The Joint Commission)
Patient Experience (Source: HCAHPS)
Confidential
29
55
Mitch Santiago
Senior Vice President
Aon Hewitt
Andy Rix
Midwest Region Market Leader
Aon Hewitt
All My Children
“Employer and Employee
Perspectives on HealthCare”
56
2014 Health Care Survey
The Future. Thinking Differently. Delivering New Value.
Facilitators:
Andy Rix
Mitch Santiago
Managed Healthcare Provider Symposium
November 20, 2014
Today’s Discussion

What’s Around the Corner in HR
– Our Business/C-suite Perspectives
– Our People/HR Perspectives
– Health Care/Benefits Perspectives
– Survey Data Results

The New Employee Health Care Experience
– Looking Ahead
– Health Experience Cycle
– Avoid Care
– Need Care
– Support Care
– Survey Data Results

Next Steps
– Questions
What’s Around the Corner
Vision 2020
57
The Future
Top HR Leader
Concerns HR
31% ’ Minds
Leaders
Growing
9%
Aging
workforce/retirement
Retention of top
talent
Competition for Talent
The mismatch between supply
and demand for talent in 2021
18%
Business
strategy
execution
10%
16%
Engagement of
employees
Development of
leaders to take
on more critical
work
Leading change
6%
3%
Source: Aon Talent Survey
Average annual % change in the talent deficit/surplus
2.1
1.0
0.5
0.5
0.0
-0.4
-0.6
-0.8
-0.8
-1.5
India
Brazil
Costa
Rica
Saudi
Arabia
China
Spain
Germany
USA
Taiwan
Source: Oxford Economics: Global Talent 2021
Other
Workforce 2020
RU RDY?
50%
By 2020 there will be five generations of
employees working together
22%
20%
7%
1%
Traditionalists
Baby Boomers
Generation X
Generation Y
Generation Z
Source: Future Workplace Survey
Shifting
Health Care Market
Key Catalysts
Market Response
New Models
Provider
Reorganization
• ACOs
• PCMH
• Performance-based
Health Plan
Transformation
New Markets
• Exchanges
• Federal subsidies
• Medicaid expansion
Consumer
Activation
Legislation
• Excise tax
• Benefit mandates
• Wellness program
restrictions
Employer
Evolution
Survey Responses
Key Findings Across 3 Themes
Driving
Defined
Commitment
Advancing
Trend
Mitigation
Elevating
the Health
Imperative
33%
50%
81%
will use private
exchanges
will continue to
increase cost sharing
offer health risk
identification tools
70%
68%
36%
use incentives
to drive behavior
plan to use
reference-based pricing
measure impact
of absence
Source: 2014 Aon Hewitt Health Care Survey
58
Employer-Sponsored
The Survey says…
Insurance
As employers contemplate a move to a private health care exchange, what do they
note as the primary advantages and biggest barriers?
Top 3 Advantages to EMPLOYER
1.
2.
3.
Improve predictability of health care cost by transferring risk to the insurance carrier (59%)
Reduce long-term cost trend through competitive market forces (57%)
Minimize employer’s plan design and vendor management responsibilities (56%)
1.
2.
3.
Increase employees’ ability to choose the right mix of plan design and price to meet individual
needs (84%)
Make employees’ health benefits more valuable to them by providing them greater control (65%)
Enhance employee engagement and accountability (45%)
1.
2.
3.
Negative employee reaction (62%)
Amount of cost savings aren’t worth the potential disruption (43%)
Loss of control over plan design (40%)
Top 3 Advantages to EMPLOYEE
Top 3 Barriers
Source: 2014 Aon Hewitt Health Care Survey
Employer-Sponsored
The Survey says…
Insurance
Managing Cost/Reducing Unnecessary Expenses
Currently
May Add in 3-5 Years
Conduct dependent audit
Adopt unitized pricing
Implement/increase surcharges for adult dependents with access to other…
Eliminate coverage for adult dependents with access to other coverage
58%
5%
Direct contract in specific locations
Best in market model; one plan; variable networks by state/local
12%
48%
18%
50%
10%
32%
49%
42%
22%
Increase deductables, co-pays
Limit coverage to COE for certain conditions
29%
47%
Reduce employer subsidies for covered dependents
Adopt reference-based pricing
Not interested
50%
29%
50%
10%
39%
11%
58%
11%
32%
28%
60%
17%
37%
16%
41%
46%
43%
Source: 2014 Aon Hewitt Health Care Survey
The Survey says…
Employer-Sponsored
Health
Physical
Financial
Emotional
Social
Use of Incentives
Reward
30%
Consequence
43%
Both Reward and Consequence
Neither Reward nor
Consequence
20%
7%
Most Likely to Influence Health and Behaviors
Most influence
47%
44%
43%
Moderate influence
Some influence
Least influence
65%
53%
47%
32%
8%
2%
Work environment
9%
Work culture
1%
8%
8%
Individual health services (keeping
people well through end of life
care)
30%
2%
2%
Community
Source: 2014 Aon Hewitt Health Care Survey
59
Engagement Tools
Employer-Sponsored
Health
Physical
Financial
Emotional
Social
Health as Part of Health Care Strategy
Currently
Next 3-5 years
Facilitate use of mobile technology to engage
participants
Not interested
35%
Provide personalized health portal
52%
54%
14%
39%
Offer awareness tools (e.g. health assessment,
screening)
7%
81%
Target health-related communications
17% 3%
61%
Worksite-related programs
29%
72%
Tobacco surcharge
9%
23% 4%
37%
41%
23%
A total of 66% of companies want to increase participation in wellness programs,
yet nearly half of employers indicate that they do not know if the use of incentives
is leading to healthy behaviors (43%) or to improvement in health risk (48%)
Source: 2014 Aon Hewitt Health Care Survey
Imagine in 2020…
…you spend more time & resources focusing
on “the curation” of an experience for your
people, and less on how they are covered!
If health insurance made us healthy, most
Americans would be by now.
Looking ahead, we have new levers to pull…
The Health
Experience
Cycle
Goals
• Reduce the gaps among
individuals, employers and
system
Avoid
Care
• Minimize barriers for
individuals
• Simplify the experience,
lower cost, better knowhow and quality care
• Reduce all types of
absence and improve the
business bottom line
Social
Financial
Emotional
Support
Care
Healthy,
High
Performing
Physical
Need
Care
• Proactively "serve-up"
timely and relevant support
and resources
60
Curating the New
Experience
Avoid
Care
Social
Emotional
Support
Care
Financial
Healthy,
High
Performing
Physical
Need
Care
Avoid Care
Personal Health
I’m not always honest
with myself about how
healthy I am.
Getting healthy is
not easy.
for the employer
for the employer
59%
85%
of consumers
say at least one
obstacle gets
in the way
say they’re in at
least good health
but are actually
overweight or obese
My health is most
influenced by people—
including myself.
Top 3
sources most influential
on personal health and
wellness
1. Advice from a doctor
2. My own view of how I feel
3. Advice from family or
friends
Avoid Care
Workplace Wellness
There is value for
me and the employer
in having strong
workplace wellness.
86%
I probably don’t work in
a strong health culture.
Behaviors Driven by
Workplace Health Culture
Strong
Weak
Perception of
Workplace
Health Culture
of consumers believe workplace
wellness programs are a good
business investment for
the employer
59% of employees say they’re
one of the reasons they stay
In a strong culture of
health, I am more likely
to do what’s good for me.
Mediocre
72%
had an annual physical last year in
a strong health culture
64% had an annual physical last
year in a weak health culture
62%
exercise at least 3x per week in a
strong health culture
49% exercise at least 3x per week
in a weak health culture
61
The Survey says…
Preventing the need for
care and lost work days by
maintaining optimal health
and safety or engaging in
unhealthy behaviors and not
seeking care
Avoid
Care
Implementing/Offering
Company-wide wellness policy and guiding principles
38%
Culture of health
Social
52%
Financial
Health productivity mgmnt tailored to individual needs
Healthy,
Onsite
High fitness center
Emotional
Support
Care
23%
41%
Physical
Performing
Health assessment
Need
Care
Biometric screening
Health coaching
Disease management
75%
71%
51%
70%
Stress program
34%
Source: 2014 Aon Hewitt Health Care Survey
The Survey says…
Currently
Next 3-5 years
Provide onsite prevention,
primary care, urgent care
Not interested
Avoid
21% 23%
Care
Provide cost transparency tools
(facility and providers)
Provide tools at no charge for
expert second opinion
57%
42% 8%
49%
27%
Providing clear access to
the health care system for
necessary preventive, acute,
chronic and catastrophic
care while minimizing time
away from work
50%
23%
Social
Financial
Use integrated delivery models
18%
56%
Healthy,
to improve primary care
High
Emotional
Physical
Performing
Support
Care
26%
Need
Care
Source: 2014 Aon Hewitt Health Care Survey
Need Care
Personal Health
Many aspects of life are stressing me out.
for the employer
Top
5
Stressors
47% Financial situation
My employer is not necessarily
helping me deal with my stress.
43%
40% Work changes
37% Work schedule
are not seeing stress help
34% Work relationships
34% Control over how
I do my work
23% My employer has nothing to help me
20% I don't know if my employer has anything
to help me
62
Need Care
Communication Channels
I’m much more likely to be using mobile
apps than I was last year.
I want tools from my employer that give me
practical guidance.
Tools & Information
79%
Consumers Find Most Helpful
regularly use at least one social
media platform or mobile application
(up 10% from last year)
61%
56%
Health plan
decision tools
Of the 79%...
General wellness
information
…50%+
54%
use community boards/blogs,
Foursquare, Pinterest, and mobile
apps at least monthly for health
and wellness activities
Cost clarity tools
Support
Care
Programs Impacting Health
Health Improvement
Environmental Health & Safety
Absence Management
Recognizing health
Reaches Beyond
Health Insurance
Shared Connections
Reporting Relationships
Values and Goals
Data Analysis and Measurement
Priorities
Communications
Integration
Employee Results
Financial Results
Minimize Frustration
Enhance Experience
Reduce Health Threats
Increase Productivity
Improve Quality
Control Risk
The Survey Says…
Currently
Next 3-5 years
Add plan options, coupled with decision
support, to guide employees to plans that
best fit needs
26%
Avoid
Care
Target certain communications based on
specific health conditions
Tightly manage chronically ill (mandatory
condition/case mgmnt., specialty networks
for care management)
Not interested
34%
61%
23%
40%
Social
Coordinate health, absence,
and/or
workers compensation
Financial
21%
Emotional
Support
Care
Healthy,
High
Performing
29%
52%
Offer supplemental medical coverage for
critical illness
40%
25%
53%
9%
25%
36%
25%
Simplifying the
experience for
those who need
ongoing support
with coordinated
tools, services
and programs
with the goal of
quality outcomes,
a positive
experience, and
enabling
a safe return to
work
Physical
Need
Care
Source: 2014 Aon Hewitt Health Care Survey
63
2014 Copyright © Proprietary and Confidential.
64
Ann Grill
Patient Experience advisor,
Enterprise Division
Press Ganey, Associates
Theresa Larsen, MPH, CPHQ
Director of Quality Improvement
Meridian Health Plan
Moment of Truth
“Engaging Your Patients”
65
Driving Patient Engagement:
Avoidable Suffering & the Value of
Great Communication
Anne Grill
Patient Experience Advisor
Enterprise Division
© 2014 Press Ganey Associates, Inc.
Patients Need Engagement with Providers
 Communication ≠
comprehension
 42% did not understand
instructions
 78% misinterpret
warnings on Rx labels
 Common themes:
 No input on decisions,
plan of care
 Questions & complaints
 Isolation & fear
 Consumers are informed
 Access to information
© 2014 Press Ganey Associates, Inc.
2
Drive Engagement: Reducing Avoidable Suffering
Avoidable Suffering
Caused by defects in
the approach to
deliver care
Inherent Suffering
Experienced even if
care is delivered
perfectly
OUR GOAL:
Prevent this
suffering for patients
by optimizing care
delivery.
OUR GOAL:
Alleviate this
suffering by
responding to
Inherent Patient
Needs.
© 2014 Press Ganey Associates, Inc.
3
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Barriers to Engagement: Cultures of Incivility
Incivility
 “Rudeness is on the rise”
 Thousands polled
 Employees are less creative
 More prone to retaliation
 Customers are turned off
 Generalize about all staff after
witnessing one event
 Incivility is expensive
 Few take action to curtail it
© 2014 Press Ganey Associates, Inc.
4
Barriers: Patient Shaming
 UC San Diego 2009 study on patient shaming
 Cohort of over 400, wide range of age/status
 50% reported experiencing shaming by their care provider
 Common causes of shaming:
 Obesity, hygiene, sexual behaviors/diseases
 Smoking, alcohol use
 Parenting choices, breastfeeding
 Medications, too much or too little
 Inability to control/manage pain
 When source is behavior- improvement was seen
 When the problem is you- fuels avoidance, lying, termination
of the relationship
© 2014 Press Ganey Associates, Inc.
5
Barriers: Chasing the Wrong Audience
 Words ≠ the full message
 National data by response category, thousands of clients
 Who are the “4s”? What does a “4” say?
© 2014 Press Ganey Associates, Inc.
6
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Avoid Suffering, Compassionate Connected Care
They need to feel…
They need you to be…
They need to get…
Informed
Knowledgeable &
Communicative
Introductions &
Explanations
Safe
Professional &
Proficient
Teamwork &
Discretion
Seen
Attentive &
Observant
Presence & Focus
in the Moment
Heard
Available &
Responsive
Listening Skills &
Tactful Responses
Connected
Compassionate &
Considerate
Kindness &
Personalization
© 2014 Press Ganey Associates, Inc.
7
Who We Are & What We Do
 The most common opportunity lies in how we introduce ourselves,
talk about our job, and explain actions/inactions
 Introductions: who are you?
 Elevator speeches: 1-2 sentence explanation of their job/role.
 Set the stage: Develop your own openers, state your goals,
make note of the time you’ve allotted.
 Plan your questions/topics out ahead of time.
 Talk through what you’re doing (assessments, technology, etc.)
 Explain actions and inactions- what you’re going to do as well as
why you might be leaving something out.
© 2014 Press Ganey Associates, Inc.
8
Elevator Speeches & Introductions
Creating a Professional, Polished Image
 Introductions (for in the moment)
 Should be for every patient & staff member, every time
 A patient should never have to wonder who you are
 They should never have to try to figure out on their
own what you do
 Elevator Speeches (for out in the community)
 1-2 sentence explanation of a person’s job/role, and
includes title or place in the organization
 Usually includes details about the site and/or the
parent organization
 Could include mission, vision, values, etc.
© 2014 Press Ganey Associates, Inc.
9
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Teamwork, Tact & Discretion
 No more…
 Blame game, finger pointing, throwing others under the bus
 Airing of dirty laundry, refusing to take ownership
 “I don’t know”, “It’s not my problem” or “I can’t help you”
 Instead, more…
 Problem solving, solution orientation
 Blameless apologies, teamwork and support
 Working on how we respond to any concern/complaint raised
© 2014 Press Ganey Associates, Inc.
10
Educating Staff About Appropriate Responses
Solve
Criticize
One-Up
Probe
Empathize
© 2014 Press Ganey Associates, Inc.
 Five types of listening responses
 Most use 1-2 of the categories
 Observation to identify
 Coaching where needed
 Suggestions for alternate
wording/behavior
11
Making Their Encounter Personal
 How do you make experiences personal for your audience?
 Do we use the patient’s name every time?
 Do we offer them choices to let them dictate an action/result?
 Do we make chit chat, or take a second to talk about
something other than their stay/visit/diagnosis?
 How do you show them that you are listening & engaged?
 What behaviors have been outlined- verbal & non-verbal?
© 2014 Press Ganey Associates, Inc.
12
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Non-Verbal






Position: sit down, position yourself towards your audience
Posture: avoid arm crossing, soften/relax stance & shoulders
Nodding: signals listening/understanding/agreement
Eye Contact: look them in the eyes when addressing/listening,
Gesturing: Touch is important but must be appropriate
Multi-tasking: Looking at chart/screen/phone signals inattention
Verbal
Presence: Key On-Stage Behaviors






Verbal Cues: Cues like “Uh huh” or “I see” show participation
Re-Stating: Paraphrasing can show you understand
Affirming Statements: Empathy vs. Sympathy
Interruptions: Avoid them at all costs
Silence: Give them time to talk, think, feel (3 Second Rule)
Shaming: Avoid judgment, it’s not your job!
© 2014 Press Ganey Associates, Inc.
13
Compassion Through Needs Narration
 Talking about our needs is not easy
“Here’s what I need
from you…”
 Stating your needs = vulnerability
 Asking patients directly for what
they need produces mixed results
 They may not answer
 They may not know
 They will undersell/downplay
 Encourage them to talk about what
is important to THEM
 Phrase it is a way that provokes a
thoughtful response
© 2014 Press Ganey Associates, Inc.
“Is there anything
you need?”
“Let’s talk about what
you need from me…”
14
Thank you for your time!
Anne Grill
Patient Experience Advisor
Enterprise Division
agrill@pressganey.com
(312) 610-5145
70
Moment of Truth:
Engaging Your Patients
November 20, 2014
What is Engagement?
Individuals and families
should be encouraged and
supported to be active
participants in care and
decision-making
The health care team should
be prepared and supported
for collaboration with
patients, families and other
members of the care team
Assign accountability,
encourage partnerships and
integrate the patient and
family perspective into all
aspects of strategic planning,
implementation and
evaluation of programs and
services
A Leadership Resource for Patient and Family Engagement Strategies. Health
Research & Educational Trust, Chicago: July 2013. Available at
www.hpoe.org.
2
IL Medicaid Health Plans
• Online access to care management program to both members
and providers
• Care Coordination
• Members and providers participation in care plan and ICT
• Interpretation services
• Member Advisory Committee & Community Stakeholder
Committee
• Telephonic and written outreach
• Health education program
• Flu prevention program
• Member experience/satisfaction survey
3
71
Meridian Engagement Strategies
• Care Coordination including use of CHOW
• Integrated system that identifies outstanding HEDIS® needs
• Member and provider incentives for preventive care
measures
• Option for providers to send reminders through portal
• Outreach campaigns focused on preventive care needs
• Transportation benefit
• Identification of medical home
• Texting program
• Online chat function
• Member and provider portal includes preventive care needs
not met
4
Connection
Source: Pew Research Center
5
Connection
• A large majority of low income, underserved, and safety net
patients want to communicate with their providers using
email, text messaging, and online patient portals.
– 60% of lower income patients in the study reported using email regularly,
– 54% said they obtained general research information from the Internet, and
– 78% expressed interest in electronic communications with health care
services.
• Digital disparities do exist among racial and ethnic minorities,
the physically disabled, lower income, and those with limited
English proficiency.
http://ehrintelligence.com/2013/02/28/71-of-safety-net-patients-wantemail-texts-and-portals/
6
72
Connection
• Do older patients use new technology?
– The 2013 Accenture Consumer Survey on Patient
Engagement showed that at least three fourths of
Medicare recipients access the Internet at least
once a day for email (91%) or to conduct online
searches (73%) and a third access social media
sites at least once a week.
7
How Connected?
http://www.accenture.com/SiteCollectionDocuments/PDF/AccentureConsumer-Patient-Engagement-Survey-US-Report.pdf
8
Managing Perceptions
9
73
Provider-Patient Gap
10
CAHPS®
2014 Average Rate
All Lines of Business
Spend enough time with you
Show respect for what you had to say
Listen carefully to you
Informed and up-to-date about care from other doctors/providers
Getting care as soon as needed
Getting appointment as soon as needed
Explain things in a way you could understand
Easy to get the care, tests, or treatment
Easy to get appointment with specialist
Discussed reasons not to take medicine
Asked preference for medicine
0
20
40
60
80
100
11
Still Relevant
12
74
Contact
Theresa Larsen
Director, Quality Improvement
theresa.larsen@mhplan.com
312-705-2900 x2106
13
75
Debbie Ryan
dryanly@woway.com
Ed Graziano
ed@mhpa.com
76