HEALTH AND PRODUCTIVITY MANAGEMENT HPM THINK GLOBALLY! BY: BRIAN D. HARRISON, MD DATE: 9/28/04
The STORM ? ? ? Perfect
Or the Perfect Opportunity? ? ?
COST OF CARE = COST OF PREMIUM Insurers don’t originate the money, they just pass on the bills. Insurers are a conduit for cash, not a source. Those who pay the premiums are the source of the money. Every insured person pays for every other person (including those needing medical miracles).
WHY ECONOMIC SOLUTIONS FAIL TO SOLVE THE PROBLEM: It’s not an economic problem It’s a HEALTH problem!
2003 HEALTH COSTS Specialty Chronic Disease Treatment _________________ Total Health Spending 700 Billion ________________________ 1. 7 Trillion ______ 7% Annual Growth 10% Annual Growth Pharmacy Services ________________ 200 Billion _____ 12% Annual Growth Pharmaceuticals _______________ 30 Billion ______ 30% Annual Growth
(CHANGING DEMAND-cont. ) HOW MUCH CORONARY DISEASE CAN BE PREVENTED WITH 2 BILLION DOLLARS PER YEAR?
YOU GET WHAT YOU PAY FOR THERE ARE 8, 000 SEPARATE BILLING CODES FOR CARE, NONE FOR PREVENTING A DISEASE
Health Insurance is a ____? Benefit – a gift you buy to make someone happy; you shop for the best value Commodity – something you buy from the lowest bidder; you buy as little as you must have Investment – considered purchase based on ROI, including risk and return; if it’s good, you want a lot
Productivity Model Final Outcome Accountability Intermediate Outcome Improve Health Status Optimize Productivity/ Job Performance Reduce Unnecessary Lost Work Time Improve Organizational Health Employer/ Purchaser Employee/ Patient Provider Health Plan/ Delivery System
Productivity Model - Three Parts Disease Management Health Management Demand Management
Relationship Between Cost and Wellness Score Annual Medical Costs Wellness Score Figure 10
Change in Cost Associated with Change in Risks Reduced Risks Increased
HOW TO “THINK GLOBALLY” Learn lessons from research and mega trends. Do “Global Accounting”of profits and losses associated with human capital.
GLOBAL ACCOUNTING requires AN INTEGRATED DATABASE Medical and Pharmaceutical claims Health Risk Appraisal scores Absence data Short & Long-Term Disability (STD/LTD) Worker Comp Turnover Direct production data or performance eval
BECAUSE YOU CAN’T MANAGE WHAT YOU CAN’T MEASURE
Health and Productivity Measurement…. Measure the prevalence of diseases and risk factors (HEALTH INDICATORS) Correlate with cost of losses from absence, STD/LTD, Worker Comp, turnover, presenteeism (PRODUCTIVITY INDICATORS)
. . enables Health and Productivity MANAGEMENT Intervene to improve a Health Indicator Measure (or at least calculate) the effect on a Productivity Indicator
THIS SETS THE STAGE FOR A VALUE-BASED HEALTH CARE MODEL Employer needs it for productivity, profit, and competitiveness reasons. Employee needs it for cost, comfort, maintenance of health reasons.
CREATING WISE CONSUMERS People need information about self care/self treatment. People need information about quality of health care providers and institutions.
WHY EMPLOYEES CARE NOW MORE THAN EVER Threat of unemployment Quality of life reasons Out of pocket costs
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