Wednesday, July 16, 2008

Update on the WRG Conference - A Sampling of Some Interesting Stuff

What an interesting WRG conference. For your reading pleasure, below are summaries of some of the presentations that really caught the ear of the Disease Management Care Blog. More to follow tomorrow…..

Blue Cross Blue Shield of Michigan is finding that offering wellness is an increasingly critical ingredient in winning accounts. Their approach is to offer a suite of wellness and disease management options that, depending on the buyer, can be ‘dialed up’ or ‘dialed down.’ They are developing their own assessment methodology that not only calculates savings vs. costs (i.e., return on investment) but changes in ‘net savings.’

Most interesting message: As outreach progresses from high to low risk, Michigan's modeling suggests that increasing the outreach to more persons with chronic illness eventually leads to a ‘tipping point’ decline in ROI and net savings.

StayWell believes best practice elements for company wellness programs include: strong organizational commitment, identification of wellness champions, linkage to business objectives, effective communications, having fulltime dedicated staff/vendors, making employee spouses eligible, offering comprehensiveness, raising awareness company-wide, targeting special interventions for high-risk persons, maximizing accessibility, providing incentives and utilizing biometric screening.

Most interesting message: Want to incent employees to fill out that health risk assessment or show up at a wellness program offering? Employee premium differentials beat cash rewards, which beat non cash rewards. Premium differentials not only increase participation rates, the non-participants subsidize the participants – which payers/purchasers like.

Emory University says there is a rich body of occupational health literature that has been around for years that conclusively shows wellness programs have a positive return on investment. There is a methodology using a health risk assessment that can assign a ‘Risk Profile’ to an employee-participant. This profile correlates with insurance claims expense. The ready availability of ‘propensity scoring’ makes a parallel control group readily available. Between the Risk Profile and the propensity scoring, analysts can approximate return on investment without having to conduct a randomized clinical trail.

Most interesting message: It is not uncommon for ROIs to exceed 3 to 1. And we shouldn’t be embarrassed to say so.

Highmark thinks that if you’re going to offer wellness, you might as well lead with your employees. That’s what Highmark did with an in-house wellness program. Read all about it at the February 2008 issue of the Journal of Occupational and Environmental Medicine.

Most interesting message: The ROI for a wellness program may not become apparent for three years.

Aetna was mentioned in a prior DMCB post, which discussed a blog post describing the insurer’s use of a lottery with a financial award to increase medication compliance. It turns out this is more sophisticated than just a simple lottery. There is a considerable body of research that shows humans tend to overestimate their chances in such games of chance. The medication-compliance lottery is a conscious exercise in “asymmetric paternalism,” in which the insurer harnesses their enrollees’ tendency to exercise poor judgment.

Most interesting message: Persons can be incented to make the right decision using bad decision logic. We can simultaneously harness and respect a person’s right to choose - wrongly.

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