Using data to tackle health care costs

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Health care costs can make up a significant portion of a household budget, with employees often having to pay large deductibles out of pocket before coverage kicks in.
 
Although Massachusetts has been ahead of other states when it comes to health care reform and extending care to all residents, we also lead in health care expenditures. From 2013 to 2014, overall health care spending in the state rose from $51 billion to $54 billion – a rate far higher than the standard rate of inflation. Spending on drugs rose 13 percent, and 19 percent of state residents were on high-deductible plans (versus 14 percent just two years earlier).
 
As a member-based organization, the MIIA Health Benefits Trust is always looking for innovative ways to bring down costs while preserving quality and convenience. A key way to do this is by analyzing data about our members’ health care utilization – not in a way that affects patient privacy, but by looking at general trends and identifying key categories where incidences (and spending) shows a spike. We can then work to tailor health care packages and worksite wellness programs that help reduce those occurrences and mitigate costs.
 
Areas to address
The MIIA Health Benefits Trust examines data on a wide variety of conditions, such as heart disease, diabetes, and circulatory issues, as well as common injuries and surgeries (elective or otherwise). We look at use and access, such as trips to the emergency room and urgent care, as well as how prescriptions are filled.
 
Demographics can also tell a story and aid in plan design and delivery. For example, in local government, a large portion of our insured population consists of retirees. (For the MIIA Health Trust, retirees account for close to 50 percent of total enrollees.) Because a significant portion of municipal retirees are younger than 65 and not yet eligible for Medicare – e.g., teachers and police officers – this is an important age group to look at for common health care issues and spending trends.
 
One key area that we look to address is diabetes. Nearly 30 million Americans suffer from diabetes and 86 million have “pre-diabetes,” all of which costs Americans an estimated $322 billion per year. With “co-morbidities” ranging from obesity and hypertension to sleep apnea and even cancer, this is clearly an area worth targeting. When opt-in diabetes disease management takes place, research shows that health care costs are reduced along with other areas of health care system use.
 
The MIIA Trust also looks closely at the incidence of emergency room visits, which can be extremely expensive and often unnecessary. A recent national study showed that about 70 percent of trips to the ER could be avoided.
 
We can work with each of our members, particularly those with spikes in ER visits, to educate employees on the availability of area urgent care clinics and drug store-based clinics – which can be ideal for quickly addressing off-hours, easily treatable conditions such as strep throat and ear infections. The cost for these options is typically far less for both the enrollee and the health plan.
 
Worksite wellness
In addition to factoring in data to design health plans, insurers are working with employers to develop and implement targeted worksite wellness programs. More than two-thirds of American employers now offer some sort of worksite wellness program.
 
MIIA will customize wellness strategies for each community based on what the data indicate are the primary cost drivers.
 
The same or similar health concerns are often seen across communities, and those tend to echo national trends – such as higher health care expenditures related to cardiovascular disease, respiratory issues, diabetes, musculoskeletal conditions, depression, and hypertension. All MIIA health programs are designed to address one or more of these conditions.
 
MIIA also aims to incorporate exercise, nutrition, weight loss, and mental health (e.g., resilience, stress reduction, and mindfulness) into wellness programs, as each of these lifestyle-related behaviors can have a significant impact on the typical medical condition cost drivers. When we look at data and see an area where cardiovascular conditions are higher, we may offer our Heart Matters onsite and online programs (which targets cardiovascular health) and weight loss programs such as Kick Start Weight Loss. When data indicate that musculoskeletal conditions are prevalent, we may offer programs such as Body Conditioning, Back Health, and weight loss programs. Well Aware promotes ongoing services such as the QuitLogix smoking cessation program and the MIIA Employee Assistance Program, both invaluable to those seeking to improve their physical and mental well-being.
 
The most effective programs we see in our member communities are those where local leadership strongly encourages participation and even participates themselves – helping to create a culture of wellness in the workplace and across departments. According to a 2010 Harvard Business Review study, workers respond much better to wellness programs when both high-level and middle managers are involved, as well as when wellness managers and/or champions are put in place to guide strategy and programming.
 
When the culture shifts for a municipal employer, it can often shift for the town as well – leading to new 5Ks and walking trails being put in place, for example. This type of shift can make substantive change when it comes to local employee health and associated costs.

Accessing tech-savvy health care
Gone are the days where health care delivery only takes place in the doctor’s office or at the hospital. Health plans are creating new ways to use technology to enhance care delivery while also mitigating costs.
 
For example, MIIA’s health care partner, Blue Cross Blue Shield of Massachusetts, will soon launch a Tele-Health program that will enable employees to have a brief medical or behavioral visit with a doctor or therapist via computer, phone or tablet, at any time of day.
 
With Tele-Health, doctors can treat minor illnesses and injuries – such as sinus infections, sprains and strains – in addition to chronic conditions and general concerns. Patients will be able to see a therapist remotely for stress management, anxiety, depression and other issues.
 
On the worksite wellness side, MIIA has a “phone coaching” program underway. After an in-person wellness course is complete, local employees have the option of accessing weekly coaching by phone from a trained wellness representative in order to stay motivated and extend their efforts to boost their own wellness. Participants are seeing great results using phone coaches for help in designing customized exercise and nutrition programs.