Linda Swan

www.healthwaysaustralia.com.au

Innovations in Population Health

12th Annual Health Insurance Summit Dr Linda Swan Managing Director Healthways Australia Tuesday, 23 July 2013


• Population Health in Australia

• What is the cost of doing nothing?

• Innovations in Population Health

• Leveraging Social media

• Evidence of outcomes

• Environmental Interventions

Content

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Population Health in Australia

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The Ultimate Goal is to Improve Well Being

Social/ Emotional

Financial

Community

Physical

Career

“Health is a state of

complete physical, mental

and social well-being

and not merely the

absence of disease or

infirmity.”

- Preamble to the Constitution of the

World Health Organisation as adopted by the

International Health Conference, New York,

19-22 June, 1946

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Population Health

• Population health is focused on understanding the

health and disease in a community or population and

then developing interventions that can improving

health and well-being.

• Fundamental to the approach is determining priority

areas where investments should be focused to address

the disparities in health status within a population.

• Encompasses a range of interventions including

preventative health, supported self care, disease

management and integrated care

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Healthy & Good

Health Habits

Wellness

Low Risk

Poor Health

Habits

Prevention

support

Health & Lifestyle

Risk Factors

Prevention

support

Well-Managed

Condition

Supported

Care

Poorly Managed

Condition

Chronic Disease

Support

At Risk for

Hospitalisation

High Risk Chronic

Disease support

High Risk

REQUIRES AN INTEGRATED HEALTH SUPPORT PLATFORM

Total Population Management

100% 50-60% 15-20% 5%

Active Care

Management

Prevention/ Risk

Management

Wellness Wellness programs designed to inspire

healthier lifestyles at each stage of life

Prevention Support Addressing lifestyle risks

that lead to chronic disease

Supported Self Care Periodic coaching,

education and support to allow self

management of conditions

Chronic Disease Support Active education and

encouragement to manage high cost chronic

conditions

High Risk Chronic Disease Support

Intensive one-on-one support for those at high

risk for hospitalisation

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Australian Government Priority Areas

• Priority population groups

• Indigenous people

• Overseas born

Australians

• Rural and remote

• Veterans

• Socioeconomically

disadvantaged

• Prisoners

• Priority age groups

• Mothers and

babies

• Children

• Young people

• Older people

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• Disease priorities

• Cancer

• Cardiovascular

disease

• Dementia

• Injury prevention

• Diabetes Mellitus

• Asthma

• Obesity

• Mental Health

• arthritis


Recent Australian Government Initiatives

• Australian National Preventative Health Agency (ANPHA)

• Be the Influence - Tackling Binge Drinking

• Donate life

• eHealth

• Fight Flu Campaign resources

• Live Longer! - ATSI

• National cervical screening program

• National Seniors Productive Ageing Centre

• National Skin Cancer Awareness Campaign

• Quit for You - Quit for Two

• STIs - Sexually Transmissible Infections

• Swap It, Don't Stop It

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http://www.anpha.gov.au/



http://www.tacklingbingedrinking.gov.au/






http://www.donatelife.gov.au/

http://www.ehealth.gov.au/

http://www.ehealth.gov.au/

http://www.nhmrc.gov.au/publications/synopses/fightflu.htm



http://livelonger.health.gov.au/



http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/cervical-about



http://www.productiveageing.com.au/



http://www.skincancer.gov.au/



http://quitnow.gov.au/internet/quitnow/publishing.nsf/Content/quit-now-apps






http://www.sti.health.gov.au/





http://swapit.gov.au/




If there was a single map of activity…

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The Cost of Doing Nothing...

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Months of expensive hospital

care can be undone by patients who just go home and go about

their normal activities.

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The Cost of Doing Nothing…


Health Status/Risk Matrix – Australia

12 12

• Health/Risk profile determines the majority of future costs o Health—Do they have more, less, or average amounts of chronic

conditions (like obesity, diabetes, cancer, etc.)?

o Risk—Are they more, less, or equally likely to engage in risky

behaviors (like smoking, poor diet, poor stress management, etc.)? R

isk S

tatu

s

Health Status

Australia

High

Low

Healthier Sicker

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Developing a Simulation Model

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Vetting with the Framingham Heart Study

Segment Average risk Low risk Average risk Low riskMale 35-44 6.00% 3.50% 6.93% 3.60%

Male 45-54 12.50% 5.00% 13.80% 6.38%

Male 55-64 18.50% 8.00% 24.28% 11.13%

Female 35-44 1.50% 1.50% 3.00% 1.23%

Female 45-54 6.50% 4.00% 9.15% 5.28%

Female 55-64 12.00% 7.50% 20.23% 10.25%

Framingham Risk Scores Simulation Risk Scores Ten-year risk projection comparison

for the onset of coronary heart disease

Overall, our model, built on national

datasets (NHIS, MEPS, BRFSS) and

epidemiology data, projects similar to

slightly aggressive risk scores in

comparison to Framingham.

We build on this type of detailed-level

data to create population views in the

World Economic Forum Kiosk

Application

Simulation model developed by BCG and Healthways, with support of WEF

Goals

To assess the healthcare and productivity costs associated with

the most costly chronic conditions and behaviors

To show how the presence of a comprehensive well-being

program would affect future healthcare costs and productivity

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Medical Cost Growth

14 14

• Medical Costs grow over a five-year horizon o Without intervention, chronic conditions can be expected to progress more

aggressively than with intervention

o Costs are driven both by the community’s demographics and its Health/Risk profile

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Medical Cost/Health Condition – Australia

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• Medical Costs by Health Condition

o The top five conditions account for about 68% of all medical expenses.

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Productivity Cost

• Productivity Costs grow over a five-year horizon

o The same conditions that require medical expenditures also contribute to lower productivity while an individual is at work.

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Productivity Cost/Health Condition / Australia

• Productivity Costs by Health Condition

o Obesity alone is responsible for 37% of all productivity loss o The top five conditions account for about 71% of all productivity loss

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Opportunity for Doing Something – Australia

•Five-Year, Cumulative Cost Savings through Interventions in Modifiable Behaviors

•By introducing comprehensive well-being improvement programs that address all eight

behaviors:

• Medical Costs reduced by 11.60%

• Productivity Costs reduced by 8.21%

• Total Costs reduced by 9.69%

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Innovations in Population

Health

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Necessity is the mother of invention…

• Forward projections predict that healthcare costs will exceed revenue available between 2020 – 2050

• 70% of the burden of disease is due to chronic disease.

• Our ageing population is living longer

• Poor data: poorly controlled disease, waste and poor

transitions/lack of coordinated care

• 1-2% of Australians drive around 50% hospital and medical expenditure.

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New models of Healthcare are needed…

Current State Future State

• Payment for Utilization

• Fragmented Care

• Patients

• Episodic

• Reactive

• Variable Methods

• Paper Intensive

• Payment for Value

• Coordinated Care

• Populations

• Longitudinal

• Proactive

• Evidence-based Care

• Electronic

Guiding Principles

Use the lowest cost methods and modalities

Focus on interventions with proven outcomes

Ensure sustainable engagement of the individual.

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Innovations in Population Health

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• Using data to drive decisions – predictive modelling

• Behavioural change to increase self management

• Targeted programs focused on the “2%”

• Improved coordination/integration of care

• Telemonitoring and telehealth

• “Rationing” of access to expensive new technologies

• Engaging corporates and business – sharing the load

• Partnerships and collaboration

• Leveraging social media


Leveraging social media...

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www.healthwaysaustralia.com.au 24

“Social Media is about sociology

and psychology more than

technology.”

- Brian Solis of FutureWorks


What social research telling us

Why aren’t people already well? People get it. But they face problems… • •

•

•

Not sure what to do Lack of time Reluctance to ask for support Easier to stop than to keep going

MeYou Health is a Healthways company

They want solutions that are: • Realistic about what they ask you to do • Convenient to factor into a busy life • Give immediate feedback


Behaviours are contagious

We need to individual.

treat the network, not just the



Gamification

What Gamification Does:

Dynamics: Make clear what to do and when to do it. Mechanics: Provide the positive and negative feedback instilling reward/penalty and progress. Aesthetics: Drive an emotional and tactile connection to the dynamics and mechanics.

Hunicke R, LeBlanc M, Zubek R. MDA: A Formal Approach to Game Design and Game Research



Employing Innovative Mobile and Social Applications

• Compelling web and mobile experiences

• Encourage people to become mindful of small actions they can take every day

• Transforming social networks into support systems

• Helping people understand how their personal decisions affect their well-being

• Engaging, educating and empowering people to make better choices

• Promoting personal growth and perceptible change

Do – involves participants

taking small actions each day

Learn – involves participants

learning about themselves, their

support networks, and what

makes them successful

Change – involves

creating healthy behaviours

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Evidence of outcomes...

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•25-year commitment initiated January 2, 2008

•1,000 telephonic “community” surveys

completed per day, 7 days/week

•1,700,000+ completed surveys

•Design support and oversight from leading

behavioral economists, psychologists, and

experts in psychometric survey design and

statistical analysis

•Largest and most comprehensive health

survey and database

Domains

Life Evaluation

Emotional Health

Physical Health

Healthy Behavior

Work Environment

Basic Access

Requires scientifically validated measurement tools

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Well-Being is Predictive of Cost and Utilisation

Harrison, Pope, Coberley, and Rula. Evaluation of the Relationship Between Individual Well-Being and

Future Health Care Utilisation and Cost. Pop Health Management, 2012.

Higher Well-Being = Lower

Cost

Higher Well-Being = Lower

Utilisation

10.1

%

18.4%

10.0%

14.2%

5.3%

9.6%

Individual Well-Being Score

Percent of Respondents with Hospital

Utilisation in 12 Months After WBA

Medium: >50-75 High: >75-100 Low: 0-50

Hospital Admissions

ER Visits

$5,172

$3,765

$1,048

$3,399

$2,605

$771

$1,885

$1,507

$344

Individual Well-Being Score

Medium: >50-75 High: >75-100 Low: 0-50

Median Costs in 12 Months After WBA

Total Cost Medical Cost Prescription Cost

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• >30% improvement in Perception of Health (overall health status)

• Statistically significant decreases in BMI for both obese and

overweight participants

• Marked improvement in medication management (eg 46%

increase in participants with up-to-date list of their medications)

• Significant reduction in all key lifestyle risk factors.

• Smoking rate reduced by >25%

• Physical Inactivity reduced by > 25%

• Poor diet reduced by > 15%

• Obesity reduced by >5%

• Excess alcohol consumption reduced by >5%

Health Outcomes

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-7.8%-7.2%

-6.1%

-13.4%

-12.0%-11.3%

Diabetes Cardiovascular Dis Total

Difference in Admission Rate Change in Treatment Vs Comparison Group

12 Month 18 Month

***

**

***

**

***

***

-5.8%

-14.1% -14.3%

-20.1%

-25.7% -25.7%

Diabetes Cardiovascular Dis Total

Difference in Readmission Rate Change in Treatment Vs Comparison Group

12 Month 18 Month

**

**

**

**

** P ≤ 0.01

Statistical significance controlling for

age, gender, number of core

diseases, and hospitalizations in prior

24 months (y/n)

* P≤ 0.05, ** P ≤ 0.01, *** P ≤

0.001

Statistical significance controlling for age,

gender, number of core diseases, and

hospitalizations in prior 24 months (y/n)

Australian Published Outcomes

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Environmental Interventions

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Blue Zones is a Community Transformation Effort to Make the Healthy Choice the Easy Choice

Blue Zones

Power 9 Principles

Move Naturally

Eat Wisely

Right Outlook

Belong

The Prototype Community

Albert Lea, MN, 2008-2009

Healthways| Blue Zones

Vitality Cities 2010

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http://bluezones.com/


Initiative in the Beach Cities in Southern California

Three Audiences:

Community (Gov/Schools)

• School Policies / Mindfulness

• Walking School Bus

• Bike/Walk-ability Policy

• Community Policy Bundle

Organisations

• Restaurant (Menu/Env. Changes)

• Worksite (Employer Program)

• Ambassador

Citizens

• Walking Moai teams

• Purpose Workshops

• Volunteering

• Plant –Based Cooking Classes

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And the Iowa Blue Zones Project™

• The Healthiest State Initiative is a community and business-

led, government-endorsed statewide initiative in which

Iowa will set forth on a multi-year journey to improve the

health and well-being of its residents. To measure the

success of this strategic endeavor, the following goal will

be established:

Iowa is the Healthiest State in five years (by 2016) as

measured by the Gallup Healthways Well-Being Index®.

• The Blue Zones Project™, as the cornerstone of the

Healthiest State Initiative, is an effort to transform 10 Iowa

communities into Blue Zones Communities™ over the next

five years.

• This is 5 year partnership with Wellmark which also includes

co-development of a Blue Zones Institute (to scale to other

communities) and web-based services and collaterals for

citizens, employers and communities.

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Conclusions

High Costs of Doing Nothing Different

• Both medical and productivity costs impose heavy financial burdens on

communities • Without interventions, these costs can be expected to grow and compound

The Primary Sources of These Costs are Known

•Chronic conditions cause people to seek care (medical costs) and reduce their

ability to work (productivity) •While behaviours do not have costs associated with them, the conditions they create

and exacerbate can have substantial costs

Intervening reduces costs and improves outcomes

•Curtailing or eliminating behavioural risks can reduce costly chronic conditions •Addressing risks before they become conditions can be a significant source of

savings

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Health & Medicine

Linda Swan