1. Traditional vs. New View of Health
(See Predictive Modeling for Health Care: Finding the High-Cost Employee)
Traditional vs. New View of Health
Traditional Model
Industry oriented towards management of diseases.
Premise that better disease management will result in lowered cost.
Typically identifying only 1-3% of the employee population, meaning only 10-5% of the near-term cost brought under proactive-care management.
Perceived-Health Model
Oriented towards all factors that contribute to a person’s sense of illness.
Premise that unless non-disease-based factors are identified and addressed, the person won’t feel better and reduce care use.
Identifies 10 percent of employees that will account for 70-80% of their costs, dramatically increasing the ROI potential.
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2. Perceived-Health Model Traditional Model
By looking at more than disease factors alone, employers can manage fewer employees, but capture and manage more of the cost.
55% of Total Medical Costs
43% of Total Medical Costs
Perceived-Health
Model
Traditional
Model
Employees Predicted to have High Levels of Near-term Care Use (disease and non-disease factors)
30%
of $$
Employees w/ One or More of Top 4 Diseases
43%
of Health
Care $$
25%
of $$
11% of pop.
4% pop
1% pop
Source: Disease Management Association
of America