1. Data-Driven Health Management Strategies
Doing the Math on Medical and Pharmacy Claims
Kirstie Settas-Jones, MBA
National Leader Mid-Market Health Management Practice
Southeast Region Vice President
Anthony Root
Vice President – East Coast Regions, Health Analytics
August 4, 2017
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2. Agenda The Business Impact Defining Well-Being
Health Management Strategies
Data-Driven Strategies
What kind of data do I need?
Report SAMPLES
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3. The Business Impact of Employee Well-Being
Clustering of financial worries, health, absence and work engagement
Employees in poor health report more absence and are less engaged at work
Poor health
Good health
Very good health
% highly engaged
27%
38%
46%
% disengaged
25%
23%
19%
Employees in poor health are more likely to be stressed and financially struggling
Financial worries
Very good health
Good health
Poor health
Unworried
Future worries
Current worries
Struggling
Poor health
Good health
Very good health
% highly stress
65%
42%
30%
Source: 2015/2016 Global Benefits Attitudes Survey, U.S.
Sample: Full-time employees with an employer health plan.
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4. The three key business concerns
Addressing what matters to employers
Health Risks
Unaddressed health risks in a population raise medical costs and impact worker productivity.
Medical Costs
Understanding where there is higher risk or excess medical spend is key to identifying solutions that lower medical costs.
Lost Productivity
Increasing health risks and higher rates of chronic conditions drive greater absenteeism and presenteeism.
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5. Employers Define Employee Well-Being Broadly
To what extent do your organization’s health and well-being programs focus on the following aspects of employee well-being?
75%
Will increasingly focus on strategies to build the health and well-being of the workplace and culture to encourage healthy behaviors
PHYSICAL
FINANCIAL
61%
28%
Includes lifestyle behavior choices to improve health, avoid preventable diseases and help members manage existing medical conditions
Having control over daily or monthly finances, on track to meet goals, ability to absorb a financial shock and have the financial freedom to make choices
EMOTIONAL
SOCIAL
36%
24%
Relates to mental health concerns such as stress, depression and anxiety
Sense of involvement with family, friends and other people within our communities
Sample: Companies with at least 1,000 employees.
Note: Percentage responding 4 or 5 on a 5-point extent scale.
Source: 2016 Willis Towers Watson Best Practices in Health Care Employer Survey.
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6. New Integrated Approaches to Well-Being Are Emerging
On the Way Out
One size fits all
Programs designed and dictated by the corporate office
Well-being programs that address physical health only
Claims that traditional well-being programs lower medical claims cost in year one
Outbound telephonic cold calls
Clunky delivery with excessive client focus on incentive management
On the Way In
Including productivity, workforce engagement and “employer of choice” in determination of program value
Programs with ownership and accountability at the local level, including champions
Well-being strategy that supports physical, emotional and financial health
Programs tailored to employee cohorts, generational groups, and/or individual members
Face-to-face and pure-digital coaching
Consumer-grade mobile experience enhanced by social support and devices
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7. Population health management
Cost distribution
80% of the people account for 20% of the costs
And 20% of the people drive 80% of the cost
50% of the people account for only 3% of the costs
Source: 2009 Medical Expenditure Panel Survey
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8. Population health management
Risk and Cost Strategies
Lifestyle Behavior Education
Access Coordination Redirection
Wellness Strategies
Cost Strategies
Source: 2009 Medical Expenditure Panel Survey
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9. Health Management Strategies for Employers
Wellness Programs
Employee Communications
Incentive Designs
Culture of Health
Wellness Solutions
Onsite Health Solutions
Telemedicine
Cost and Quality Transparency
Patient Advocacy
Access to Care Solutions
Second Opinion Solutions
Other Targeted Solutions
Disease Management
Case Management
Targeted Solutions
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10. Data-Driven Wellness Analysis
How many members over 50 have had a colonoscopy?
How does your member risk stratification compare to benchmark??
What are your workforce demographics? What are your member demographics?
Do you know your specific wellness or preventive screening Gaps in Care?
Are there Gaps in Care in your LOW risk groups? Where?
Are there Gaps in Care in your MEDIUM risk groups? Who?
Are you looking at your health risk assessment (HRA) data?
Are you looking at your biometric data?
How are your people distributed?
What is your plan design? Have you made recent changes
Are you measuring Participation? Activity? Outcomes?
What is your average employee turnover?
What’s more important: lowering risks or lowering medical costs?
Are you looking for ROI or VOI? What are your metrics?
What wellness support are you getting from your carrier?
Is your carrier currently subsidizing your wellness efforts?
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11. Wellness Strategies For Employers
Health Risk Assessment
Biometric Screening
Condition Management
Health coaching
Weight Loss
Walking-At-Work
Wellness Programs
Wellness Portal
Program Branding
Newsletters
Multiple Channels
Mobile Apps
Employee Communications
Participation Based
Activities Based
Outcomes Based
Tobacco Cessation
Regulatory Compliance
Incentive Designs
Senior level buy-in
Include in vision
Include in mission statement
Wellness Committee
Hold departments accountable
Culture of Health
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12. Data-Driven Access to Care Analysis
Are your members over-utilizing ER services?
Are your members under-utilizing primary care office visits?
How is your urgicenter use trending?
Are your diabetics seeing their doctor enough?
Do you have excess numbers of MRIs? CT Scans? How do you know?
What percent of your members have not submitted a claim in the last year? Is that good or bad?
Are an excess of opiates or pain-killers being prescribed? Where? By whom?
Do you have excess hospitalizations for cardiac conditions? How would you know?
What percent of your members haven’t submitted claim in the last year? Is that good or bad?
Are you paying too much for ER services compared to your marketplace?
Are people seeing their primary care physician after going to the ER?
Are there geographic disparities around seeking medical care?
Are members utilizing generic or mail-order Rx options?
Are there a disproportionate number of Saturday and Sunday ER visits?
What conditions are driving hospitalization utilization? Is over-utilization occurring?
Are your PBM utilization trends in line with your medical claims trends?
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13. Access to Care Strategies for Employers
Geographic concentration of employees
Convenience
Cost control
Productivity Improvement
Onsite Health Solutions
Reduce ER overutilization
Offset Urgent Care expense
Efficiency for common ailments
Telemedicine
Increase health engagement
Allows members to control their costs
In tandem with HDHP and cost shifting
Cost Transparency
Telephonic assistance with navigating complexities of health care system
Quality of care Transparency
Patient Advocacy
© 2017 Willis Towers Watson. All rights reserved.

14. Data-Driven Targeted Solutions Analysis
What percent of costs are accountable by your top 5% of members?
What acute conditions are disproportionately driving costs?
What is your rate of elective spinal surgeries?
What specialty pharmaceuticals are driving your overall costs? What percent?
What diagnostic groups are most expensive for your plan?
Are there significant Gaps in Care for your diabetics? Members with Congestive Heart Failure (CHF)?
What chronic conditions are disproportionately driving costs?
How does your cost stratification compare with comparable populations?
Are cancer expenditures unnecessarily high? In line with prevalence?
Are diabetics getting the care they should be? What percentage of overall costs do they account for?
What populations have the highest Gaps in Care?
Do you have more people taking too many different prescriptions that they should?
For what chronic conditions is there an excess disease burden (Prevalence X Cost)?
How costly are Complications of Pregnancies or Newborn Complications?
Are you paying more for hospitalization than other employers in your area?
Is arthritis a major medical cost driver for you? Pharmacy cost driver?
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15. Targeted Solutions for Employers
High cost claimants
High risk claimants
High complexity patients
High uncertainty medical situations
Second Opinion Solutions
Pharmacy demand management
Specialty provider identification
Narrow Network
Other Targeted Solutions
Asthma
Cardiac
Respiratory
Diabetes
Mental Health
Back Disorders
Disease Management
Catastrophic Care Management
Renal Care / Dialysis
Cancer Care
Rehabilitation
Home Care Solutions
Case Management
© 2017 Willis Towers Watson. All rights reserved.

16. Data-Driven strategies
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17. Data-Driven Strategies
Why is data important?
Shift from REACTIVE strategies to PROACTIVE strategies
Data is the foundation for designing effective strategies
Effective strategies are measured by results; results are measured by data
Ongoing data measurements are critical to ever-changing populations and health status
Effective cost and health strategies impact business costs
© 2016 Willis Towers Watson. All rights reserved. Proprietary and Confidential. For Willis Towers Watson and Willis Towers Watson client use only.

18. Data-Driven Strategies
Report SAMPLES
Tracks cost and utilization trends
Clinical cost and care drivers
Pharmacy dashboard and deep dive
Identifies key, high cost disease states
Spotlights gaps in care for specific conditions
Provides risk stratification for client population
Identifies gap in preventive care
Understand high cost claims
Provides benchmark normative values
for key metrics
Estimates potential cost savings from
closing gaps in care
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19. Your Annual Costs
What are your spending? How does that compare to your competitors?
Current Year Spend
Membership
Employees
$33,925,059
6,680
2,806
Benchmarking your medical and pharmacy costs:
Against your industry norms
Against employers with similar demographics
Against your year over year trend
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20. Costs and Utilization
What is driving your overall costs? How is utilization trending?
Understanding:
Cost of care
Access to care patterns
Hospitalization costs and trends
Office visits utilization compared to benchmark
Number of ER visits and costs compared to marketplace
Drug utilization and trends
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21. Pharmacy Trend
What is driving your overall costs? How is utilization trending?
Pharmacy Dashboard
Understanding:
Prescribing and utilization patterns
Inflation and cost disparities
Top drugs by usage
Top drugs by spend
Specialty medicine profile
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22. Dashboard What is your population health profile?
Care Gap Index Stratification
Risk Stratification
Cost Stratification
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23. Key Conditions
What conditions are driving medical costs? How does our organization compare to the norm?
What is your organization spending on asthma? Cancer? Back Pain? Heart Disease? Depression?
For what conditions are you seeing excess ER visits? Excess hospitalization?
What medical conditions and situations warrant focused strategies.
Are your members with acute and chronic conditions seeing their physician when they should?
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24. Gaps In Care
What can you tell me about practice patterns and access to quality care?
We identify key risks and gaps in care for your member population, and for members with specific conditions.
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25. Risk Stratification
How does our population compare to bench mark in terms of health risks?
Do your covered members have a higher than predicted risk profile?
Are there gaps in care issues for high risk and medium risk cohorts?
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26. High Cost Claims
What conditions are driving our highest dollar claims?
What conditions are driving your high dollar claims?
What conditions and procedures account for the 5% of claims that drive (on average) 58% of your overall spending.
What can you do about it?
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27. Estimated Savings Model
What could we save if we closed gaps in care?
For this client, based on what we know from claims experience, reduction in gaps in care would theoretically yield $ in savings based on recent claims experience.
This is 10.4% of their total spend.
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28. Thank you kirstie.settas-jones@willistowerswatson.com
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