FacetoFace Disease Management Diabetes Coronary Artery Disease Hypertension
Face-to-Face Disease Management Diabetes Coronary Artery Disease Hypertension Back Pain Obesity Cancer Asthma Arthritis Allergies Sinusitis Depression Congestive Heart Failure Lung Disease Kidney Disease Sky. Disease. Management. com
Agenda • • History Of The Asheville Project Initial Results Pinnacle Pool Sky Disease Management Clinical Research & Peer Reviews Overall Program Results: Global & Client Specific Sky’s Clinical Approach Validation and Accountability Partner Reinsurance Carrier Subsidies Sky. Disease. Management. com
History Pinnacle Pool Sky. Disease. Management. com
Frequency/Severity Matrix Frequency Severity High Frequency Low Severity High Frequency High Severity Low Frequency Low Severity Low Frequency High Severity Sky. Disease. Management. com
Diabetes-Related Comorbidities 2– 4 times greater risk of heart disease 60– 65% have hypertension 2– 4 times greater risk of stroke 60– 70% have some degree of nervous system damage • Leading cause of adult blindness • Leading cause of ESRD (40% new cases) • >50% lower limb amputations • • 1993 NEJM study of impact of lowering HA 1 c Sky. Disease. Management. com
Clinical Outcomes: Avg. Glycosylated Hemoglobin Sky. Disease. Management. com
Diabetes-Related Indirect Costs • 8. 3 sick-leave days annually • 1. 7 sick-leave days for employees without diabetes • $47 billion in productivity forgone due to disability, absence, and premature mortality Sky. Disease. Management. com
Direct Medical Costs Over Time* *Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003; 43: 173 -84. Sky. Disease. Management. com
Nearly $2, 000 In Grants Awarded Sky. Disease. Management. com
Clinical – HEDIS 2010 Indicators vs. Actual Site …Averages through August, 2010 Sky. Disease. Management. com
Research & Outcomes Hypertension. 5 Year, 6200+ Patients. Journal of American Pharmaceuticals Association. o 53% decrease in risk of cardiovascular event. o 50%+ reduction in risk of related cardiovascular emergency department visit. o 31% reduction in medical costs related to cardiovascular patients. Diabetes Study. 5 Year, 200 Patients, Journal of American Pharmaceuticals Association. o Total direct medical cost decrease $1, 200 to $1, 872 per patient per year. o Estimated productivity increases estimated at $18, 000 annually. Asthma Study. 5 Year, 200+ Patients. Journal of American Pharmaceuticals Association. o Total direct medical cost decrease $725 per patient per year. o Indirect cost savings estimation of $1, 230 per patient per year. Sky. Disease. Management. com
-19% Claims versus National Norms Sky. Disease. Management. com
Client Specific Outcomes 1275 Employee National Employer • This self insured client has enjoyed significant savings over basic medical trend. As you can see below, their medical and prescription drug costs in this past year were 38% less than otherwise expected. Over the past 6 years, they have accumulated total savings over basic healthcare trend of $16, 406, 495. Of note, there were no plan design changes during this period of time to be responsible for this savings, but only proper medical management. $3, 800, 000 $3, 600, 000 $3, 400, 000 $3, 200, 000 $3, 000 $2, 800, 000 $2, 600, 000 $2, 400, 000 $2, 200, 000 $2, 000 $811, 872 -26. 05% Year 0 Year 1 Year 2 Year 3 Actual Costs Medical Trend Year 4 Sky. Disease. Management. com
Client Specific Outcomes 200 Employee Municipality • Faced with budget constraints as a municipality, this client deployed our medical management process and have enjoyed great success. Their 4 year savings over basic medical trend amounts to $2, 130, 483. In the most recent year, their claims were 26% less than otherwise expected. Sky. Disease. Management. com
Client Specific Outcomes 290 Employee Automotive Industry • This multi-state self funded client has had great success with their claims history since implementing our medical management. Over the past 4 years, they have accumulated savings of $2, 015, 232 over normal medical trend. In the most recent year, their claims were 23% less than expected trend, resulting a single year savings in excess of $750, 000. Sky. Disease. Management. com
Client Specific Outcomes 350 Employee Non-Profit • Reliance on public funding and support caused this employer to explore every possible avenue to maintain healthcare costs. The result of these efforts has compiled savings of $816, 487 over the past 3 years. In the most recent year, they experienced medical costs 22% less than otherwise expected based upon normal healthcare trend. Sky. Disease. Management. com
Evidence Based Medical Norms & Employee Compliance What Makes Sky Disease Management Work? Pinnacle Pool • Risk Assessment and Stratification • One-on-One Meetings with High Risk Members • Employee Compliance Reporting • Various Disease Categories Diabetes Coronary Artery Disease Hypertension Back Pain Obesity Cancer Asthma Arthritis Allergies Sinusitis Depression Congestive Heart Failure Lung Disease Kidney Disease Sky. Disease. Management. com
Employee Compliance (example) Sky. Disease. Management. com
Employee Compliance (example) Sky. Disease. Management. com
Implementation Time Line Week 1 Client enters into contract and signs business associate agreement Health risk assessment begins, and authorization documents are distributed to employees Initiate any desired onsite lab draw, or arrange for alternative method of obtaining biometric testing Documents are remitted to Sky and risk assessment and stratification begins If necessary, recruiting begins for additional nursing staff that is best suited to the client’s specific needs Week 2 Risk assessment and stratification of all participants continues based on the health risk assessments Receipt and review of client group’s lab results If necessary, vetting of potential nurse candidates Week 3 If necessary, begin interview process for registered nurse Risk assessment and stratification is concluded Sky. Disease. Management. com
Implementation Time Line Week 4 If necessary, conclude interview process, select new hired nurse candidate Week 5 -7 If necessary, implement nurse training program Introduce selected registered nurse to client Provide client with information necessary to begin scheduling initial employee appointments Week 8 Begin scheduled high risk member employee appointments Schedule return dates and follow-up appointments for worksite. Sky. Disease. Management. com
Marketplace Shifts ACA Causing A Major Market Shift To Self Insurance • Staggering Fully Insured Renewals • Community Rating Will Increase The Rate Of This Shift Sky. Disease. Management. com
Self Insurance Resources • Reinsurance Marketing • Stop Loss Placement & Claims Administration • Self-Insured Reporting • Broker Based Resources for Underwriting & Actuarial Work • Preferred Risk Pooling Sky. Disease. Management. com
QUESTIONS …. . Sky. Disease. Management. com
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