Sec K EHM Programs

Question 1

Recommended measures for assessing EHM programs

Answer 1

• The recommendation covers the following 7 domains*
  1. Financial outcomes
  2. Health impact
  a) Physical health impact (e.g. blood pressure and cholesterol)
  b) Mental and emotional health impact (e.g. depression and anxiety)
  c) Health behaviors that impact physical and mental health (e.g. physical activity and tobacco use)
  d) Summary of health measures (overall risk reduction and individual risk reduction)
  3. Participation - categories are recommended based on the level of interaction needed to produce an outcome:
  a) Telephonic contacts - categories for 1-2, 3-4, & 5+
  b) Web-based contacts - categories for 1-5, 6-10, & 11+
  c) In-person contacts - categories for 1, 2, & 3+
  4. Satisfaction (such as overall satisfaction, effectiveness, and member experience)
  a) Patient satisfaction
  b) Client satisfaction
  5. Organizational support
  a) Organizational support elements
  b) Employee-perceived organizational support
  c) Leaders-perceived organizational support
  6. Productivity and performance
  a) Time away from work due to poor health
  b) Productivity loss while at work due to poor health
  c) Objective measures of worker performance (such as employee performance ratings)
  7. Value on investment - a comparison of the investment vs the outcomes
  a) Outcomes may be specific clinical measures or dollar amounts representing the monetized value of outcomes
  b) Investments include direct costs (such as program fees and incentives), indirect costs (such as employee time), and tangential costs (such as employee morale and company reputation)

Question 2

Steps of the EHM value chain

Answer 2

• These help in understanding how EHM programs add value*
  1. Assess all individuals in the population to identify opportunities to maintain or improve health
  2. Engage individuals with programs and tools through which they can address these opportunities
  3. Continue engagement long enough for them to acquire and sustain healthy behaviors
  4. Sustained effective engagement will result in preventing or reducing lifestyle-related risk factors
  5. Sustained healthy behaviors and clinical outcomes will result in fewer ER visits, hospitalizations, and procedures related to lifestyle-related risk factors
  6. Fewer ER visits, hospitalizations, and procedures yield medical, absenteeism, worker’s compensation, and disability cost savings
  7. Improved employee productivity and performance contribute to improved financial outcomes
• Metrics for the 1st 5 steps are referred to as plausibility metrics. They check whether the EHM programs accomplished enough to make the claim of savings plausible. Plausibility metrics should be reported alongside any financial metric*

Question 3

EHM value proposition

Answer 3

• This is how EHM adds value for the employer*
  1. Identify opportunities to:
  a) Improve (or maintain) health, and
  b) Mitigate or eliminate current risks or avoid future risks
  2. Address these opportunities with effective programs and tools to improve the population’s health status, improve productivity, and lower health-related costs

Question 4

Benefits to stakeholders of using standardized measures for assessing employee health management (EHM) programs

Answer 4

1. Employers and benefit managers - core metrics can facilitate comparisons and provide a basis for developing vendor performance metrics. Employers can use this data to identify gaps in their programs
2. Benefit consultants - a standard set of metrics may lead to reliable comparative data for making vendor recommendations and for negotiating performance standards
3. Health management program managers - core metrics will provide data to fine-tune health enhancement interventions
4. Accrediting organizations - metrics can be used to evaluate vendor and health plan compliance
5. National health management policy makers - core metrics will facilitate development of recommendations for use by federal and state policy makers
6. EHM service vendors - core metrics will create a level playing field for competitors and encourage product improvements to achieve benchmarks
7. EHM participants - will benefit from product improvements stemming from competition to achieve benchmarks

Question 5

Considerations in choosing whether to use modeled or measured savings for EHM calculations

Answer 5

1. Measured savings are not accurate for small populations, so models should be used for them. A common cutoff point is 25,000 members
2. Measured savings calculations require fully-adjudicated claims data. But savings models require only data typically generated through the program, such as demographics, participation, risk factors, diseases, or gaps in care
3. Measured savings are generally calculated annually, while modeled savings can be run with any desired frequency
4. Measured savings inherently incorporate the organization’s specific data. Modeled savings calculations must incorporate this data to be as accurate
5. Measured savings are validated (or audited) by a third party. Modeled savings are developed based on published evidence or studies

Question 6

Steps taken to develop a standard set of measure for EHM programs

Answer 6

1. Review the literature to discover what metrics are currently used to measure performance of EHM programs
2. Obtain guidance and advice from subject matter experts
3. Identify and/or develop recommended measures
4. Review the work with key stakeholders to obtain feedback and consensus
5. Release the work through conference presentations, publication, and other channels

Question 7

Definitions of modeled and measured savings for EHM calculations

Answer 7

1. Modeled savings are estimated by multiplying factors from published studies by the utilization reductions or other results of the EHM program
   a) The use of a savings model is strongly recommended for organizations who do not have the population size and funds required for a valid claims savings measurement study
2. Measured savings are estimated by comparing actual claims to what claims would have been without EHM

Question 8

Organizational support elements for EHM programs

Answer 8

• These are deliberate steps the employer can take to create an environment that supports health and well-being*
  1. Company-stated health values
  2. Health-related policies
  3. Supportive environment
  4. Organizational structure
  5. Leadership support
  6. Resources and strategies
  7. Employee involvement
  8. Rewards and recognition

Question 9

Recommended financial metrics for EHM programs

Answer 9

1. Directly-monetized claim savings - one of the following metrics should be selected:
   a) Cost trend compared with industry peers - compares trend to peers without EHM
   b) Adjusted-expected compared to actual cost trend - compares expected to observed trend, with trend decomposed into components such as demographics and non-demographic. Credit is taken for EHM-impactible components
   c) Chronic vs non-chronic trend comparison - used for disease management. Compares expected trend (from the non-chronic population) to observed trend (from the chronic population)
   d) Cost or trend comparison or program participants vs non-participants - compares cost trajectories of the two groups, after neutralizing the impact of non-EHM differences
   e) Comparison with matched controls in a non-exposed population - compares cost trajectories of members who meet criteria for EHM program targeting in the employer’s population with members who meet criteria in a comparison population that does not have EHM program
2. The monetized impact on utilization that is potentially preventable by EHM - monetizes a downward trend in ER and hospital visits and procedures that can be prevented by EHM
3. Financial impact based on a model that links to what occurred during the program and characteristics of program participants
4. Reduction or prevention of lifestyle-related health risk factors - relates reductiuon in or prevention of lifestyle-related health risk factors to published evidence on the economics of preventing and reducing such risk factors

Question 10

Lagging indicators of savings for EHM programs

Answer 10

• These often improve after sustained high performance on leading indicators*
  1. Functional status
  2. Quality of life and well-being
  3. Absenteeism and presenteeism
  4. Morbidity (ER, hospital, procedures)
  5. Healthcare claims cost

Question 11

Leading indicators of savings for EHM programs

Answer 11

• These can indicate during the 1st year whether a program is likely headed for savings later on*
  1. Identification, stratification, and targeting (outreach)
  2. Program enrollment and use of tools
  3. Continuing engagement or program completion
  4. Behavior change
  5. Behavior maintenance
  6. Process of care
  7. Medication adherence
  8. Achieving clinical targets
  9. Patient activation
  10. Satisfaction with EHM
  11. Well-being