Midwest ESOP Conference. September 11, 2015
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1 Midwest ESOP Conference September 11, 2015
2 Why are you here today? I want to fix my company s healthcare problem Rising healthcare costs are: Negatively affecting my bottom line, EBITDA, stock price, etc Making me less price competitive Making me less attractive when recruiting new talent Unfairly burdening my people with high employee contributions 2
3 Why Are Company Healthcare Costs Rising? 3
4 Who is Telligen? Mission-Focused Organization Founded in % ESOP in employee-owners HQ in Des Moines with offices in Baltimore, Boston, Chicago, Denver, Minneapolis, and Oklahoma City Our Mission: We improve the quality and cost-effectiveness of healthcare for consumers and providers Federal Government: National Health Policy to Programs Quality Improvement Programs: Providers Improvement, Quality Measures, Public Reporting Alternative Payment Models: Comprehensive Primary Care Initiative, Pioneer ACOs, Medicare Shared Savings Program 4
5 Who is Telligen? State Population Health Medicaid Programs Physician Practice Transformation Commercial Population Health Self funded Employer Health Plans Public Entities and Unions (Taft-Hartley Plans) Managed Care Organizations Insurance Carriers & TPA s Physician Practice Transformation Telligen s Employee-Owner Expertise It s In The Numbers Oklahoma Medicaid $182 million in realized savings over five years 6:1 demonstrated ROI 98% of providers would recommend the program 88% of patients were very satisfied Clinical: over 350 nurses, physicians, pharmacists, QI specialists, certified chronic care professionals, public health experts, social workers, epidemiologist Technical: over 175 developers, biostatisticians, database architects, analysts, etc 5
6 What do we do? Clinical Expertise Technical Expertise Healthcare Intelligence We combine extensive clinical and technical expertise to solve complex healthcare challenges 6
7 Telligen s Value Proposition Telligen improves the health of your plan members while managing the rising costs of healthcare through innovative population health management solutions. 7
8 What is Population Health Management? 7 8
9 Predictive Modeling Identify and stratify the population for care management interventions Develop new programs Analysis of members utilization history 8 9
10 Key Measurements in Predictive Modeling Relative Risk Score Definition: this is the weight assigned to a member using cost data Example: a RRS of 2.5 means a member is expected to cost two and one half times the average Resource Utilization Band Definition: a measurement of the use of resources 0 = no or only invalid diagnosis 1 = healthy user 2 = low 3 = moderate 4 = high 5 = very high 9 10
11 Services Engagement Strategies Outcomes Disease Management For plan members with chronic diseases, nurse health coaches facilitate member and provider engagement on evidence-based practices and member self-management of their condition. Asthma Cardiac COPD Diabetes Chronic (multiple high-cost co-morbid conditions) Sleep apnea Depression and obesity (interwoven into all programs as applicable) Dedicated health coach Flexible hours Secure Mobile apps Video conferencing Educational materials Support incentive design Collaborative calls between health coach and provider Member progress summaries to provider Care gap reporting to provider Member engagement Condition specific metrics Care intervention results Closure of care gaps Reduction of relative risk scores Patient activation scores Treatment adherence 11
12 Programs Engagement Strategies Outcomes Case Management For members with acute or complex medical care needs, nurse case managers coordinate care through member and provider engagement. Catastrophic Oncology Transplants Care transitions Emergency reduction program End stage renal Specialty medications Narcotic review Dedicated nurse care manager Secure Two way text communications Mobile apps Video conferencing Educational materials Collaborative calls between nurse care manager and provider Members progress updates to provider Care gap reporting to provider Promotion of evidencebased care Gross savings Engagement Reduction in relative risk scores Reduction in readmissions Reduction in emergency room usage Member satisfaction Referral to disease management 12
13 Services Additional Outpatient Services Outcomes Utilization Management For all plan members, nurses evaluate the medical necessity of select inpatient and outpatient medical service. Inpatient confinements (acute medical/surgical, rehabilitation, long-term acute care, skilled and hospice admissions ) Behavioral health (acute, partial hospitalization, intensive outpatient and residential treatment) Steerage to in network providers and facilities Discharge planning Appeals Referral to case management Durable medical equipment Procedures Imaging Therapies (PT, OT, SP) Behavioral health visits (partial hospitalization, intensive outpatient) Specialty review IRO Steerage to narrow networks Promote evidence-based care Gross savings report Days and discharges per 1000 Reduction in readmissions Utilization by service type Utilization by Diagnostic Related Grouping Member satisfaction Referral to case management 13
14 Telligen s Story 14
15 Fixing Telligen s Healthcare Problem Background Fully insured non-profit physician trade association (pre-esop) Approx 1,200 total lives on our health plan Year over year double-digit medical premium increases Significant plan design changes made every year to lower increases Also made carrier change to lower premium increases Introduced participation-based wellness program Facing increasing competitive pressures on our business 15
16 Simple View of Controlling Costs Plan Sponsors have Three Levers to Pull 1. Improve Financial Management of the Plan Fully Insured vs. Self Funded Evaluate the Risk EVERY year Consider sharing risk with members through CDHP approach Consider joining a captive 2. Cost Shift to Employees Plan Design Changes Employee Contributions 3. Improve Your Population s Health In the long run, will make the greatest impact 16
17 Fixing Telligen s Healthcare Problem What did we do? The Year of The Epiphany Began building a true Culture of Health and Well-Being As a Population Health Management Company, we have to be authentic in the marketplace Conducted a communication and education campaign Hired a Health Benefits Consultant who Gets It! Developed a comprehensive Health Benefits strategy Launched a new wellness program called RevUP Your Health! Comprehensive programming based on aggregate population risks Added Biometric Outcomes into incentive design 17
18 Fixing Telligen s Healthcare Problem What did we do? The Year of Transition Transitioned to 100% Employee Owned Company Transitioned Health Plan from Fully-Insured to Self-Funded Wellness Incentive Design weighted further to Biometric Outcomes Set Company-wide goal for reduction of biometric risks 18
19 Fixing Telligen s Healthcare Problem 2014 Company Goal Focus on High Risks Maintain the percentage of employees with No High Risks at 36.4% or better. Reduce the percentage of employees with one High Risk by three percentage points, to 38.5% Reduce the percentage of employees with two or more High Risks by one percentage point, to 21.0% 19
20 Fixing Telligen s Healthcare Problem 2014 Company Goal Focus on High Risks Biometric Measures considered High Risk: Waist Circumference: Measure of > 35 inches for women OR > 40 inches for men Fasting Glucose: Measure of >/= 126 mg/dl( may indicate diabetes) HDL: Measure of < 40 mg/dl Total Cholesterol: Measure of >/= 240 mg/dl Blood Pressure: Measure of 140/90-159/99 mm Hg Positive Cotinine (Smoker) 20
21 2014 Results Reducing High Health Risks Goal Actual 2 or more High Biometric Risk Values Reduce 1% Reduced 2% 1 High Biometric Risk Values Reduce 3% Reduced 2.7% ALMOST! No High Biometric Risk Value Maintain Increased 4.8% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 36.4% 41.2% No High Biometric Risk Value 41.5% 38.8% 1 High Biometric Risk Value 15.7% 16.0% 2 High Biometric Risk Values Employee Only (N=388) 5.4% 3.4% 3 High Biometric Risk Values 1.0% 0.6% 4 High Biometric Risk Values Time 1 Time 2 High Biometric Risk Definitions: High Biometric Risk Definitions Waist Circumference: > 35 inches for women OR > 40 inches for men Fasting Glucose: >/= 126 mg/dl HDL: < 40 mg/dl Total Cholesterol: >/= 240 mg/dl Blood Pressure: 140/90-159/99 mm Hg N=141 N=160 N=161 N=151 N=61 N=62 N=21 N=13 N=4 N=2 21
22 2014 Cost Results 2014 Medical/Rx Costs Lower than projections Able to accrue savings for reserves 22
23 Fixing Telligen s Healthcare Problem Continuing to Execute our Strategy 2015 No Plan Design Changes! Implemented Rewards & Recognition Program including Well-Being Implemented Telligen s Disease Management program Selected a new Well-Being partner for strategic alignment 2016 No Plan Design Changes! Pharma Transparency Tool Telehealth Solution Implement Telligen s UM/CM programs 23
24 Final Thoughts to Consider Make sure your broker/consultant Get s It! Develop a comprehensive Health & Well-Being strategy Build a Culture of Health and Well-Being Senior leaders have to be invested! Engage the right health benefits partners Hold your Carrier or TPA accountable if they re managing health Acknowledge the complexity of the problem and engage specialists Be Transparent with your Employee-Owners! 24
25 Contact Us Doug Ventling Vice President, Health Solutions Troy Cook Vice President, Sales 25
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