Consumerism, Population Health and Retail Pharmacy: New Models for Engaging At-Risk Populations

Presented by Harry L. Leider, MD, MBA at Empower 2016 on May 6, 2016

Dr. Leider offers insight on new models for engaging at-risk populations including how innovative digital health programs that include retail incentives can improve health and wellness at scale. He also covers how community-based pharmacy services can engage at-risk populations and improve outcomes.

Transcript

1. Harry L. Leider, MD, MBA CMO & Group Vice President, Walgreen Co. Hosted By
2. Member of Walgreens Boots Alliance ©2016 Walgreen Co. All rights reserved. Confidential and proprietary information. For internal use only. Consumerism, Population Health, and Retail Pharmacy: New Models for Engaging at-risk Populations Harry L. Leider, MD, MBA Chief Medical Officer & Group Vice President
3. 2 Objectives 1. To explore how consumerism changes how we interact with and can influence patient populations 2. To review the major barriers to achieving positive clinical and financial outcomes within population health programs 3. To discuss some emerging tools and technologies that show great promise to engage high-risk populations
4. 3 My professional journey…..: • 3 managed care organizations (HCHP, HealthNet, XLHealth) • 2 DM/PHM companies • 1 Healthcare consulting company – created PHM software • Specialty lab – focused on assessing medication adherence for chronic pain and SMI • Walgreens/WBA – “global health and wellbeing company” My passion – “Improving the health of populations, at scale, within a sustainable business model…” © 2016 Walgreen Co. All rights reserved.
5. Consumerism in Healthcare
6. 5 Traditional View of Healthcare Held by Patients • Physician as sole expert • Patients receive care and advice only in offices and hospitals • Patients expected to work around provider’s schedules • Very limited access to health information • Quality of care is assumed • OOP costs low (insurance covered, cash, or pro-bono care) © 2016 Walgreen Co. All rights reserved.
7. 6 Drivers of Consumerism in Healthcare 1. Disruption of traditional bond with primary care physician • Large panel size • Limited time spent with patients • Generational changes in attitude 2. High OOP costs/HSAs • Averaging $1,300 per commercial member 3. Growing shortage of PCPs 4. Healthcare information via the Internet 5. Shifting expectations derived from other industries • On-line Banking, Amazon 6. New models of healthcare delivery • Retail clinics, telemedicine, health apps © 2016 Walgreen Co. All rights reserved.
8. 7 The Emerging Healthcare Consumer • Since I am paying for more of my care – I want information on cost and quality – and value! • I want access to healthcare when and where it is convenient for me! • I can research my condition before I interact with a provider • I can look at how others rate my provider (Yelp!) • I may not need or value the central role of a primary care physician © 2016 Walgreen Co. All rights reserved.
9. Challenges in Population Health
10. 9 Top Diseases for PHM and Value Propositions (MCO/ACO perspective) Prevalence ROI Quality Metrics Heart Failure Low Very High YES Asthma MOD LOW YES COPD LOW/M L/M YES ESRD Very Low HIGH NO Diabetes MOD Low YES Cancer Low L/M NO Rare Diseases Very Low MOD NO CAD (2nd prevention) MOD MOD YES Comorbid Mental Health High MOD YES See also: Goetzel, et. al., Healthcare Financing Review /Summer 2005/Volume 26, Number 4 19 Melek SP, Milliman American Psychiatric Association Report, 2014
11. 10 Engagement Drives Outcomes: Its all about the math… Claims & EMR data can identify additional patients with a disease Outreach – phone, digital, provider-based Clinical and Lifestyle Interventions Number of patients identified Number of patients enrolled Effectiveness of Interventions 80% 50% 20% X X 10% Reduction in costs on a population basis
12. 11 My experience at XLHealth with chronically ill seniors in Medicare Health Support 1. Population health program for 15,000 seniors with heart failure and/or diabetes • 3 year Medicare Health Support demo • Target net savings = 5% 2. Patient engagement strategy: • Introductory letter from CMS • Multiple Outreach calls by XL health nurses • Invitation to come to our “screening centers” • Home remote monitoring scale for CHF patients • All services free of charge © 2016 Walgreen Co. All rights reserved. 50% maximum enrollment at 12 months despite massive outreach effort and offer of a free program
13. 12 The “Achilles Heel” of Population Health • Is not the effectiveness of our clinical interventions… • Is not our ability to identify members who need support • Is not our ability to risk stratify the population It is the inability to engage high-risk individuals and maintain engagement over time! © 2016 Walgreen Co. All rights reserved.
14. Consumer-driven Strategies to Engage Patients
15. 14 Core Strategies 1. Incentives to participate 2. Tools that are easy and fun to utilize 3. Support from trusted professionals – when and where support is needed 4. Support from a larger community
16. 15 Core beliefs on impact of mHealth for Wellness, Fitness, Health, and Education 1. Changing and maintaining health behaviors is extremely difficult 2. Wearables, apps, devices can generate initial consumer engagement 3. Engagement typically decreases rapidly over time - unless the health problem is urgent or critical 4. Continued use can be reinforced with rewards: • Cash value awards/points – universal health currency • Gamification (badges, competition, etc.) 5. Improving health outcomes requires digital AND the availability of trusted human support 15 ©2013 Walgreen Co. All rights reserved.
17. 16 Balance Rewards for healthy choices™ Balance Rewards for healthy choices™ helps people adopt healthy behaviors - by integrating incentives with in-store and digital support. ©2014 Walgreen Co. All rights reserved. Confidential and proprietary information.
18. 17 Connecting wearables, apps and rewards into the largest connected device/consumer platform ©2014 Walgreen Co. All rights reserved. Confidential and proprietary information. App Partners Device Partners 24+ Device Partners
19. 18 Built on small-step methodology ©2015 Walgreen Co. All rights reserved. Confidential and proprietary information. We support and reinforce behavioral change by: 1. Encouraging goal setting 2. Providing health information 3. Tracking progress 4. Rewarding healthy behaviors and commitments
20. 19 Largest Connected Wellness Ecosystem of Any Healthcare Retailer ©2015 Walgreen Co. All rights reserved. Confidential and proprietary information. >1,000,000 active users 1.7 million goals set 80 million miles logged 600,000 users through connected devices/ Apps >1.5 billion points awarded
21. 20 Once signed up, people stay engaged with the program ©2015 Walgreen Co. All rights reserved. Confidential and proprietary information. *Active defined as having logged an activity in the past 30 days 1. Walgreens data on file. Data collected September 2014. Retention of active Balance Rewards for healthy choices™ members with connected device*1 93% 62% 77% 69% 65% 70% 72% 69% 71% 71% 72% 72% 50 55 60 65 70 75 80 85 90 95 100 1 2 3 4 5 6 7 8 9 10 11 12 Percentage of people still active Months
22. 21 Balance Reward for Healthy Choices: Association with Significant Weight Loss ©2015 Walgreen Co. All rights reserved. Confidential and proprietary information.
23. 22 Our Digital Platform Drives Improved Outcomes © 2015 Walgreen Co. All rights reserved. Confidential and proprietary information Participants lost an average of 3.3 lbs 8 Hypertensive patients are 2.5 percentage points more adherent 7 Diabetic patients are 5.4 percentage points more adherent 6 Email reminder increase PDC by 2.6 percentage points 5
24. 23 Digital Health Advisor helps with goal achievement • Powered by WebMD • Customized goals and action plans support lasting lifestyle changes • Interactive programs for: – Emotional health – Exercise – Nutrition – Smoking cessation – Weight management – Diabetes • Participants earn Balance® Rewards points for making progress ©2015 Walgreen Co. All rights reserved. Confidential and proprietary information.
25. 24 Pharmacy Chat team trained to coach members to engage in healthier lifestyle choices • Pharmacy Chat team trained in health coaching • Participants are given support resources • Topics with support: – Fitness – Nutrition – Smoking cessation – Weight management ©2015 Walgreen Co. All rights reserved. Confidential and proprietary information. Hi! My name is Mary S., Pharmacist. How may I help you? Tom: Are there any medications that can help me quit smoking? Mary S., Pharmacist: Congratulations on your decision to make healthy choices. Walgreens has a wide range of nicotine replacement products over the counter from patches to gum. There are also inhalers, which are prescription items. Tom: Any other information that would be helpful for me? Mary S. Pharmacist: There are Government Quit Lines available to help with individual coaching and medication help at: http://smokefree.gov/talk-to-an-expert. or you can call 1-800-784-8669. Tom: Any other advice? Mary S., Pharmacist: In the beginning it will be difficult so start slow and small and try to solidify a good habit. This will form a good foundation for additional progress. Do not be discouraged by initial failures or hiccups, this is expected. I wish you much success on making healthy choices.
26. 25 Telemedicine: Mobile Pharmacist Support, Prescription Management, and NP/Physician Virtual Visits ©2011 Walgreen Co. All rights reserved. Current App: Mobile Refill and Pharmacy Chat WebMD DHA and Symptom Checker MDLIVE Choose clinician Telemedicine Visit with Walgreens NP or MD Live Physician Adding virtual clinician visits to the Walgreens app flow allows consumers to access a clinician or pharmacist from anywhere…..
27. 26 Telemedicine and Behavioral Health © 2016 Walgreen Co. All rights reserved.
28. 27 Applying this Strategy of Rewards, Digital Tools, Support: Applied to Many Conditions and Populations 1. Rewarding ESRD patients for keeping their dialysis visits and adhering to their medications 2. Rewarding heart failure patients for weighing themselves and logging their weights every day- trigger to seek help with weight gain 3. Rewarding diabetics for uploading their sugars and adhering to their medications 4. Rewarding patients for walking post-discharge from the hospital 5. Rewarding patients for taking the PHQ-9 tool to screen for depression © 2016 Walgreen Co. All rights reserved.
29. 28 Definition of a “New Technology:” “Something that doesn‘t yet really work!”
30. 29 Evaluation Criteria for Digital-Health Tools 1. Is this a high priority condition/opportunity? (clinical and economic) 2. Is the “intervention/content” consistent with evidence- based medicine? 3. Is the tool something that patients will adopt? 4. Is the tool something that physicians will support? 5. Is the tool “best-of-breed?” (or near the top of competitors) 6. Is there a sustainable business model and adequate ROI
31. 30 Summary 1. Consumerism is changing how individuals want to interact with providers and plans – and improve their health! 2. The ”Achilles Heel” of population health is achieving sustainable engagement! 3. New technologies and tools combined with incentives and trusted advice provide an innovative “platform” for sustained engagement of diverse patient populations. © 2016 Walgreen Co. All rights reserved.
32. ©2016 Health Integrated. All rights reserved. Hosted By