CIA Annual Meeting Session 3203 Measuring Wellness: The Issues? Tom Brogan President June 28 th,...
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Transcript of CIA Annual Meeting Session 3203 Measuring Wellness: The Issues? Tom Brogan President June 28 th,...
![Page 1: CIA Annual Meeting Session 3203 Measuring Wellness: The Issues? Tom Brogan President June 28 th, 2005.](https://reader030.fdocuments.us/reader030/viewer/2022032414/56649ee75503460f94bf776d/html5/thumbnails/1.jpg)
CIA Annual MeetingCIA Annual MeetingSession 3203Session 3203
Measuring Wellness: The Issues?Measuring Wellness: The Issues?
Tom BroganPresident
June 28th, 2005
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Ever evolving environmentEver evolving environment
• Labour shortages
• Changes to retirement law
• Two-tier health care
Court decision
Public opinion
Journalistic bias
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Health & WellnessHealth & Wellness
Health is a state of complete physical,
mental, and social well-being and not
merely the absence of disease and infirmity.
World Health Organization Constitution, 1948
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Wellness PerceptionWellness Perception
Survival
Freedomfrom
disease
Ability to perform daily
activities
Qualityof
Life
Shift aw
ay in
view
ing h
ealth
From
QUANTIT
Y to Q
UALITY
Measures:• Infant mortality• Life expectancy
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Wellness PerceptionWellness Perception
Survival
Freedomfrom
disease
Ability to perform daily
activities
Qualityof
Life
Shift aw
ay in
view
ing h
ealth
From
QUANTIT
Y to Q
UALITY
Measures:• Prevalence Rates• Incidence rates• Clinical outcomes
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Wellness PerceptionWellness Perception
Survival
Freedomfrom
disease
Ability to perform daily
activities
Qualityof
Life
Shift aw
ay in
view
ing h
ealth
From
QUANTIT
Y to Q
UALITY
Measures:• Productivity Loss• Absenteeism• Disability
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Wellness PerceptionWellness Perception
Survival
Freedomfrom
disease
Ability to perform daily
activities
Qualityof
Life
Shift aw
ay in
view
ing h
ealth
From
QUANTIT
Y to Q
UALITY
Subjective Measures obtained through questionnaires
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Measuring Quality of LifeMeasuring Quality of Life
• Quality of life measurements through structured questionnaires
• Various instruments developed:
World Health Organization: WHOQOL
EuroQol
SF-36, etc.
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Measuring Wellness:Measuring Wellness:Conditions do applyConditions do apply
• Current state of health
The ill - need treatment
The healthy - need prevention
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Top10%
=56%of
Cost
Cost ConcentrationCost Concentration
0%
20%
40%
60%
80%
100%
5% 10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Private Drug Plans 2004 ODB 2004/05
Cost per ClaimantPDP: $3,866ODB: $8,446
From most expensive to less expensive claimants
Source: BROGAN INC. Private Drug Plans Database
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Defining Wellness:Defining Wellness:Conditions do applyConditions do apply
• Current state of health
The ill - need treatment
The healthy - need prevention
• Age
• Economic status
• Location
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Is health care providing wellness?Is health care providing wellness?
• Drugs
Can improve wellness
Reduce morbidity, mortality
Provide economic benefits
Not the sole answer (perhaps not the most
important solution)
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$0
$10
$20
$30
$40
92/93
93/94
94/95
95/96
96/97
97/98
98/99
99/00
# Deaths
0
500
1,000
1,500
Drug Cost
Drug Costs Deaths
Reduced Mortality, HIVAIDSReduced Mortality, HIVAIDS
Source: BROGAN INC. Ontario Drug Plan
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Reduction in Hospital UtilizationReduction in Hospital Utilizationfor Asthma 1990-2000for Asthma 1990-2000
-61%
-24%
-48%
-70%
-60%
-50%
-40%
-30%
-20%
-10%
0%
Hospitalizations Days of Stay Avg. Length ofStay
% R
isk
Red
uct
ion
Source: Innovation Crossroads – The health and economic value of new medicines, GSK
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Age Standardized Mortality Rate Age Standardized Mortality Rate per 100,000 Men, Canada, 1969-1997per 100,000 Men, Canada, 1969-1997
0
100
200
300
400
500
600
7001
96
9
19
71
19
73
19
75
19
77
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
Cardiovascular Disease
Ischemic Heart DiseaseAcute MI
Source: The Changing Face of Heart Disease and Stroke in Canada, 2000
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Reduced Risk with 1% ReductionReduced Risk with 1% Reductionin Blood Glucose Levelsin Blood Glucose Levels
25%
16%
24% 21%
33%
12%
0%
5%
10%
15%
20%
25%
30%
35%
Anydiabetes-
relatedMicro-
vascularMyocardialinfarction
CataractExtraction
Retinopathy12 Years
Micro-albuminuria
12 years
% R
isk
Red
uct
ion
Source: Innovation Crossroads – The health and economic value of new medicines, GSK
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Age-standardized breast cancer incidence and Age-standardized breast cancer incidence and mortality rates, Canada, 1985 to 1999mortality rates, Canada, 1985 to 1999
2735
0
20
40
60
80
100
12019
85
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
Incidence Mortality
Source: Statistic Canada, Health Reports Vol. 15, No. 2
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Wellness…Wellness…Why should we care?Why should we care?
• Cost to clients, employers, society
Lost work time
Premature mortality, morbidity
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Burden of IllnessBurden of IllnessSelected Medical ConditionsSelected Medical Conditions
$0B $5B $10B $15B $20B
Cardiovascular Diseases
Musculoskeletal Diseases
Cancer
Injuries
Respiratory Diseases
Mental Disorders
Digeestive Diseases
Direct Costs
Indirect Costs
Source: Health Canada, 1998
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Wellness…Wellness…Why should we care?Why should we care?
• Cost to clients, employers, society
Lost work time
Premature mortality, morbidity
• Business opportunity
• Social obligation
• Urgent need
Cannot count on government
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Measuring Wellness…Measuring Wellness…It’s all a matter of perspectiveIt’s all a matter of perspective
• Employee
• Employer
• Insurer/Third Party Administrator
• Public sector health care system
• Recipient/Beneficiary: Age
Current health status
Socio-economic status, etc.
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GivenFrom
InsurerPerspective
How can you influence health?How can you influence health?
• Biological factors
• Lifestyle choices
• Environmental conditions
• Health care system
Prevention
TreatmentDeterminants of Health, Page 9, Romanow Report
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Health care componentsHealth care components ~ all as important ~ ~ all as important ~
Each condition requires different actions:
• Life-style choices:
Healthy living, smoking, obesity, etc.
• Physicians/Testing:
Compliance, early detection (ex. PSA)
• Drug therapy:
Ex. Diabetes, RA, High-Cholesterol etc.
• Hospitals:
Injuries, surgeries, etc.
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Role of InsurersRole of Insurers
• Break cost containment philosophy, silo
thinking: move to economic value
• Health & Wellness = more costs:
Tests, drugs, treatments, monitoring, etc.
More aggressive treatment
• Results hard to measure, benefits hard to
quantify
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Role of InsurersRole of Insurers
• Promote aggressive treatment
• Incentives for healthy living
• Incentives for prevention and early action
• Incentives for compliance
• More member education
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Wellness…Wellness…answering the basic questionsanswering the basic questions
• Wellness - operational definition required
• Philosophical issues
Investment or cost
Degree of intervention
• Wellness has economic benefits
• Innovative programs required - courage and
persistency demanded