By BETSY TAYLOR
Kathy Scarnaty, a 53-year-old from Mechanicsville, Va., has dropped 17 pounds in the past year. She always tried to eat right before her weight loss, but now has honed in on how many proteins, vegetables, fruits and carbohydrates she should consume daily. And she has really stepped up her exercise routine, with two cardiovascular and two strength training sessions every week.
Scarnaty's lifestyle changes are impressive, but, so too are the changes being made at health care systems to encourage them. Scarnaty's employer, Bon Secours Virginia, used a new health care model which helped Scarnaty and other employees assess and improve their health. At the Catholic Health Assembly in June, Stephanie McCutcheon, principal with Maryland-based McCutcheon and Co. — which provides services to assist large integrated delivery systems to progress to population health systems — and Dr. Molly Coye, chief innovation officer for UCLA Health, will discuss work being done at Bon Secours Virginia health system and UCLA Health with populations of health care system employees and their families. The programs encourage wellness, improve care coordination and reduce health care costs. Michael Spine, Bon Secours Health System vice president of business development, and Laura Ostroff, the system's vice president of benefits, also will discuss how the models and best practices in these efforts can be adapted elsewhere. The session is called "The Journey to Value-Based Care for Population Health: Sharing, Scaling and Replication to Accelerate."
Healthy incentive
In 2011, Richmond-based Bon Secours Virginia health system, which is part of Marriottsville, Md.-based Bon Secours Health System, began instituting a population health approach for roughly 9,000 employees covered by its self-insured health plan. Charlotte Perkins, performance management officer for Bon Secours Virginia, said the pilot program began to address rising health care costs and to prepare for a shift toward population health management. In the 2010 plan year, Bon Secours Virginia offered the pilot to employees covered on its health plan; in the 2011 plan year, the system added spouses to the program, and the intent is to add children into the program this year. As of last month, 4,271 people have taken part, Perkins said.
McCutcheon explained that under the value-based population health model, the system starts to work with people "as soon as they enroll in their health plan, rather than only when they show up at their doctor, or emergency room, or hospital." Bon Secours Virginia encouraged people to complete a health assessment, including a biometric screening — which is a screening to determine a person's risk level for certain diseases or medical conditions — and laboratory tests to provide more information about their risk factors for certain conditions.
The program design encouraged participants to take advantage of personal health coaching, primary care consultations and ongoing support for self-management of chronic conditions. In the program's first year, the system offered employees a $900 premium reduction if they had a personal health assessment, which already was covered by employees' insurance plan. Before the incentive, 45 percent of employees had the assessment, but after the pilot's first year, 95 percent had. In the second year, employees could receive additional $300 incentives for each of these milestones: completion of the personal health assessment and biometric screening, having a routine physical, and maintaining a body mass index of 27.5 or less.
The health coach talks to employee clients about their health status, offers support on achieving health goals and links them to a primary care doctor if they don't have one. The doctor receives the detailed assessments and tests in advance of meeting with the patient, McCutcheon said. From there, participants can opt into wellness programs to manage chronic conditions, reduce stress, lose weight or improve their physical fitness.
Message received
Scarnaty, who works at five Bon Secours Virginia locations testing for proper fit of medical masks, said her husband Joe's heart attack in March of 2013, at age 54, prompted both of them to look more closely at their health. "I thought, especially when compared to others' lifestyles, that we were doing the right things for our health," she said. The heart attack called that into question. Through the Bon Secours Virginia program, which is voluntary, she learned not just that her cholesterol was high, but specific information related to the size and type of cholesterol particles in her bloodstream. She was at greater risk for heart disease than she had realized.
She enrolled in a 12-week wellness program with a fitness trainer and nutritionist through Bon Secours Virginia. She lost about half of the weight while in the wellness classes, which ended in December 2013, and half on her own. She valued the education, resources and a support network of other employees as she worked to improve her health. "You don't (usually) have the opportunity to have all those things at your disposal. I was lucky to be part of the program. They were committed, and expected a commitment from me, and that was a big part of it."
Hot spotting
The system found that about 48 percent of its annual $75 million spending on employee health care costs was on about 400, or 4 percent, of its covered employees, which Perkins said was not uncommon for employers with large populations. Based on its findings from the employee health risk assessments, the system is focusing on four medical risk factors to improve population health: It encourages employees to lose weight in order to reduce BMI to 27.5 or lower, to become more active if sedentary, and to take steps to reduce hypertension and lower cholesterol. Beginning in 2011, the system also decided not to hire smokers. Employees who smoke can join smoking-cessation programs.
Bon Secours Virginia says its health care spend was $42.7 million, well below its projected $58 million in fiscal year 2012, and an actual decrease of more than $2 million from fiscal year 2011. The system has seen a drop in the number of employees in its high and moderate risk factor populations as people improved their health. Bon Secours Virginia saw hospital admissions of employees in its health plan decrease by 3 percent, emergency department visits decrease by 11 percent, and outpatient surgery decrease by 8 percent in fiscal year 2012.
Multiplier effect
During 2011, UCLA Health learned of the early progress being made at Bon Secours Virginia to improve employee health and partnered with the system to learn its approach and to develop its own version, Coye said. UCLA Health expects to meet its target of having 500 employees in its pilot program by mid-2014.
"Engagement rates for the health risk appraisal, biometric testing and health coaching plus primary care visits are in the 80 percent to 90 percent range, which is extraordinarily high for employer-sponsored wellness programs," explained Coye. She said data on potential savings attributable to the population health approach of the pilot should be available in a few months. "If they track with the rest of the utilization data, this should be a major success," she noted.
UCLA Health plans to expand its population-based health program to 15,000 employees in 2015. From there, the system will extend the program to include employees' families. Bon Secours Virginia and UCLA Health are organizing a collaboration of five to eight health systems focusing on employee health to share best practices.
During their assembly session, McCutcheon and Coye will talk about the innovation/transformation model Bon Secours and UCLA are using in their population health initiatives. "Because operational leaders and staff are fully involved in the design and implementation teams, the pilot projects can be rapidly scaled to full deployment once the initial pilots are completed," said Coye.
View a video of McCutcheon and Coye previewing their session.