Changing Employee Health and Cost Trends Using an Innovative Approach to Care Management

Cammack Health shows industry-leading results in a white paper, Reversing the Trend: Changing Employee Health and Cost Trends Using an Innovative Approach to Care Management, just released.

The study shows a reversal of the troubling trends uncovered in the 2011 issue of Cammack Health’s annual Benefits Survey of Hospitals, which revealed that Montefiore’s per employee per year (PEPY) health plan expenses and utilization were above average for New York hospitals. The solution, as the study shows, arose from a partnership between Cammack Health, Montefiore Health System’s Human Resources department, and Montefiore’s nationally recognized Care Management Organization (CMO). The results demonstrate that the creation of the Montefiore Employee Care Guidance Program (Care Guidance), along with health plan design changes, substantially cut costs while improving member health.

In 2011, Montefiore’s per employee per year health plan expenses were $12,475 vs. $11,982 for the New York hospital average. In addition, their utilization was also above average and its members cost share was below average.

In order to reverse these trends, Montefiore, CMO, and Cammack Health leveraged the CMO’s existing care management model to create the Care Guidance Program. The goals of this program were to educate and encourage health plan members to make healthy choices, assist members experiencing significant health issues to navigate the healthcare system, identify members at risk of health problems early and guide them to wellness programs, and reduce costs by improving health trends and encouraging members to seek care within the Montefiore Health System.

The Care Guidance Program is a voluntary “opt in” program available to everyone covered by the Montefiore health plan and provides health education care coordination and disease management. The program is largely telephonic with some on-site services and participants work closely with a Personal Health Nurse. This designated healthcare professional works with participants to guide them to the most appropriate healthcare resources, to encourage medication compliance, and promote other healthy behaviors.

“We understood some people might view this kind of program cynically, as simply a means of managing claims. But it’s not being done by the claims administrator; it’s being done by a separate entity,” explains William Shanahan, former Vice President of Human Resources at Montefiore. “This, plus the fact that the program is voluntary, sends a clear message to employees that the program is here to help you and your dependents, not to mandate you to do anything. From what we’ve heard anecdotally, this approach has worked to reassure people.”

Anne Meara, RN, Associate Vice President of Network Care Management, adds that, “The concern was that people would see the program as Big Brother or invading their privacy. Yet the majority of people we contact are very appreciative of an offer for help. The program has generated significant goodwill, positive word of mouth and even referrals from coworkers participating in the program.”

Key figures from the study include a decline in Montefiore’s per employee per year costs from $14,899 in 2012 5o $13,853 in 2014. Engaged membership lead to significant and positive changes, such as claims cost being reduced by 10.8%, utilization reduced for key categories, including a 19.6% reduction in inpatient admissions, 26.7% reduction in non-maternity-related inpatient admissions, and 13.$% reduction in emergency department visits.

About Montefiore Health System

Montefiore Health System is an academic medical center and integrated delivery system serving residents throughout New York’s Bronx and Westchester communities.

Montefiore’s employee health plan has been self-insured for more than 25 years and covers 20,000 employees and dependents, including management, clinicians, nurses, and support staff.

About Cammack Health LLC

With the shift from pay-for-service to pay-for-performance reimbursement, healthcare organizations must fundamentally transform how they deliver care. Success requires real behavioral change—on the part of health system leaders, caregivers, and healthcare consumers. It’s a complex challenge. Where do you start?

Cammack Health has been working with hospitals and health systems to improve their performance and efficiency since long before the term “accountable care” was coined. Our in-depth understanding of the complex dynamics of healthcare delivery, utilization, and reimbursement enables us to provide practical solutions that make a real difference.