Welcome to Population Health, Structural, quote, Accountable, end quote, Care Approaches for Target Population. This is Lecture c, the business of population health. The objective for this session is to summarize the current state of the business of population health. Including the value statement, the sustainability of the population health management business, and the identity of key stakeholders. In a speech to the American Medical Association in June, 2009, President Barack Obama issued this competitive challenge. Quote, today, we are spending over $2 trillion a year on health care- almost 50% more per person than the next most costly nation. And yet, as I think many of you are aware, for all of this spending, more of our citizens are uninsured. The quality of our care is often lower, and we aren't any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do, end quote. The US spends more on health care as a percentage of gross domestic product than any other developed country in the world. In spite of these investments, Americans are obese, and millions suffer from preventable, chronic diseases. According to the Institute of Medicine, despite spending far more per person on health care than any other nation, the US ranked 17th (for men) and 16th (for women) in terms of life expectancy among 17 high-income countries. Population health from the employers perspective is very complex. Many of the determinants of health are affected both positively and negatively by employers. Who contribute substantially to population health by creating jobs and family income, setting employment policies. And influencing health behaviors through worksite cultures and safety practices. And these businesses are the purchasers of healthcare for their employees. Business leaders have tremendous incentives and compelling reasons to build cultures of health in the worksite and, therefore, in the community. Employers must develop strategies for work force and community health if they wish to maximize employees as a competitive asset. And remain competitive in the US marketplace and, indeed, in the global marketplace. To date, most companies have focused on investments that seek to meet health care and safety expectations. From providing basic health care services to employees, to reducing or mitigating the negative health impacts from company operations or product use. The nation's largest companies, however, face increasing pressure to improve health outcomes by promoting wellness and prevention. Primary, secondary and tertiary prevention not only for their employees, but also for the broader population that is impacted by their corporate actions. Stakeholders reflect a sphere of influence that extends well beyond a company's care employee base. The stakeholders are employees, the government, community organizations, consumers, and investors in a local market. Companies, therefore, are asserting much stronger roles in improving population health through prevention and wellness. Efforts have addressed employees, their customers, suppliers, local communities around the business, and the general public. And here are a few examples. Walmart has committed to providing greater access to affordable and nutritious food in areas composed of lower-income neighborhoods and communities. Kaiser Permanente is partnering with Home Box Office to raise awareness about the obesity epidemic in the US. As we discussed previously, there are tremendous incentives for employers to improve population health. If they improve the health status of employees, and therefore productivity, the impact is great on the employer's workforce. They can control direct and indirect costs to the employer. Indirect costs are absenteeism, disability, and presenteeism. Which is employees who show up to work but are not completely productive while they are present at the job. They can create both the image and the reality of a healthy community that helps recruit and retain workforce talent. Employers can increase buying power and consumption levels for business products by improving the health of the community. They can strengthen their own brand recognition within the community. They can generate positive feelings of civic pride and responsibility and of being a constructive member of the community. And finally, employers can create public and private partnerships and a multistakeholder community leadership team that can become the foundation for community-based collaboration and problem solving. Employers can form employer-based health coalitions. Community-based health improvement strategies can emerge from these employer-based coalitions. And have emerged during the past three decades. The purpose of the coalitions is to address rising health care costs through value-based purchasing. One such coalition is the Partnership for Prevention. Coalitions collectively represent employers and can provide more leverage on local health care delivery systems than any single company might. Coalitions now applying that same philosophy to influence strategies for broader community health improvement have been very successful. A couple examples of coalitions that have been very successful are the National Business Coalition of Health, the NBCH. They have formed partnerships that focus on cardiovascular health, diabetes, asthma, and depression, as well as prevention and wellness. The Florida Healthcare Coalition has also been very successful. They have partnered with the American Lung Association to bring asthma programs. Specifically, one asthma program called Open Airways, which is a school-based asthma risk assessment and health education program for children, to local schools. Wellness programs have become very common in the United States, where 92% of employers with more than 200 employees offered programs. Most frequently targeted behaviors are exercise, smoking, and weight loss. 63% of employers offered exercise programs to employees, 60% offered smoking cessation classes, and 53% of employers offered weight loss programs. However, participation rates in the programs are low. Only 20% of eligible employees chose to participate in employer-based programs. In terms of the impact the programs are having on the intended effect of increasing wellness and increasing health of the employed population. A summative review in the scientific literature provides evidence of positive impact for diet, exercise, smoking, and alcohol use on physiological markers and health care costs. Limited evidence for effects on absenteeism and mental health are seen from these programs. So wellness programs and population health programs have achieved a high penetration in the United States. The Affordable Care Act increases employer-based coverage and promotes wellness programs through many provisions. $200 million are dedicated to wellness program start-up grants for businesses with fewer than 100 employees. The Centers for Disease Control and Prevention (CDC) provides resources for evaluating employer wellness programs. The Department of Health and Human Services will award $10 million from Affordable Care Act funds to develop and expand wellness activities. Such as tobacco-free policies, flex time for physical activity, and health food choices in the workplace. The Affordable Care Act also raises the limit on rewards that employers are allowed to offer for those who participate in a population health program. There is significant and profound impact on businesses. The US business community competes in a dynamic global economy, now. The US has historically achieved success in the global market place by excelling at traditional measures of business performance. Innovation, technology application, production engineering, capital deployment, marketing, sales, distribution, and customer service. Increasingly, two factors put the US business community at a competitive disadvantage. And they are disease burden, such as obesity in the US workforce, and increases in costs, such as health insurance for employers. How well the US business community responds to the related challenges of improving health and transforming health care becomes a driver of market success and of America's future competitive and economic security. Do population health programs, and the benefit of those programs, justify the investment? Promoting population health and preventing disease unites the goals of improving health and decreasing health care costs. Whether wellness and prevention programs are cost effective or not depends on such factors as the cost of the intervention. The probability of the disease onset in a population. The effectiveness of the intervention. And the cost of the disease. Some preventive measures may be cost savings, while others may be more expensive than high-tech medical care for the disease. Employers are satisfied with the results of the program, though 50% of employers do not know their program's return on investment, or ROI. The peer-reviewed literature for return on investment is sparse, compared to the widespread uptake of wellness and population health programs Who delivers population health programs in the United States? Health insurance carriers, such as United Healthcare, offer programs through their company, Optum Health. Health care delivery systems, such as hospitals and clinics, offer population health programs. There are several wellness companies. Healthways, Corporate Wellness Solutions, WellAdvantage, and hundreds of other for-profit companies. Medical organizations, such as the American Lung Association, offer programs for asthma. And finally, public health agencies, such as the Department of Health, Aging, and Disability. Workplace wellness programs have achieved a very high penetration in the marketplace. 75% of employers with more than 50 employees are now offering programs, which equals 100,000 organizations. Uptake in smaller employers is reportedly much lower. Uptake is expected to continue to increase as programs become more comprehensive and more accessible for smaller workplaces. Employers are taking a long-term view on investments and returns. The Affordable Care Act will help sustain the trend of increase in programs as it is likely to increase employer-based coverage and employers' interest in cost-saving measures. This is a dynamic and innovative industry, and it has certainly outpaced its proof of concept. This concludes Lecture c of Structural, quote, Accountable, end quote, Care Approaches for Target Population. In this lecture, we discussed the business of population health. In summary, you have learned about the perspective of population health from the employer's perspective. Incentives for employers to improve population health. The business of wellness and population health. The impact on business. In summary, in this unit you've learned about the accountable care movement, clinically integrated networks, models of care, and payment reform. Population-based care management and the challenges of chronic care management, the role of social and community factors, and how health IT can be effective for improving population-based care management. And finally, you've learned about the business of population health. The value proposition, sustainability, and key stakeholders of the business of population health.