Category Archives: Medications

A Game-Changing Predictive Health Risk Index

A Game-Changing Predictive Health Risk Index


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We’re all defined by numbers. Social Security number, age, height, weight, bank account, credit score. Each of them tells something about you now or in the past, but none of them can predict your future.

There’s a new kind of number that is designed to predict something – your future health. It’s HCMS Group’s Human Capital Risk Index® (HUI, patent pending). The HUI (pronounced “Huey”) score takes into account more than 300 variables, including how many and what kinds of prescription drugs you take, what medical diagnoses you have, your healthcare history, how much time you’ve lost from work, and other important factors like your job compensation.

There are many other health risk calculations available — for assessing your chances of having kidney failure, heart disease, cancer and other diseases. Health insurance companies and health benefits consultants are creating broader metrics, attempting to get ahead of medical costs. Most of these are based on healthcare claims data and specific disease factors.

However, the predictive powers of most disease risk calculators are limited, according to company benefit managers who’ve tried them. “It seemed like we were always looking in the rear-view mirror,” says one.

What sets the HUI risk index apart is that its design gives the number considerable predictive power, based on more than a decade of research using the HCMS Group’s research reference database of almost 4 million people covered by more than 1,600 employers. As a person’s HUI score rises above an average of 1.0 for the general population and approaches 2.0 or higher, the chances of a complex health situation and high medical costs increase dramatically, research shows.

HCMS researchers compared the HUI score with a common disease risk metric and measured each index’s findings against actual healthcare costs for the 12 months through July 2012. The HUI’s predictive power for health benefit costs for the entire population was almost twice that of the disease index. It was also superior in forecasting disability compensation costs for the 5% of patients who account for more than 50% of medical spending. And it was almost twice as accurate in assessing a person’s likelihood of being in the 5% high-cost group. (See graphic below.)

The difference lies in the HUI’s unique formulas. It gives full weight immediately to medical diagnoses rather than waiting for medical claims to materialize. Expenses for some diseases such as cancer accumulate over time and may show up months or years later. The HUI score also relies on a big-data reference database that includes much more than just healthcare claims, providing a more complete picture for the whole person.

The HUI score is as dynamic as a credit score. Just as people are able to repair their finances and improve their ability to borrow, new research is showing that patients who own their health by helping themselves through adopting healthier behaviors become better consumers of medical care and improve their HUI scores – and their health.

Predictive Power of Risk Index

 

*Based on an R2 statistical measure of significance used to assess predictive power measuring the relationship between risk score and total health benefit costs.
** Based on a pseudo R2 as measured from the logistic relationship between risk score and the likelihood of being high cost.
 
— By Robert L. Simison, HCMS Communications

On behalf of HCMS Data Analytics


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Can a Backache Be Contagious?


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Contagious BackacheIf you have a backache, a knee sprain, or some other injury to the body’s structure of bones, joints, and muscles, the risk that someone else in your family has such an injury rises by more than a third.

That’s what researchers at HCMS Group LLC discovered in analyzing healthcare data on more than 3.7 million people whose medical benefits were provided by more than 200 employers. They found that when a covered employee has medical costs for treating a musculoskeletal condition, there’s a 27% likelihood that a dependent will, too. That compares with a 20% risk for dependents when the employed family member doesn’t have such an injury.

Among dependents, the risk is higher for adults than for children, but the findings are consistent across all groups. (See figure 1 below.)

Likelihood of Dependent Musculoskeletal Cost

For more than a century, economists and psychologists have observed a contagion effect in social networks and workplaces. One 1996 study found that health symptoms often spread through groups of workers without any physical cause. In 2000, researchers, led by Dr. Hank Gardner,  the CEO and principal owner of HCMS Group, analyzed data on claims for workers’ compensation and family leave. They found evidence that workers learning from each other about the benefits fueled a contagion effect in filing of claims.

With respect to musculoskeletal conditions, multiple cases within a family can have significant cost ramifications. Average annual expenses for treatment of these conditions range from $500 to $55,087, according to HCMS Group research. The low end of the scale is for the healthiest 50% of the population. At the high end are those in the 5% of the population who account for 50% of healthcare costs. People in this group have an average of 10 other conditions, with several medications and specialists involved in their treatment. (See previous blog post. For information on HCMS Group’s 5|50 Solution™ designed to address this problem, click here.)

 

— Robert L. Simison, HCMS Group Communications

On behalf of HCMS Group Data Analytics

 

This is the final installment in the series on musculoskeletal discoveries. Please visit the links below to read the other posts in this series:

1. Musculoskeletal: Top Contributor to Total Claim Costs

2. Musculoskeletal Costs Nearly Twice that of Condition-Specific Costs

3. The $55, 087 Backache

 


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Video 5 of Hank Gardner’s Series: Human Capital Risk Index — Population Risk Stratification


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In order to manage risk, you need to be able to predict it. Health benefit costs continue to rise at an unsustainable rate. Thirty to forty percent of costs are driven by over-utilization and waste. This waste cannot be analyzed with reactive cost reports and analytics; you need a comprehensive, predictive risk assessment.

HCMS Group’s Human Capital Risk Index® (HUI) is the only leading risk score that predicts and measures human capital health and job performance risk (not just disease).

Built from our diverse research reference database of over 3.2 million individuals from over 100 distinct populations, the HUI takes various data types into account; it utilizes lost-time, medical, pharmacy, and compensation data in order to provide the best assessment of risk and predict high-risk/cost cases.

Our HUI is unique in the fact that it incorporates lost time data and enables our evaluation of a full spectrum of risk. Using lost time data allows us to predict progressive HUI scores before claims cost even come in. This foretelling risk index allows us to provide the right service at the right time without delaying cost-saving and risk-prevention opportunities due to a lag in claims data.

Learn more about HUI by watching the video below.


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The 5%: On more medications (Especially pain medications)


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The 5%

As we have shown in earlier blogs, “the 5%” is comprised of workers who are spending the most in total integrated benefits costs and are accounting for about 50% of all costs. On average, the 5% receive more than ten medications and see ten providers annually.

Because total benefit costs for the 5% are 20 to 30 times higher than the 95%, one can expect a higher rate of utilization in every area.

Pain medications are the most frequently prescribed class of medication.  Pain is not usually a unique condition, but instead a symptom of another condition or a result of a procedure.

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What makes a person expensive in healthcare? Not what most people think.


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A question from the audience last month: “We spend the most in healthcare on a small portion of really sick people. You don’t expect them to shop for care during an emergency do you?”

I was giving a presentation about the important role that cost-conscious consumers can and should play in healthcare. The person asking the question, as everyone could tell, disagreed with the idea. While I doubt anything changed her mind, her loaded question illustrates some common misconceptions in healthcare: 1) high costs are driven by catastrophic medical events; and 2) treatments for these severe conditions leave little room for discretion and often require quick medical  decisions.

In this context, it’s no wonder many people jump to an extreme conclusion when they hear the term “consumerism,” because they assume it means patients need to stop and compare prices in the height of an emergency. Continue Reading


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Paying patients to take drugs, or helping them make informed choices?


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It’s hard to imagine something scarier than a heart attack: crushing pain, combined with the realization that the organ you rely on to beat every second of every day is in trouble. Suddenly, you are mortal.

Many patients who experience a heart attack consider it a wake-up call, and a reason to take better care of themselves: “Maybe I should walk more and lose a few pounds.”  Certainly, for heart-attack victims who are prescribed a medicine to drastically reduce the chances of another heart attack, there is a strong motivation to take it.

But here’s the surprising part: often they don’t. In the year after a heart attack, only about 40% of patients take medications as prescribed (1).

Nudging people toward making good choices

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Note to consumers: the rules in healthcare are a little different


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Let’s say you’ve invented a new product. Before you can sell it, you need to figure out its price such that you maximize revenue without pricing it higher than your customers will pay.  If it costs more than similar products, you’ll need to figure out how to convince people to pay more for your product than they might elsewhere.  This is how healthy, rational consumer markets work, promoting innovation that balances cost and quality. To contrast, now imagine you’ve invented a new product in healthcare. Guess what?  You get to set the price without worrying what cost consumers will tolerate because they won’t be paying for it directly, and it doesn’t need to reflect how well the product works!

Because consumers don’t realize that the price of healthcare products and services is set very differently than prices in other markets, it leads to perceptions and behaviors that can be expensive and even dangerous.  Here is a personal example:

An older relative of mine, Gladys, came to visit last year.  While here, she became ill and I took her to my family physician.  Among other outcomes of the appointment was a prescription refill, which she took to the pharmacy.  Upon returning to my house, Gladys was clearly upset:  “Why did your doctor give me a cheap medicine?” “I’m sorry, Gladys, what do you mean?” “My doctor gives me the good medicine, the $60 one.” “Gladys, I think she gave you the generic; it’s the same medicine, it just costs less.” “If it was as good as my medicine it wouldn’t be so cheap,” she grumbled.

Gladys kept the medicine during her visit, but told me a few weeks later that the ‘cheap’ medicine didn’t work so she went back to her own doctor to get the “good medicine.”

Gladys is a strong believer in the axiom: ‘you get what you pay for.’  And in most other industries, Gladys would be right. Continue Reading


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In healthcare, why it is best that we choose for ourselves.


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Faced with a difficult medical situation, it is not uncommon for patients to ask doctors for advice.  But asking, “Doctor, what should I do?” is a very different question than, “Doctor, can you help me understand and weigh my options?” It may sound like semantics, but your involvement and participation in making personal health decisions can make a difference in your recovery.

A recent study showed that patients who make their own choices report better recovery than those for whom choices were made by doctors (1).  Regardless of WHAT choice was made, the patients who did their own choosing reported better physical and psychological outcomes; active choice-making had its own healing power.  It may also protect us from unwanted consequences.

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I have a Holiday wish: that we muster the courage to reign in national spending. Entry 13 – 2010


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‘Tis the season to wonder how to work off the extra pumpkin pie calories and pay off those Black Friday purchases! We know that a dollop of reality isn’t anyone’s holiday favorite,, but it may be timely for all of us to acknowledge the belt-tightening our country must face as we approach the New Year. If social spending cuts in England, Greece, Spain, Germany and other countries are any prediction (1, 2), some would argue that we are late in taking action. Is there hope that we’ll wake up and realize that now is the time to start trimming our national spending—even as we trim our tree—by making tough, necessary choices?

Consider some sobering facts. In the year 2015 (3):

  • Government spending (federal, state, and local) per capita will be over $25,000 per year.
  • Healthcare will become the single largest component of spending (besides interest on debt).
  • Spending will far exceed revenue leaving us with over $20 trillion in debt. Continue Reading

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