Marty:
Okay, let’s get started. Thank you all for taking time out of your busy schedules to join us here today for the Engagement Health Group’s webinar, on why most condition management is missing the mark. My name is Marty. And speaking for our entire team, we are so excited you join us here today.
Joining us here today is Jack Curtis, CEO and co-founder of EHG, and Dr. Jennifer Musick, President and also co-founder of EHG. We also have a special guest with us today whose company has benefited greatly from our solutions and we’ll introduce him to you a little bit later on. Before we get started, a couple of housekeeping items.
First, we will limit this webinar to 30 min. We totally respect, how valuable your time is.
2, we hope to leave about 5 min for questions at the end. If you have any, please submit them through the Q&A function and address them to the host. Finally, we are recording this so you will all receive a copy of this. Here’s today’s agenda. Starting with an introduction to Engagement Health Group that I will walk you through very quickly right now.
So, Engagement Health group was formed a year ago by the merger of Corporate Health partners, Jack’s organization, and Engagement Health Group, Jen’s organization. We now have over 40 years of combined experience and offer virtually every population health management solution available in the marketplace today. In terms of our differentiators, it really starts with our experience. We are true professionals. We know this industry inside and out and we’re able to help our clients. In terms of our portfolio again, we offer virtually every solution. Allowing employers to have a one-stop shop. Engagement is so important to us. Hence it’s the first word, the name of our company.
Let’s face it, without engagement, nothing else matters. The topic of today’s discussion in terms of condition management as well as critical care management we have an ROI of 301 and we will prospectively agree to that on proposals that we quote. So again, with me here in the webinar is Jack Curtis. He’s the CEO again and co-founder of He has a 20-year-long and distinguished career in the wellness industry at corporate health partners. Also with us is our president and co-founder as well, Dr. Jen Musick. Jen is a clinical pharmacist and she too has a 20-year-long career in the clinical management arena with health solutions. It’s now my pleasure to turn this over to Jack, who will review with you the problem with most condition manager programs. Starting with engagement. Jack, take it away.
Jack:
Yeah, thank you, Marty, and thanks to everyone who is participating today. We greatly appreciate that. As we stated in previous webinars the problem is that chronic disease is bad and getting worse. 6 out of 10 have it. In fact, 4 out of 10 have 2 or more. So, 90% of the health care claims are for people with chronic diseases where 60 to 80% aren’t proactively engaged in their health. The patient disengagement rate went up from 23% to 34%.
Which is about a 50% increase. And it’s reported that about 71% of patients Refer to let physicians just make their decisions for them. They just opt out and let the physician make their choices. The number of active patients has decreased from 51% to 44%.
So as a result, only 2 out of 5 people actively. Participate in managing their health.
Worse, there’s only 13% that are engaged in health insurance Disease Management Programs, and even worse, many are undiagnosed. Most of these care management programs are firing off of claims data. So what about all the people who never filed a claim? They’ve got ticking time bombs in terms of blood pressure, blood sugar, and so forth.
That hasn’t been caught and we try to catch those with screenings. So as Marty already said. It’s really about engagement. Without that, the solution doesn’t matter. But with engagement, not only are they engaged in the program, the population health management. But they also engage in other benefits and their work. And we can average 89% with our best-practice programming.
So what’s the engagement? What do we do about it? To achieve true engagement there are 2 different pieces to that.
The first is the best practices in relationship to program planning. The second is with relationship to the program delivery. So for program planning. We start with not being tied to the carrier. We’re agnostic, which is a good thing because so many people just don’t trust the health plan. We recommend visible, credible leadership support. Meaningful incentives. And not taking a one-size-fits-all approach. They don’t feel very special if you do that according to data that’s available, program objectives, and budget. It’s much more personalized and therefore much more engaging.
In terms of delivery. Comprehensive program promotion and member education. Multiple times multiple ways so that you attract everybody or engage everybody according to their way of learning or listening. A multimedia hands-on aroma process. Is important because it’s often that personal touch that makes the difference. Face-to-face delivery and advocacy, particularly with programs that have our coaches because they’re trained to build rapport and trust and draw people out. The best engagements achieved with condition management are part of a comprehensive program. Building a true culture of hell. So once you have an engagement then, you need to have an effective program to keep people in.
So with that, I’m gonna introduce my partner and co-founder. Dr. Jen Musick.
Jen:
Thank you, Jack. Before we go into the details of our condition management program, let’s talk about why it was created and how it’s evolved over the last 20 years. As a trained clinical pharmacist, I consider myself a wellness industry outsider. After receiving my Pharm. Degree from the University of Iowa I completed an ambulatory care community practice residency that really focused on community and commercial practice and condition management. The 3 things that I learned during my residency training that created my passion for starting health solutions are that healthcare is really good at taking care of us when we’re sick we have the best hospital, specialist equipment, etc. It’s not great at managing chronic disease. On the other side of the spectrum, wellness programs are really great at keeping healthy people healthy, educating the population, raising awareness, and preventing disease, but also not really great at managing chronic disease. Then I came across the Ashville project, whose data was, published the year I was a resident pharmacist in 2001. The Ashville project really validated that the pharmacists engaged in chronic disease management can not only improve health but deliver ROI.
So in 2004, I started health solutions using the Ashville model to solve the gaps in health care and wellness.
Our mission was and still is today to provide the right care to the right member at the right time by using a care team model that includes the member, their PCP, and our EHG clinical pharmacist. In 2007, we continued to evolve the program and improve the effectiveness of our disease management model. So in 2007, we integrated behavioral health coaches as part of the care team with the pharmacist, the member, and their personal physician to focus as intensely on behavior modification as clinical management. We had been monitoring and seeing measurable health improvement almost immediately when starting when starting health solutions and starting our condition management approach.
So in 2009, we began measuring the claims impact of our disease management coaching program, which was demonstrating results of 3 to one and even higher. So the disease management program had proven successful for high-risk members based on screening data from the time it really started. So in 2017, we began using data analytics to expand the target population. And include members with high-risk medical claims. So for example, members that have diabetes have gaps in care members, or the ones that have heart disease have gaps in care that they are spending $50,000 or more in claims. So we were really able to target the population and expand from just screening participants to members that were generating claims for chronic disease that we’re not participating in the wellness program. In 2022 we focused on improving the member experience. So while improving the effectiveness of our disease management model we launched our high-risk coaching kits, including the freestyle library as part of the disease management program to allow enrolled members and their care team to better measure monitor, and manage their chronic conditions.
So in 2024 and beyond where are we going? We’re looking forward to expanding the EHG care team model to include specialists like mental health counselors, which are already on staff, to include specialists like mental health counselors, which are already on staff mental health counselors, certified diabetes, mental health counselors, which are already on staff, which are already on staff mental health counselors, certified diabetes educators, and dieticians to provide a comprehensive approach to condition management. We’re also now working on integrating beyond that health coach kit. And really integrating device data right into the wellness portal for easy sharing of that biometric health data that’s being collected by the member with their EHG care team. So the EHG disease management model is a pharmacist-managed chronic disease management program that leverages a care team approach that much like the slide shows here includes the member, their personal medical provider, and our clinical pharmacist to improve health, reduce risk and cost.
By leveraging data from screenings and claims if they’re available medical claims, we identify members with uncontrolled chronic disease and or high-risk screening results.
And assign them to an EHG health coach and pharmacist to work with the participant and their personal physician monthly.
So a couple of key points there. As Jack mentioned, you know, a few slides prior, our chronic disease management model doesn’t just target members who are generating claims.
We’re also able to identify potential eligible members through high-risk screening data to really again expand that footprint of chronic disease management. Typical carrier chronic disease management. We also are looking for those that are uncontrolled, which is another key differentiator, right?
So we don’t engage members that are controlled. For example, for the members with diabetes on your health plan who are already doing the right thing, we don’t engage those members in our condition management program, unlike carrier programs that target all members with a condition. This really does help save employers time and money, managing risk to the health plan. Using this care team model we target members based on screening data and medical claims data, engaging their personal physician really is what allows us to generate that 3 to one return on investment for our employers.
The solution to success really is in the approach. So to take that care team Model and really dig a little deeper, let’s talk about what that approach includes. Our delivery model is personalized and one on one. Participants meet with their assigned health coach for confidential sessions every month and they complete an orientation session with their assigned clinical pharmacist for a medication review and then order their coaching kit.
The health coaches are responsible for developing relationships with participants, which really does help us Yield high participation, participant retention, and high engagement rates.
The health coach really provides lifestyle education, goal setting, support, and accountability through the condition management program. The clinical pharmacist develops relationships with the member, and the health coach, but most importantly, with a member’s personal physician, which helps drive rapport, and credibility with that personal physician on the members behalf.
The responsibility of the clinical pharmacist is really to work with the health coach, the participant. But again, as I mentioned, most importantly, the employee’s personal physician every month to provide Disease management and medication therapy management, providing observations and suggestions to the PCP to quickly get the conditions under control. This model also helps us quickly refer to other programs like critical case management if and when needed. The EHG care team is really able to provide high-risk members the time they need to effectively manage chronic disease, which is really what’s missing from the current healthcare system and structure, especially with the average office visit now lasting 7 min. The clinical pharmacist is really responsible for as I mentioned working with the health coach, the participant but most importantly the patient’s personal physician to provide what is needed through observations and suggestions and to the provider to really get conditions under control very quickly.
The clinical pharmacist’s goal is to fill the gap between the participant and their personal physician to ensure that the medications, prescribed are optimally meeting the needs and goals of care. To achieve this, we do believe it is important to develop an individualized patient-centered plan in collaboration with a participant’s physician that is evidence-based in cost-effective. We’re not looking to interfere with the patient-provider relationship or replace that PCP we’re looking to help support the patient through their journey and help bring information to the PCP between provider visits to again quickly get conditions under control.
So how do we do that? Our clinical pharmacists evaluate the appropriateness of the participant’s medications. We’re able to identify and resolve medication-related problems. We offer therapeutic recommendations to optimize medication regimens and those communications with the PCP. We’re able to help promote compliance techniques with the member and our health coach. Last but not least, we’re able to provide education to the provider and the participant about medications and how they impact overall health and well-being.
So we have a proven process that engages high-risk members and creates an effective care team with the member and their personal physician that results in measurable health improvement and reduced health risk and cost.
So this is kind of the phases of our participant journey shown here, but let me show you how we put this all together and how it feels to be a high-risk participant journeying through our EHG Condition Management Program. So it starts with education. So high-risk participants receive, you know, multiple approaches for outbound outreach. So that’s the first step that’s different in this process. It is outbound outreach to get members educated and enrolled. So what you can see here is Henry’s EHG health coach sees on the platform that he’s eligible for the condition management program as she perhaps for his upcoming education session.
During his appointment, Jane will discuss his risk factors with him and the benefits of the program during that appointment.
Henry is willing to give the program a try even though he’s already working with the doctor and isn’t quite sure how this can help support him further. But he enrolls so Jane goes ahead and schedules with Henry his first health coaching session and his orientation session.
So now we move into the enrollment phase of the journey. Henry has his coaching orientation session he learns about his coach and his pharmacist. They talk about, the coaching program details, and the schedule. They talk about what his goals are for the program cycle and they schedule him with his pharmacist. So now Henry has learned more about his coach and more about the coaching program. He feels better, but he’s still unsure if the process in the program can really help him. Now we move into engage. The first step in the engaged process is that Henry really completes his orientation session with his pharmacist. The pharmacist during that session is going to explain how she will be working with his personal physician on proper medication treatment and how she’ll be available to Henry as needed as well.
Henry now starts to feel better with the extra support but is a little concerned he’ll now be told what to do by 3 people. Henry, now again, has a scheduled coaching appointment. His monthly scheduled coaching appointment. So Henry now participates in his first official coaching session now that he’s been oriented and enrolled in the program. And so his health coach, Henry, and Jane review his biometrics. They start talking about the lifestyle changes that are needed, and that are impacting his chronic condition, and discuss goals and most importantly his motivation. That open dialogue between himself and his health coach really allowed Henry to begin accepting the help that’s being provided through the program.
Henry starting to feel better that he now has a team of advocates to help him manage his risk factors and his condition because it’s hard. Managing Chronic disease alone is really hard. So. He’s accepting of the help though he is still slightly hesitant, until he really starts to see improvements. So now we’re continuing to engage. Henry is in the health condition management program. Henry is now scheduled to engage with his EHG health coach monthly, so he has monthly Coaching appointments and he knows how to reach his health coach and his clinical pharmacist if he needs anything in between those sessions.
And then we move on to evolve. We let the condition management program go to work and his care team goes to work.
Henry continues to meet with his health coach monthly. They have established a great relationship while it’s been difficult to hear about the severity of a situation Henry remains open-minded to the lifestyle changes that his health coach is proposing.
He no longer feels like he’s being told what to do, but rather that his part of the team collaborating on what’s best for his life. During one of those coaching sessions, Janet, his clinical pharmacist identified some side effects that Henry is experiencing with his medications, Henry receives a call from Morgan, his health coach. She shares that they’ve collaborated with Henry’s medical provider on a new medication that won’t have a similar side effect profile. This seems doable to Henry and now he’s really starting to feel optimistic. Henry can now see how his health coach and his pharmacist coach work with him and his medical provider to move his coaching and treatment plan forward while also empowering Henry for long-term success. Toward the end of the program, the goal really is that Henry successfully completes his program, he remains engaged throughout the program at the end.
He has now, improved his biometrics, and gaps in care and proved that he has graduated out of condition management coaching and moved into behavioral health coaching to ensure that he continues on the right path. He’s feeling great and empowered to keep working with his health coach to stay on track and his condition managed on his condition management and to be well. One out of 2 people though will make progress, but may not completely resolve their risk factors. And so those members, you know, Excellent, make great progress but still have some work to do to really graduate out of the program. So another path for Henry might be that while making great progress, he needs to really stay enrolled in condition management to completely resolve his areas of risk.
So Henry Re-enrolls in the program because he’s seen the benefit to him so he continues to work with the team. And his personal position to get his chronic condition under control and most importantly prevent those complications. He does know that this is best for his best interest since he’s already felt the benefits of the program. So our condition management program delivers measurable results. High engagement, 75% or more enrolled members complete the coaching or enrolling the coaching program and complete the program at the end. They’re highly satisfied, 95% of participants are satisfied or extremely satisfied with the condition management program. 90% of it enrolled members improve their high-risk health factors and then again, cost reduction. There’s a 3 to one benefit to cost ratio, from cost avoidance, and one out of 2 members, 50% will completely resolve their high-risk health factors at the end of the condition management program. I can tell you of our successes all day long, but you must hear directly from a customer.
Employers in the United States represent a hundred 57 million covered lives so they can have a major impact on the health of their employees and their families. I’m going to introduce you now to a long-term client of EHG, providing coaching programs, specifically condition management to his employees and their spouses. But you can hear directly from him the impact his organization has made on the lives of his employees and their families.
I’d like to introduce to you today, Mr. Eric Vanlacher. He is in Clinton County, Auditor and Commissioner of Elections, and an ISACCA ISAC Board of Directors representative. Thank you, Eric, for your time today. Turn it over to you.
Eric:
Well, thanks, and thanks for allowing me to share this story. I hope it helps folks who are listening and participating today help them make their wellness decisions as they move forward too.
Yeah, so a few years ago we started our journey into a wellness program. You know, Clinton County has always been very active with risk management and we had a self-funded health benefits plan that we wanted to keep viable back then. So it was around 2014, 2,015. Our health benefits consultants suggested that we look at a wellness program. So besides, wanting to help our coworkers stay healthy. We were also facing increased insurance premiums and increased pharmaceutical expenditures. So we took some time to dive into what was causing those things and what we realized was that a lot of the medication expenditures we were incurring had to do with high blood pressure and diabetes.
So we knew at that time obviously a preventive program could help us lower that risk for our employees. Also for our health benefits program and about that time too through our health benefits program, we were working with a third-party case management that was helping our employees return to work from illnesses or injuries or they were even helping them a little bit with their chronic conditions. So we knew it was important that we find, you know, in a wellness program, something that would help stay with us and encourage us down that successful path. So we went out for RFPs and for the wellness program and what we did is besides the RFP, we we told all the participants who wanted to submit an RP, you have to come in here and also give us a presentation to the board that was scoring the RFPs.
And to be honest with you, it was very obvious at that time when we went through that process that health solutions were going to be our choice because it was just the focus that they put on the coaching and the continued programs that we knew through our case management through health benefits was really going to help our employees to improve their health. So, we’ve been with the program as Jen said since, 2,015, but we know we’ve done that because we know it’s been helping our employees, especially pay more attention to their health since we started this program 8 years ago, when we first started this program 8 years ago, the very first step was to just do a basic health screening for all those who wanted to participate and it was kind of eye-opening is that during that first wellness screening. We identified 3 of our coworkers who were diabetic, but they didn’t know they hadn’t been officially diagnosed because they weren’t seeing a doctor regularly and now they’ve they know that and now they’re getting what they need to do to manage that.
And so that was great for them. It just was incredible during that first screening. We sent 2 of our coworkers straight down the street, to the hospital to the clinic. Because at that time they were showing. Irregular blood pressure and hypertension issues. So, those stories got out in our organization and really woke up a lot of our employees to start paying more attention to their health care and doing preventative things that will benefit them and their families but it also has benefited their co-workers.
As we’ve been going through this, we have fewer sick days. It also helps our self-funded health benefits plan, which our employees do contribute to, which is all based on premiums. So it helps them that way too. And that’s all anecdotal information, but we do have some empirical information that’s shown us that our members’ collective stage 2 hypertension was cut by more than 50% since 2021. and our pre-diabetic went from 33% of those screened in 21 to 27% 2 years later. LDL cholesterol numbers from 21 to 23 and the normal range increase from 27 to 37%. Those in the top high or I’m sorry the too high range drop from 12% to 7%.
So those are the examples of what we’ve seen. And why we continue to stay in this program, and how it’s helped our coworkers and our health benefits plan.
Jack:
Thanks, Eric. That was very compelling. We appreciate it so much. You taking the time, to help us out today and we appreciate your leadership there within Clinton County. It means so much to hear from somebody who’s actually experienced the benefits. and Marty, thank you for sharing the voice of the customer from a participant’s perspective. And we’ve got lots more of those where that came from. In summary, we wanted to point out that it requires a very engaging and comprehensive approach. To make condition management effective.
True engagement is where it starts. If you don’t press toward that 75% that Jen mentioned you don’t get the people that are resistant to taking care of themselves. We feel like the secret sauce is having a trusted coach as an advocate for the participant. Which keeps them involved and gets them plugged into meaningful benefits that can help them with their condition. A lot of what they do is related to behavior modification because what causes much of chronic disease is behavioral and so if we address that and also the closing gaps in care is a behavioral choice we help them make a better choice.
Lastly, delivering that care coordination and MTM with our pharmacist is very key because it engages the PCP and forms that care team that gets optimal results. So bottom line, we’re just not gonna be able to manage health risk and healthcare costs sustainably without engaging and effective condition management. Coming up in February, we have “Your sickest members who are not getting the care they need”. This is 5% of your population that’s driving 60% of the cost and we’ll talk about how to get your arms around that. In March, we’ll talk about how to achieve and measure comprehensive population health management. Lots of numbers in there for those who like me love to go through the numbers. And then in May, we’ll talk about how to address the missing ingredient in population health management.
Thanks again for joining us today and Marty I’ll turn it back over to you.
Marty:
Wow. Great job, everyone. And Eric, that was truly inspiring. Thank you so much.
It looks like we do not have time to answer any questions. Again, we want to keep this to 30 min. We respect how valuable your time is. So just in closing, thank you so much for joining us. We will soon produce this recording and send it out to you all. and finally, as you can see, here at the bottom, my name, and email address. Please contact me with any questions or any help that you might need. We look forward to working with you. So have a great afternoon and thank you so much for your time.