First year results of an innovative new program to help City employees and their families live healthier were presented to City Council. Reported by City of Portland Human Resources staff and Moda Health, promising results of the Healthy Foundations program - such as a 50% reduction in Emergency Room visits - highlight a model that other employers could adopt to empower their employees to take steps to improve their health while reducing future health care trends.
For most health plans, a small percentage of enrollees require a lot of health care. This means spending on care for less than 5% of individuals accounts for about half of the total amount spent on all health plan participants. Moreover, the individuals in this group are often grappling with multiple chronic diseases. Chronic diseases are increasingly pervasive and expensive, but managing them with simple and consistent steps can yield significant health improvements and cost savings. Identifying those individuals with chronic diseases is a strategy health insurers and providers are calling “hotspotting,” and the “hotspotters” approach one of the models used for the City’s Healthy Foundations program.
In the City of Portland’s CityCore plan administered by Moda Health, almost 48% of the total dollars spent in the last five years has been for individuals with claims over $20,000. The exact number of people with these very large claims varies, but the percentage ranged from 3.4% to 4.1% of those covered by the plan. Healthy Foundations seeks to improve the health of this relatively small group of people by offering comprehensive mobile chronic care management and personalized prevention and wellness goals.
The first year results are very encouraging. In addition to a 50% reduction in ER visits, 59% of people in the program lowered their prospective risk score. This is a positive outcome not just because participants have reduced their risk scores but because a person’s risk score tends to increase over time as they age. Participants of the program also increased their use of preventive care methods, including the number of prescriptions. This makes sense since provider interventions had failed prior to participants’ enrollment in Healthy Foundations. Overall, two-thirds of the active group in the program used less benefit dollars than in the prior plan year. All participants felt their health and quality of life had improved.
I’m thrilled the City is taking an innovative approach to employee wellness, and I’m grateful to the Moda Health team for their enthusiastic collaboration on the Healthy Foundations program. I look forward to continuing to work with my colleagues to identify other ways the City can get more from the health benefits we provide our employees. Good ideas are worth sharing, and I hope other local employers will take note of the City’s innovations and actively engage in driving changes that reduce their own health care trends, leaving more money in their employees’ paychecks and improving the overall health and vitality of our community.
For more information on the City of Portland’s Healthy Foundations program and to read the first year report to Council here.