Inspera Health, specializing in managing chronic conditions for high-cost claimants, collaborates with the Validation Institute to validate its health impact index. This partnership enhances Inspera’s credibility, showcasing its effective approach in healthcare outcomes and cost management. Through this validation, the company demonstrates its commitment to transformative health solutions and measurable impacts on patient health.
Key Takeaways from Inspira Health’s Approach
- Validation by Validation Institute: The Validation Institute has certified Inspira Health’s impact index, enhancing trust and credibility in their healthcare outcomes. This validation underscores the effectiveness of Inspira Health’s approach to managing chronic conditions.
- Focus on Multiple Chronic Conditions: Inspira Health targets individuals with multiple, simultaneous chronic conditions, often averaging around eight per participant. Their comprehensive approach addresses the complexity of each patient’s health needs, beyond typical single-condition programs.
- Innovative Measurement Index: Inspira Health has developed a Multiple Chronic Condition Health Impact Index that consolidates 12 different health metrics into a single, comprehensible measure. This index helps in accurately tracking and improving patient health across various domains.
- Long-Term Cost Management: By focusing on a demographic that is traditionally in the top spenders of healthcare services, Inspira Health aims to significantly reduce long-term healthcare costs. The company’s strategies are designed to stabilize and improve health outcomes, which in turn helps in managing and predicting healthcare expenses more effectively.
Introduction
Validation Institute:
I’d like to welcome Lee Murphy, founder and CEO of Inspira Health, to learn more about their organization and validation. Good morning, Lee.
Lee Murphy:
Good morning.
Validation Institute:
Nice to see you and it’s great to have you here today. Inspira Health focuses on high-cost claimants that generally have multiple, usually five or more, ongoing chronic conditions. These conditions range from hypertension and high cholesterol to asthma or anxiety and really all the way through to IBS, chronic pain, obesity, migraines, diabetes. I’m sure the list goes on and on. The Validation Institute recently validated Inspira Health multiple chronic condition health impact index. Can you talk a little bit about how Inspira Health measures its impacts?”
Lee Murphy:
Absolutely, thanks. The reason that we went to the Validation Institute is because if I was another Health Solution, most of the other Health Solutions focus on single conditions.
So if I’m diabetes, I’m looking at A1C; if I’m weight, I’m looking at weight; if I’m musculoskeletal, I’m looking at pain, I’m looking at range of motion, and things like that.
Our population is people with five or more simultaneous chronic conditions, and if you look at our participants, our participants actually average close to eight. So, when you think of people with eight chronic conditions, it’s like how do I measure impact, how do I measure the change, and everybody has a different combination of those conditions.
Granted, ninety percent of our population comes in completely sedentary; they’re overweight. What we were doing in the past was we had about eight different measures that we’ve been doing this 25 years so, you know, 15-20 years ago we had about eight measures and we were reporting out on each measure and it was too much for clients to make sense of.
So what we did, as we’ve expanded our repertoire of how we measure our impact, we now have 12 separate metrics that we use and we combine them into what we call an index, the multiple chronic condition health impact index.
That is a combination of biometrics, of lifestyle and behavior, of third-party instruments that we look to measure. So, what we did is we said, ‘What’s important?’ Well, what’s important is if somebody has diabetes, it’s an A1C score that’s out of range and can we get it back in range? What’s important is that if somebody is overweight, are they a BMI above a 30 and can we reduce that BMI? So what we did is we said for each of those 12 conditions and those 12 metrics are activity minutes, sleep, weight, those are all measured by Fitbit or Fitbit scales.
We’re trying to remove self-report whenever we can. We look at physical health and mental health as measured by the SF-36, a validated licensed instrument with probably about 30,000 published studies.
We use the patient activation measure, the PAM, looking at health activation, and then we look at blood pressure, total cholesterol, and blood sugar. We look at pain; that’s the only self-report, but that’s how pain is measured in a clinical setting also.
And then we look at social needs, and we’re using the CMS social needs survey to measure that. So if somebody is at risk, so somebody’s above the threshold in any of those measures, they get points in our index.
So if you’re at risk, you get between zero and five points; if you’re at elevated risk, you get between five and ten. So you end up with a composite score possible of 120; nobody has 120.
But what we then do is we say when somebody comes into our program at baseline, what’s their score? Then every quarter, we measure, every year we get updated biometrics, and so what we’re able to do is show a client that we’re improving the health of the population across these 12 domains, and in there, we include care gaps and we include following prescription protocols and all of that, that’s all part of engagement in our measure.
And if I can show the change, I know that long term I’m going to be able to impact overall health and overall cost. I can guarantee you that if on these 12 measures we’re not showing improvement, there isn’t any chance you’re going to get improvement in long-term health or long-term cost savings if the person’s not improving there.
The Validation Institute came in and said, ‘Okay, when we look at these measures, this makes a lot of sense. We will validate that improving these measures is a good metric to measure important health.
Overcoming Short-Term Cycles to Address Chronic Conditions with Inspira Health
Validation Institute:
So you spoke a lot about outcomes and obviously the cost savings which I guess would be secondary for an employer, right? So why don’t employers focus on the population that Inspira Health targets?
Lee Murphy:
That’s actually pretty easy to answer. Historically, nobody looks at claims data; nobody does data analytics that said, ‘What percentage of my population has five or more simultaneous chronic conditions?’ It’s a combination of medical conditions and mental health conditions.
People look for diabetes; they look for depression; they do start to look for some combinations of those, but it’s typically related around diabetes in some other case, musculoskeletal in some other case. They’re not looking for five.
We’re focused on those five conditions that when you change how somebody eats, how they sleep, how they move, how they understand their health, and how they engage and they deal with their mental health, they will all transform any of those conditions and so part of our mission is to actually to get people to just look at this and when you want to look at these conditions you have to break out of a 12-month physical cycle.
You are asking an organization to break out of 12-month fiscal cycle when all of their measures, all of their metrics, all of their bonuses happen in, happen to, or are related inside that 12-month cycle; it’s difficult.
But if you look at claims over a three-year period of time, half of the population that we focus on are in the top 10 percent of three-year spend, and ninety percent is in the top 20 percent. That’s where, when you really want to look at managing or looking at long-term cost, looking at this population becomes important.
Assessing the Long-Term Costs of Chronic Conditions for Employers
Validation Institute
So how much do these members with five or more chronic conditions cost employers?
Lee Murphy:
So typically, and we take out the shock claims before and after because that’s a regression to the mean look. So when I take all that out, if they’re going to average about $25,000 or $30,000 in claims in any given year.
If you look at the JAMA article, the Journal of the American Medical Association, they give a factor of if you have chronic conditions, you can add 55 cents for every dollar in healthcare spend for absence cost.
And so if you look at somebody with $25,000 or $30,000 in claims, they’re going to spend about $45,000 a year total. The average age of a participant in our program is 52 to 53 years old.
The average length of service is 15 years, so if you look at somebody if I go to our population that has seven or eight chronic conditions, they’re 53 years old, they’ve been with you for 15 years.
I guarantee you they’re not career mobile. They’re not looking for that next job. They’re spending their entire energy and focus hanging on to their job for their benefits because they’re sitting in a rolling series of health crises.
You’re going to have them on your plan until they’re eligible for Medicare. That’s 13 years, 12 to 13 years in the future. If you do the math and you add an inflation factor, you’re going to spend about $500,000 over the course of each individual’s career that’s left in your plan. That’s the measure when you look at why do you want to look at this population.
The other piece I think that’s important to know is that when you look at high-cost claimants, this is the only portion of high-cost claimants that I can proactively identify.
If I looked at your claims data, I could tell you who’s going to be in this high-cost group in 2027. You can’t do that for traumas or tragedies for people that are typically your high-cost spend.
I can do that because they’re in there now, they’re not going anywhere. That group will continually get bigger, but I can tell you who 80% of that group will be four years from now because they’re in that group today.
Validation Institute:
Thank you very much for the wonderful work you’re doing helping these folks and also helping these employers contain their costs. For everyone out there, I encourage you to learn more about InspiraHealth by reading their validation reported at validationinstitute.com. Lee, thank you so much for being here today.
Lee Murphy:
Thank you. I appreciate it. Have a great day.
