# Presentation: 742220

## Jeff Rideout, MD, MA, FACP
Chief Medical Officer, Cisco Systems
(acknowledgement to P. Hymel, MD, Cisco Health and Wellness Medical Director)

March 13, 2007  

**Chief Medical Officer, Cisco Systems**
**(acknowledgement to P. Hymel, MD, Cisco Health and Wellness Medical Director)**
- March 13, 2007

- Employers Driving Healthcare:  Does It Help Activate Consumers and/or Providers?

**Notes:**
Corporations getting into the business of health - - health prevention, wellness, and – yes – care.
As healthcare executives this can look one of two ways – like a threat among many or an interesting business opportunity...
In the next hour, our intent is to talk about what some large corporations are doing, share Cisco’s story as a bit of a case study, and I hope hear from you about your perspective regarding this trend that is upon us...

## 45K+ employees in 80 countries; 20K at corporate headquarters in San Jose, CA
Average 5 years length of service; 93% retention rate
33% engineering/IT, 33% sales, 33% all others 
All connected to commoninternet tools
Nearly all are Cisco shareholders
Average age of Cisco employee is 38
18% of employees drive 81% of cost
Generous benefits, modest cost sharing

**Winner All 9 Years!**

- 45K+ employees in 80 countries; 20K at corporate headquarters in San Jose, CA
- Average 5 years length of service; 93% retention rate
- 33% engineering/IT, 33% sales, 33% all others
- All connected to commoninternet tools
- Nearly all are Cisco shareholders
- Average age of Cisco employee is 38
- 18% of employees drive 81% of cost
- Generous benefits, modest cost sharing

**Notes:**
2006 ranked # 11 – up from #25
Large purchaser of healthcare
Policy influence at the national and state level
Global perspective and competitive pressures
Technology enabled for most work processes
Familiar with and vested in the business and technical issues related to power of HIT 

## Most Cisco employees have low health risks...

- Employee Participants

- Employee Participants by Age & Risk

**Notes:**
Strategy # 1- 
Many of Cisco’s low-risk enrolled employees will tend to higher risk levels with time and age unless effective programs are employed, and employees are engaged in managing health – CIGNA/UHC

## .. but have real health issues

- Source: Cisco results obtained from WebMD based on HRA participants

- Prevalence of Risk Factors and Modifiable Health Conditions

**.. but have real health issues**

**Notes:**
We know significant opportunity exists for improvement
Americans could change personal health status dramatically with simple, practical, inexpensive and easily-understood actions such as
Increasing physical activity
Controlling weight
Quitting smoking
Behavioral changes would also improve the quality of life and have positive effects on job performance and morale
1 Pelletier B, Boles M, Lynch W. Change in health risk and work productivity over time. Journal of Occupational & Environmental Medicine 2004; 46(7): 746-754

## Lost productivity costs much more than direct medical costs

- 2005 health and productivity program costs

- 1Source: 2005 Cisco paid and incurred reports;  LTD and WC results include reserves for claims incurred in year

-  2005 gross health & productivity cost totaled $619.2 million

**Lost productivity costs much more ****than direct medical costs**

**Notes:**
Add definition for presenteeism

## Cisco Strategic Health Initiatives 2008-2009

- Develop more robust rewards for healthy behaviors
- Implement more sophisticated health coaching program
- Engage employees to be better health care consumers
- Support healthcare transparency
- Expand physician pay-for-performance (SVHIT with Intel, Oracle)
- Expand secure messaging program
- Build an onsite clinic that showcases 21st best clinical and IT practices

## SVHIT - Pay for Performance Links Employers and Providers 

**Collaborative effort started by employers in 2005**
**Selection of highest volume practice sites for Cisco, Intel, and Oracle employees in Silicon Valley**
**10 IPAs and multi-site medical groups invited--7 participating first**
**Incentives based on the NCQA Physician Practice Connections (PPC)  2006 standards**
**Each employer paying maximum of $50K to each qualifying group**
**Cigna adding to rewards**

**Notes:**
Sharon--Collaborative effort started in 2005
Initiative led by Cisco – then Oracle and Intel team
10 provider groups invited to participate; 7 accepted and are continuing with the program

##                      Linked employers and medical groups increase impact 

**All 7 groups receive rewards; 25 practices with more than 1,800 physicians recognized by NCQA**
**PPC recognition also counts toward California IHA P4P IT measures**
**SVHIT is Bridges to Excellence site; Cisco executive on BTE board**
**Next steps:  **
**Continue performance improvement**
**Add employers, providers**
**basic data exchange?**

**Notes:**
Sharon or Linda?

## SVHIT Results

**28%**
**Use of e-messaging**
**Care management process**
**Use of existing EHR**
**Medication lists**
**14%**
**Tracking referrals**
**Progress toward EHR***
**Streamlined patient work flows**

**57%**
**Reminders to patients**
**43%**
**Same-day appointments**
**Data mining **
**28%**
**Electronic Health Record**
**Disease registries**
**Reminders to clinicians**
**Post-hospital follow-up**
**E-prescribing, E-lab results and**
**	****E-radiology results**
**14%**
**Secure messaging**
**Post-visit follow-up**

*Source: On-line survey conducted by Gibson and Shelton, SVHIT, 03/07/2007*

**Provider groups added patient-centric capabilities to qualify for recognition...**

**...****and made improvements in services **
**and processes**

## Cisco-PAMF pilot proves  the value of secure messaging

- 87% reported spending less time away from work; strong preference for communicating in this way
- Speedy direct access to physician perceived as major benefit
- Employees avoided office visits, reducing company’s benefit costs by $14,536 in first year
- Secure messaging had positive impact on employee productivity, saving company $126,704
- ROI estimated to be greater than 4:1
- Pilot extended for another year; opened enrollment to all employees and dependents

**Cisco-PAMF pilot proves  the value of secure messaging**

**Notes:**
We recently worked with a company that wanted to demonstrate the effectiveness of secure messaging. The hypothesis was that employees who use secure messaging will not only have lower cost of care, but will be more satisfied with the healthcare benefits provided by the company. 
All 650 PAMF physicians, using PAMFOnline through MyChart from Epic, are participating in the service. 
More than 500 employees signed up to participate, and the company is paying their one-year, $60 subscription fee.

The study was completed in June 2006. Employees in the pilot reported increased satisfaction with their overall healthcare experience due to secure messaging. 
Physician-patient messaging helped reduce the number of hours they spent seeking treatment for non-urgent, routine  care, and therefore increased their productivity. 
Users also reported spending less time waiting in their physicians’ offices, with a corresponding decrease in interaction with office staff  and greater overall satisfaction with the office-visit experience. 
The company estimates a better than  4-to-1 return on  investment (ROI) for companies whose employees use secure messaging to interact with their physicians and manage their health.

The company in this engagement? Cisco.

NOTE:  To be conservative we limited the ROI calculations to two of three possible calculations: 1.  cost avoidance: savings related to avoided cost of office visits and 2.  savings due to increased productivity: hours saved times average Cisco employee hourly rate (loaded).  We did not include the third which is lost opportunity cost.  That is, the cost of an employee being unavailable to handle business or grow revenue.  While this is possible to calculate, we determined that the calculation is perform and harder still to explain and justify.  Additionally, the case is compelling without adding the complexity of the lost opportunity cost issue.  

Utilization of PAMFOnline Services: During the course of the year, there were 359 unique Cisco employees who logged onto PAMFOnline.  The number of log-ons varied during the year from a high of 1052 in March of 2005 to a low of 610 in September; the average number of logons per month for Cisco employees during the year-long pilot was 712.

## Employers as Health and Wellness Providers

**Employers as Health and Wellness Providers**

**Notes:**
Everything old is new again - - but this time with a twist.  
Cisco is working hard to not only control cost of care for its aging population – but also make headway in what we call value purchasing.  Making certain our dollars are spent on the right things for our employees so that the benefits include access, quality and an appropriate patient experience so that they are valued by our employees.
We are also intending to use what we do as an example for others as we use the setting as a showcase for the power of IT in enabling a seamless, patient-focused experience...
So let’s start with the Cisco story...

## Change the health management experience for employees
Customized services and location
Online processes and transactions
Electronic health management tools
Health coaching
Wellness programs tied to fitness center
Enable cost-efficient, convenient care; reduce benefit costs and increase productivity
Showcase Cisco technology and interoperability in a healthcare environment
Further distinguish Cisco in attracting and retaining top hi-tech talent

- Change the health management experience for employees
- Customized services and location
- Online processes and transactions
- Electronic health management tools
- Health coaching
- Wellness programs tied to fitness center
- Enable cost-efficient, convenient care; reduce benefit costs and increase productivity
- Showcase Cisco technology and interoperability in a healthcare environment
- Further distinguish Cisco in attracting and retaining top hi-tech talent

**Notes:**
We want to use the Health Connections as a demonstration showcase of how Cisco’s Technology can create a new healthcare delivery model.

Changing the healthcare experience for Cisco Employees
Online appointment scheduling; easy arrival registration and payment capability tied to employee badge
Paperless records – accessible anytime, anywhere
Convenient onsite pharmacy and laboratory

Providing a powerful demonstration for Cisco customers
Co-located, state-of-the-art employee health services including a clinic and fitness center 
Tangible example of Cisco’s commitment to its employees, the environment, the healthcare industry and the power of technology to change lives

Improving the bottom line for Cisco
“Healthy” vs. “sick” employees are 22% less likely to get injured on the job, 38% less likely to miss work, and 74% more engaged when they are at work – all leading to greater productivity
Significant Cost Savings – estimated at more than $1 Million after first year from pharmaceutical process changes and employee productivity enhancements – alone

Our intention is to be state of the art and innovative in every dimension; from the facility construction to the level of service to each individual  to the demonstration of this model to Cisco’s customers, both inside and outside the healthcare industry.
As a technology innovator, Cisco Systems is uniquely positioned to change the way we experience health care. We will create a best-in-class health care experience, that will lead to better health, greater productivity and lower health care costs. We will use our workplace results to inspire our customers and partners.  

## Slide 13