Town Hall Meeting

Remarks by Jill Berger

Town Hall Meeting at the AHRQ 2007 Annual Meeting

September 27, 2007

Good morning, everybody. I am delighted to be here. I can't tell you how meaningful it is both for me to see such a large room full of stakeholders and we're all speaking from the same page, which is great.

I'm here today to talk about how we at Marriott are trying to offer integrated health care that's driven by technology. Just to give you a sense of who we are, we actually just opened our 3,000th hotel in China, and in the United States we have about 2,000 hotels spread across the country. We cover about 75,000 associates; about 160,000 covered lives. It's a very diverse group of associates. So when you look at the fact that we are spread out like we are, and that we are a very diverse group of associates, we have our challenges. Because I think the importance of health care, of good integrated health care, is not only to talk about what providers need to do but also talk about what our members need to do.

So let me talk a little bit about our strategy. We, like a lot of other employers, feel like we have to offer benefits, because we want to be able to attract and retain talent. But like our brethren employers, like all of you out here, we're experiencing large increases in health care, and we just got our 2008 rate so... we hopefully are stemming the increase. With a lot of the programs that we have in place with the increases, is still pretty high.

One of the things that we have done in the past, as we have tried to mitigate the cost increases, is hit the plan design. You know, the best way to stem utilization is to increase co-pays. And I can tell you that works in the short term. But you won't be surprised to hear that it doesn't work in the long term. And one of the things that we have found out is that we have to become smarter as an employer about the plan design. Really, our goal is to make sure that we do what we can to bring a central care to our associates. So we're developing long-term strategies to manage the high-risk illnesses, to improve patient safety, and increase productivity. And I'm going to talk a little bit about ways that we're trying to do this.

The first thing that we have to do as we look at plan designs, look at our associates and bringing the central care to our associates, that's going to mean something different for our different associates. It's got to be patient-centered. And we have found that working with a high-tech company who can integrate our data and bring the programs to use that data is what we need to do. And we at Marriott partner with a company called Active Health Management. It really has helped when it comes to the integration of health care, because what they enable working our health plans, is they collect all of the data, all of our claims data, pharmacy data, lab, a good bit of our lab values. They put it in a system, but it's not just any system—it brings intelligence into data decisions, so it's not just a place to store but it's a place to use it.

They can take a look at the data, and they can run it up against medical intelligence and identify gaps in care and improvements so we can improve patient safety. We've actually been working with them for about the last 8 years, and the system has grown immensely. It's become a lot more robust, not only in what it collects, but in how we use the data.

One of the first things we did, and one of the first things that Active Health did, when they identify a gap in care that they communicate it to the physician. And you know, some of the feedback they got from the providers... I'm sure you can all relate to this: "Hey, you know I need to add that drug, but the patient won't come back into the office," or "The patient won't take it." And so one of the things that we added was, okay, we have this data on the patients, it's got to be sent to the patient. And so we started to do that, and now we're bringing the patient into the loop, and we can show evidence that that has improved compliance with the care considerations that Active Health generates. In order to do this, we also wanted to make sure that we had a system in place where if somebody received something in the mail that said "Hey you know, you are (and I'm not a clinician, so you can easily guess that), but you are a diabetic, you've been on a starter dose of Glucophage® for a year. Your hemoglobin A1c is still a big problem, you need to go back to your doctor and talk about the dosage of drugs, or whatever. . ." It's in patient-friendly information, by the way, and the information does go to the provider first. Sometimes that generates, what we're trying to do is generate proactive outreach to the member but also inspire the member to work as a partner with their provider. And they both have the same data to work from.

We formed a disease management company called InformCare Management, or Active Health did, where our members have someone to call. They have a health care coach, a nurse, who can help answer questions about their conditions, so it's part education, but more importantly they also teach our members how to become better partners with their provider. What are the questions you should ask? What are your responsibilities? Why aren't you following up on some of the advice your provider gave you? And arming them with this information and educating them and, again, it's a very diverse population, so we can educate them in many cases in the language in which they're comfortable speaking. It's very helpful. And then following each dialogue with a health care coach, they generate a very simple one-page sheet, which outlines the discussion. This is what we discussed and this is your homework, so to speak — go to your physician, get your cholesterol checked, ask these questions.

Arming the patient with this data, and it's data that has been integrated and bumped up against medical intelligence, has improved the system significantly.

So the next feedback that we got, that we started to collect, our health care coaches, for instance, talking to our associates, when the question came up that, you know, "Why aren't you more compliant with your meds?" The affordability issue came up. I can tell you that we have learned, as I'm sure you know, there are lots of barriers to why somebody isn't compliant. Some we can affect. We can affect the co-pays and make the drugs more compliant. And so we've done this—we call it our value-based formulary. We started with drugs related to diabetes, heart disease, and asthma, mainly because the medical literature says that if patients are more compliant, it's going to make them healthier, and it's going to affect the health care costs. And what we did is we reduced the co-pays. So, if it's a generic drug, we made them free. If it's a brand name drug, we cut the co-pay in half. And, again, this all is going towards our goal of how do we get the essential care to our members.

And so we started this, and the way we communicated it is Active Health, through all their data, identifies the members who are eligible for this reduction in co-pay, and by using technology, we're also making sure we're not incenting them to take a drug that actually is bad for them. Once they've identified the members, they send the information to our PBM, Express Scripts; also goes to Aetna, our health plan on the HMO side, and the information is loaded into the system so when our members go to the pharmacy, they get the reduction right there. It has been, I won't say easy to administer, because I'm sure Active Health and Express Scripts would disagree, but it has, you know, we've been able to administer it.

So, then we send a letter to the doctor saying, "Hey, by the way, we've reduced the co-pay." Active Health sends another letter to the member to remind them and to say "Hey, these drugs are now more affordable for you." And so that helps on the communication side.

We have been doing this for a couple of years now. We've looked at our data, and we know that probably what we're losing in co-pays, we're gaining back on the medical side. Without looking at disability and productivity, I think it's about a wash, we think. As the years go by, you know, we have a population where it takes several years to really get a message out that we're going to see even bigger improvements. So really we want to start bringing this value-based plan design in other places. So the next thing we did is, we look at our latest data and it's abysmal or it's not even—our data doesn't even come up to national averages, and our folks just aren't getting the preventive care they need.

A lot of this, it's an affordability issue, it's a cultural issue, it could be a language issue. And so, again, the easiest thing for us to address first was the affordability issue, so we've made preventive care visits, tests, all free to the member, so that it incents them to go. We're communicating the heck out of it. Both on the national level, as well as getting all of our hotels involved in communicating this. And hopefully what we're going to see from this is an increase in our folks getting preventive care.

We want to take this further, but I can tell you that when it comes to messing with the co-pay, that's much harder. And even though our folks have an ID card from, let's say Aetna, that says free preventive care, you know when they. . . providers are so used to billing, you know, putting in a diagnosis or taking a co-pay, that that's another kind of paradigm we have to break. You know, employers are starting to make this break. So we're working on that at the same time. We'd like to make office visits related to diabetes, heart disease, asthma, free so it goes hand-in-hand with our value-based formulary, but we haven't figured out how to do that yet. But actually, we're working with a number of large employers plus a number of health plans to figure that out. So we're just starting down this road of value-based plan design. We have a lot of work to do. You know, we're all going to have to make decisions of how do we bring the essential care that we need to to our members?

Again, use of a high-tech or partnership with a high-tech company that knows how to use the data, that bumps it up against medical intelligence, is, we've found it essential for us. Our next step is we are in the process of rolling out our personal health record, and it all comes under the theme of health care's everybody's responsibility and, members, we're going to arm you with as much information as we possibly can.

And it's a great system if our folks go on to use it. It's automatically populated with claims data. We're hoping to get other data from members when they log on. They fill out a health risk assessment, tell us about their smoking or their, you know, their symptoms of certain diseases that wouldn't be captured otherwise; the over-the-counter meds they're taking. This is all a journey for us, so while we're doing that, we're also teaching our members how to use a computer and how to be comfortable with a computer; we're making them available at our hotels. All in the name of trying to improve the way that health care is delivered. So, those are our challenges and these are our first steps in addressing it. But like I said, I think it's great that we're all here today talking about it. So, thank you.

Current as of July 2008