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Sharon - Consumer Driven Healthcare Success Factors
 

Sharon - Consumer Driven Healthcare Success Factors

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    Sharon - Consumer Driven Healthcare Success Factors Sharon - Consumer Driven Healthcare Success Factors Presentation Transcript

    • Consumer Driven Healthcare Success Factors August 30, 2010 C. William Sharon, CEBS Leah Martorana National CDH Practice Leader Benefits and Compensation Aon Consulting Administrator Fowler White Boggs P.A. 1
    • Agenda • Aon’s Perspective on CDH Success Factors • Case Study: Fowler White Boggs P.A. 2
    • Aon CDH Experience CDH Breakdown (By Type Plan) Expertise 4% 2% • 350 CDH Clients • HRA and HSA plans 7% • Total replacement and slice 11% – 279 “slice” offerings – 71 full replacements 39% • All major CDH vendors – Aetna – Anthem 36% – BlueCross – CIGNA – Humana – United Healthcare • Aon’s plan in place 10 years HRA = 137 HSA = 127 HRA full replacement = 38 HSA full replacement = 26 HRA and HSA = 15 HRA and HSA full replacement = 7 3
    • #1: Consumer Engagement….Not a Plan Four key building blocks for an • Consumerism effective program: – a set of techniques designed to transform members to be more Account Based Consumerism effective health care Health Plan Tools consumers • Consumer driven healthcare (CDH) – consumerism using an Wellness DM account-based (HRA or Incentives Incentives HSA) plan design 4
    • Behavior Change in Three Areas Value Purchasing Improved Health Manage Chronic Ask price of service Use preventive Use disease Consider alternatives benefits management Complete health program Research doctor and hospital quality assessment Follow evidence Reduce weight based guidelines Use generic Rx Stop smoking Use a premium Urgent care vs. ER doctor Outpatient vs. Manage stress Maintain personal inpatient Get biometric medical record Online consultation screenings Use medical home Retail health clinics Use online health coach Use center of excellence 5
    • #2: Design CDH Plan Right • Employees don’t want a “High Deductible Health Plan” • Actuarially equivalent CDH plan • Meaningful employer provided account value • 100% preventive services • No copays • Attractive out-of-pocket maximum • The greater the CDH plan enrollment the better the savings 6
    • Employee Employee + 1 Family Employer $750 $1,500 $2,250 Account Preventive Care covered at 100% Member $750 $1,500 $2,250 Responsibility Deductible $1,500 $3,000 $4,500 Employee 20% in-network Coinsurance 40% out-of-network Out-of-Pocket Maximum $2,000 in $4,000 in $6,000 in $4,000 out $8,000 out $12,000 out Employee Contribution Wellness Incentive to complete health assessment, comply with DM program, no tobacco usage, etc. 7
    • #3: Long Term Strategy • Consumer behavior change does not happen overnight • 30+ years of managed care to overcome • Requires senior management commitment • Measure consumer engagement metrics • Modify plan design, wellness/DM incentives and employee communications every year or two based on consumer engagement metrics 8
    • Managed Care Consumerism Health plan and provider Participant and provider control utilization manage care More “skin in the game”; Pre-paid health plan; low health insurance to protect copays against risk Plan restrictions such as pre- authorization and step More participant control therapy Strong DM and wellness Minimal DM and wellness; programs with strong no incentives incentives Large network but Large provider network encouraged to use premium providers 9
    • Wellness Financial Incentives Continuum Less intrusive Most aggressive Undefined/lower ROI Measurable/high ROI Reward for Reward Based Reward for Reward for Activity On Risk Achievement Adherence • $ for completing a • Waived co-pays on • $ to maintain low • Lower premium for health assessment diabetes medication cholesterol non-smokers • $ for enrolling in a • $ for colonoscopies • $ to reduce cholesterol • $ to maintain a target chronic disease • 100% benefit for 10 points BMI for 12 months management program compliance with EBM • $ to stop smoking • $ to maintain low blood • $ for completing an care • $ to maintain BMI below pressure for 12 months online or telephonic • 100% benefit for 25 wellness program preventive care • $ to hit biometric • $ for participation in screening results biometric screening • Reduced copays for use of high quality providers 10
    • #4: Consumer Friendly • Simple plan design • Single “sign on” for all consumerism tools – Account, medical, Rx, wellness, and DM • Integrated administrative platform – Account, medical, Rx, wellness, and DM integrated • Visible and understandable wellness incentives • Easily accessible wellness and DM programs 11
    • #5: Employee Communications • Requires comprehensive employee communications campaign • Small group employee meetings work best – Led by trusted, credible meeting leaders • Management support necessary • Employees will be skeptical of the new program • Key employee communication tactics: – Claim examples – Online plan selector tool – What’s in it for the plan participant? 12
    • Potential CDH Program Results • Reduce health care cost trend rate without cost shifting to employee • Reduce utilization of unnecessary services – Fewer office visits, fewer scripts • Lower cost treatment setting – Generic Rx instead of brand – Urgent care instead of ER – Outpatient hospital instead of inpatient • Increase in preventive services usage • Improved wellness and DM participation 13
    • Potential CDH Program Results 100% $$$$ CDH Enrollment 80% 60% ss v viing ng 40% Sa a mS m ris er i s me 20% su m u C Con s on 10% 5% Preventive HA Web DM Generics PHR Benefits Tools Consumer Engagement 14
    • What is Current CDH State? • 18 to 20 million CDH members – 500,000 CDH members in 2003 • Growing 20-30% per year – Increase in full replacement CDH • 45% of Fortune 500 have a CDH plan • Four drivers of CDH growth: – Consumerism “tipping point” – Double digit health care costs – Down economy – National health reform limits cost shifting and eligibility exclusions 15
    • Next Generation Consumerism • Expanded wellness/DM incentives • Medical home – Holistic primary care • Onsite clinics with wellness/DM focus • High performing networks – Steering members to best cost and quality • Medical tourism (domestic and international) • Centers of excellence for specialty services such as bariatric surgery, transplants, cancer, etc. 16
    • Fowler White Boggs P.A. CDH Case Study Leah Martorana Benefits Administrator 17
    • Why Consumer Driven Health in 2006? • 450 employees – White collar, professional, busy, minimal “self-service” • Traditional HMO and PPO plans with 50/50 enrollment • Costs increasing 14% per year from 2002 to 2005 • Low consumer engagement – Low usage of preventive services, online health assessment, web tools, etc. 18
    • Consumerism at Fowler White •2006: Implemented Consumer Driven Health Plan •2008: Eliminated HMO •2009: Introduced Healthy Pledge Premium Differential •2010: Added New HRA plan •2011: Elimination of POS Plan 19
    • New HRA Plan in 2006 • Plan design actuarially equivalent to HMO – Rich by competitive standards • 100% preventive services • High HRA fund of $1,000/2,000/3,000 • 100% coverage after deductible • Slightly lower employee contributions made the HRA plan the “best deal” 20
    • HRA Plus vs. HRA Basic Benefit HRA Plus Plan HRA Basic Plan (NEW for 2010) In-Network In-Network Fund (firm pays) $1,000/2,000/3,000 $500/1,000/1,500 Deductible (before fund) $2,500/5,000/7,500 $2,000/4,000/6,000 Out of Pocket Max (before fund) $2,500/5,000/ 7,500 $3,000/6,000/ 9,000 Physician Visit 0% AD 20% AD Hospital Inpatient 0% AD 20% AD Hospital Outpatient 0% AD 20% AD Urgent Care 0% AD 20% AD Emergency Room 0% AD 20% AD Preventive Care 0% 0% Rx Retail 0% AD 20% AD Rx Mail 0% AD 20% AD 21
    • Post 2006 Changes • No changes to HRA plan in five years • Eliminated HMO and changed to Aetna in 2008 • Added wellness incentive in 2009 – (1) health assessment, (2) no tobacco, and (3) DM – $9/14/20 bi-weekly contribution differential • In 2010: – Added second “low option” HRA Basic plan – Increased wellness incentive to $20/30/40 – Added spousal surcharge – Liberalized 100% preventive service guidelines 22
    • Integrating Consumerism and Wellness • Wellness shown to yield $3 return for each $1 invested* • Ongoing Wellness Events/Programs at Fowler White: – Boot Camp – Yoga – Start! Walking Program (over 50% participation) – Biometric screenings – Lunch and Learns – Health & Benefits Fair – Smoking Cessation Program – Healthy Pledge Premium Differential – Wellness Committee Meetings – Executive Physical Reference: Adapted from WELCOA. (2006). Planning wellness: Getting off to a good start, Part I. Absolute Advantage (5)4, p. 1-92. 23
    • Fowler White Successes • CDH enrollment has increased each year since inception • Recipient of American Heart Fit Friendly designation (‘07, ‘08, ‘09, ‘10) • Winner of Jacksonville’s Healthiest 100 Award • Named one of 15 Fittest Companies in America by Mens Fitness in ‘08 • Tampa Bay Business Journal’s Healthiest Employer contest finalist 24
    • Financial and Engagement Results • Before CDH/wellness program – 14% per year cost increase average from 2002 to 2005 • After CDH/wellness program – 6% per year cost increase average from 2005 to 2009 with minimal plan design reductions – Current PEPM ($760.04 as of 7/10) is less than PEPM three years ago ($774.76 as of 7/07) – Increase in web tools usage – Increase in preventive services usage – Increase in generic Rx usage – Increase in wellness pledge (76% of participants) – Increase in wellness program participation 25
    • Fowler White Learnings • Culture can’t be changed overnight • Senior management support is a must • Enthusiasm for Wellness Program is contagious! • Communication is key - Employee Presentations - Emails & Pre-Enrollment Newsletters - One-on-Ones - Post Enrollment follow up Q&A • New Hire on-boarding is critical 26
    • Questions? 27