Healthcare Benefit Cost Strategies for 2012
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Healthcare Benefit Cost Strategies for 2012

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  • High claim years are going to happenShow chart and stats
  • Network discounts Goal is to compare the cost for the same service at the same facility by the same providerNeed a fair representation of servicesInpatient facilityPrimary care and specialist services (surgeons, anesthesiologist, radiology, oncology)Many problems with vendor responsesProvide average cost within areaProvided lowest cost of all providers in areaMay not reflect severity of illnessConfidential informationIndependent audit to verify accuracy
  • Network discounts Goal is to compare the cost for the same service at the same facility by the same providerNeed a fair representation of servicesInpatient facilityPrimary care and specialist services (surgeons, anesthesiologist, radiology, oncology)Many problems with vendor responsesProvide average cost within areaProvided lowest cost of all providers in areaMay not reflect severity of illnessConfidential informationIndependent audit to verify accuracy
  • Newer contracts are less generous to PBMMore transparency
  • What do you know about your risk pool?High risk: diabetes, high blood pressure, obese, smokersIndustry and age implicationsWhat happened?Heart attack Knee replacementHow is compliance with preventive screenings and medications?
  • Plan designHigh deductible plansValue based designsTargeted limitationsEligibilitySpousal carve-outs for working spousesDependent auditsPreventive approachesIdentify potential problemsOnsite clinic
  • Very common Shift benefit cost to employeesChart on how many are affectedDecisions to makeComplete replacement of existing option or new optionIncentives to elect high deductible optionLower employee contributionsEmployer contribution for HSA or HRAStatistical data is starting to show behavior modificationsDesign attracts all types of employees
  • Ok to use higher or lower benefits to steer utilization towards low cost providersExamples: MRIs and X-rays, dialysis, oncology servicesKeep generic Rx copayments low while increasing brand copayments
  • Visit limits are ok and dollar limits are notMore flexibility for benefits not part of “essential benefits” definitionExamples Limit of 15 chiropractic visits$10,000 limit for sleep disorders (if not part of essential benefits)Definition of appropriate emergency room usage and higher copayments for ER visits.
  • Spousal carve-outs for working spousesConsiderationsIs the other coverage comparable Is the other coverage affordableHow do you enforce it?Dependent auditsEasy financial decision when the expected savings is more than the cost of auditOne employer defaulted to a “not covered decision” if the employee did not respond to the request for data.
  • Identify potential problemsFlag problems before they become larger onesFlag noncompliance in medication usage for chronically sick.Methods includesHealth screeningsAllow spouses to participate as wellCompliance with age-appropriate guidelinesData mining Rx usage Q for Gomez – what do you once you identify the sick person?
  • Conceptually good idea if goals can be meetLower cost of services compared to using existing network of providers (hard dollars)Improvement in clinical measures because of easy access (soft dollars)Reduced out of office time (soft dollars)Other considerationsMore face time with doctorsAbility to add wellness coachingAbility to monitor health of chronically sick membersNot cost efficient for smaller employers
  • Because rates are averaged over two years, it will take a couple of years for costs to declinePlans will likely see high requirements drop quickly to zero within a few years of rates increasing
  • Areas of Expertise Include: Cash Balance Plan Defined Benefit & Pension Defined Contribution & 401(k) Employee Stock Ownership Plan (ESOP) Flexible Spending, HRA & HSA Healthcare Actuarial ConsultingLearn more at www.nyhart.com
  • Areas of Expertise Include: Cash Balance Plan Defined Benefit & Pension Defined Contribution & 401(k) Employee Stock Ownership Plan (ESOP) Flexible Spending, HRA & HSA Healthcare Actuarial ConsultingLearn more at www.nyhart.com

Healthcare Benefit Cost Strategies for 2012 Healthcare Benefit Cost Strategies for 2012 Presentation Transcript

  • Strategies & Opportunities to
    Lower Your Healthcare Costs in 2012
    Presented by Randy Gomez, FSA
    www.nyhart.com
    Copyright 2011. All Rights Reserved.
  • Randy Gomez, FSA
    Senior Healthcare Actuary
    randy.gomez@nyhart.com| (317) 845-3595
    Qualifications or certifications:Enrolled Actuary; Society of Actuaries Fellow; Member of the American Academy of Actuaries.
     
     
  • Agenda
    • Know your plan
    • Cost Based Strategies
    • Design Based Strategies
  • Know Your Plan
  • What causes higher medical costs?
  • Best Practices for Ongoing Analytical Services
    • Benchmarking against norms for larger risk pools and the plan’s own history
    • Information on cost and clinical outcomes
    • Action steps
  • Cost Based Strategies
    • Evaluation of network discounts
    • Evaluation of administrative expenses
    • What is your data telling you?
    • Raise employee contributions
  • Network Discounts
  • Administrative Expenses
  • Prescription Drug Contracting
    • What do you know about your risk pool?
    • What happened?
    • How isyour compliance with preventive screenings and medications?
    • Key questions
    What is your data telling you?
  • Raise employee contributions
    • Benchmark against norms
    • Incorporate wellness incentives
    • Surcharges for working spouses
    • Incremental contributions for multiple options
  • Incremental contributions for multiple options
  • What are your experiences?
  • Utilization Based Strategies
    • Plan design
    • Eligibility
    • Preventive approaches
  • High Deductible Strategies
  • Value Based Strategies
  • Targeted Limitations
  • Eligibility Strategies
    “If your spouse has coverage at their job, they are not eligible for our plan.”
    “Are your dependents really eligible?”
  • Preventive Approaches
  • Onsite Clinics
  • What are your experiences?
  • ANY QUESTIONS?
    This concludes our discussion
  • Randy Gomez, FSA
    Senior Healthcare Actuary
    randy.gomez@nyhart.com| (317) 845-3595
    Qualifications or certifications:Enrolled Actuary; Society of Actuaries Fellow; Member of the American Academy of Actuaries.
     
     
  • So Where is the Peak?
    Sign up for
    more webinars
    Register for upcoming educational events on pensions, 401(k), healthcare and other actuarial and employee benefits topics at:
    www.nyhart.com/events/
  • ACTUARY &EMPLOYEE BENEFITS
    Established in 1943, Nyhart is an ESOP with 84 employees and offices in Indianapolis, Chicago, Atlanta and Kansas City.
    Areas of Expertise Include:
    • Cash Balance Plan
    • Defined Benefit & Pension
    • Defined Contribution & 401(k)
    • Employee Stock Ownership Plan
    • Flexible Spending, HRA & HSA
    • Healthcare Actuarial Consulting
    Learn more at www.nyhart.com
  • ACTUARY &EMPLOYEE BENEFITS
    16 Actuaries Consulting In 48 States.
    Nyhart is one of the nation’s largest independent actuarial and employee benefit firms, consulting to and administering the plans for clients with more than $14 billion in assets. Our team of benefit advisers deliver personalized analysis and recommendations, translating complex calculations and issues into common language that enables corporations, associations, churches and governments to effectively manage their retirement and health care benefits.